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Oral Disease > Chronic Facial Pain > Flashcards

Chronic Facial Pain Flashcards

1
Q

What is chronic pain also known as? (3)

A
  • Atypical facial pain
  • Atypical odontalgia
  • Burning mouth syndrome
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2
Q

What is the epidemiology of chronic facial pain? (2)

A
  • 7 - 14% of the population MAY have chronic facial pain

- 10 million chronic pain sufferers in the UK

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3
Q

What are the stages of management of chronic pain? (1+1,2)

A
  • Assessment and diagnosis
  • Ensure no cause for concern
  • Explanation and reassurance
  • Discuss / suggest treatment options
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4
Q

What are the eight ways to characterise facial pain? (8)

A
  • Location
  • Localisation
  • Duration
  • Character
  • Precipitating factors
  • Signs
  • Aetiology
  • Treatment
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5
Q

Summarise TMJ facial pain with the eight indications (8)

A
  • Location: temple, ear, jaws, teeth
  • Localisation: poor, but usually unilateral
  • Duration: weeks to years
  • Character: dull, continuous
  • Precipitating factors: chewing, yawning
  • Signs: limited mouth opening, ?click
  • Aetiology: stress, parafunction
  • Treatment: physiotherapy, behavioural, antidepressants
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6
Q

Summarise Neuralgic facial pain with the eight indications (8)

A
  • Location: nerve distribution
  • Localisation: fair to good
  • Duration: seconds
  • Character: lancinating, paroxysmal
  • Precipitating factors: touch, wind, vibration
  • Signs: none
  • Aetiology: idiopathic, MS
  • Treatment: tegretol, nerve block, neurosurgery
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7
Q

Summarise Atypical facial pain with the eight indications (8)

A
  • Location: diffuse, deep ?across midline
  • Localisation: poor, does not fit anatomical boundaries of trigeminal nerve
  • Duration: weeks to years
  • Character: dull, boring, continuous, can be throbbing, aching “like a toothache”
  • Precipitating factors: stress, fatigue, ill
  • Signs: none
  • Aetiology: nerve injury, stress
  • Treatment: antidepressants, behavioural (CBT), LA block does not help
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8
Q

Summarise Vascular facial pain with the eight indications (8)

A
  • Location: orbit or upper face
  • Localisation: usually good
  • Duration: minutes to hours
  • Character: throbbing, deep
  • Precipitating factors: alcohol
  • Signs: lacrimation, eye injection
  • Aetiology: vasomotor, ?allergic
  • Treatment: triptans
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9
Q

What questionnaires are available for investigating chronic pain? (2)

A
  • McGill Pain questionnaire

- Visual analogue scale

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10
Q

What is the theory behind biopsychosocial assessment? (1+3)

A
  • Three parts to pain:
  • Biological
  • Psychological – anx/dep
  • Social context – work/finance/family
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11
Q

What is oral dysaesthesia? Include reference (2)

A
  • Burning pain in the tongue from any cause

- IASP 1994

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12
Q

What is the aetiology of oral dysaethesia? How is it diagnoses? What is the management and prognosis? (4)

A
  • Aetiology: unknown
  • Diagnosis: exclusion initially
  • Management: CBT improved 6/12, oestrogen increased taste
  • Prognosis: unknown
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13
Q

What local causes do you need to eliminate for burning mouth? How would you do this? (7)

A
  • Bacterial oral swabs
  • Fungal oral rinse for candida
  • Allergy patch test
  • Geographic tongue observe over time
  • Parafunction dental examination
  • Oesophageal reflux tooth erosion
  • Xerostomia salivary flow rates
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14
Q

What systemic causes are there for burning mouth? (5)

A
  • Decreased Iron folate B12
  • Diabetes
  • Climacteric (menopause – in women)
  • Psychogenic
  • Cancerphobia
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15
Q

What is the management for burning mouth? (2)

A
  • Correct deficiencies

- Alter medications

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16
Q

In what areas can controlled trials investigate pain improvement? (4)

A
  • Topical
  • Systemic
  • Psychological
  • Not all placebo
17
Q

With what medication have positive trials have taken place for burning mouth? (5)

A
  • Topical clonazepam
  • Antidepressants
  • Alpha-lipoic acid
  • Capsaicin capsule
  • Cognitive behavioral therapy -EB
18
Q

What four symptoms are important in atypical facial pain? (4+1 reference)

A
  • Present daily and persist for most or all of the day
  • Should be confined at onset to a limited area of one or both sides of the face, but may spread to the upper or lower jaws and a wider area of the face and neck
  • Should not be associated with sensory loss or other physical signs
  • The pain may be initiated by trauma, but persist without any demonstrable local cause
  • Reference: IHS 1988
19
Q

What should laboratory investigations demonstrate in atypical facial pain? (1+1 reference)

A
  • Laboratory investigations should not demonstrate relevant abnormalities
  • Reference: IHS 1988
20
Q

What are the associated features of atypical facial pain? (3)

A
  • Facial swelling/flushing
  • Altered sensation
  • Lacrimation (tears)
21
Q

What was Lascelles, 1966? (5)

A
  • 40 patients with Atypical facial pain (depressed)
  • 4 week crossover trial of MOAI, phenalzine (15mg tds) vs. placebo
    After 4 weeks
  • 75% of patients showed improvement in pain and
  • 30% showed improved depression
22
Q

Define and reference atypical odontalgia (1+reference)

A
  • Severe throbbing pain in the tooth without major pathology

- IASP 1994

23
Q

Describe atypical odontalgia (5)

A
  • Pain associated with a tooth or tooth socket without any major pathology
  • Constant throb or ache
  • Precipitated by dental procedures
  • Dental treatment: no difference or improvement for a week
  • If the tooth is extracted the pain often recurs after a few weeks at a new site
24
Q

Describe what happens after removal of a tooth with atypical pain (3)

A
  • Pain remains same (with no tooth)
  • Pain moves to adjacent teeth
  • Pain in gingival tissue that previously surrounded tooth
25
Q

What is the aetiology of atypical odontalgia? (5)

A
  • Sensitisation of nerves may occur after infection, extraction or even RCT
  • Changes within the CNS and possibly ongoing neural activity
  • ?? Female prevalence
  • Tends to be older patients
  • ?? Psychosocial factors
26
Q

What are abnormal pain responses? Give three examples (2)

A
  • At the site of injury or no injury e.g. chronic pain, abnormal pain responses can occur
  • e.g. phantom limb pain, AFP, traumatic lingual nerve dysaesthesia
27
Q

What is Hyperalgesia? (1)

A

Stimulation is more painful

28
Q

What is Allodynia? (1)

A

Non painful stimuli are painful

29
Q

What is Spontaneous pain? (1)

A

Pain in the absence of stimulus

30
Q

What is Central sensitisation / secondary hyperalgesia? Describe (5)

A
  • Changes in the behaviour of central (SC) cells
  • Induced by tissue injury
  • Increased spontaneous background firing
  • Hyperexcitability to other low threshold input
  • Increased size of receptive fields
31
Q

What are the possible types of therapy for atypical odontalgia? (4)

A
  • Stress management - ? through GMP
  • Relaxation / hypnosis
  • Cognitive behaviour therapy, CBT (probably includes both of above)
  • Psychological help for other problems inc. talking therapy
32
Q

What is CBT? How can it help? (1+2, 1)

A
  • It is a way of talking about:
  • How you think about yourself, the world and other people
  • How what you do affects your thoughts and feelings.
  • CBT can help you to change how you think (‘Cognitive’) and what you do (‘Behaviour’).
33
Q

What is the theory in CBT? (1, 1+4)

A
  • A Situation - a problem, event or difficult situation
  • From this can follow:
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions
34
Q

Describe Feinmann, 1984 (4)

A
  • 93 patients with AFP or FAM (35% depressed)
  • Double blind controlled trial of dothiepin vs. placebo with dose titration
  • After 9 weeks - 71% pain free
  • Withdrawl of drug at 6 months led to relapse in some patients
35
Q

Describe Harrison et al, 1997 (4)

A
  • 181 patients with AFP or FAM
  • 3 months Randomised Controlled Trial of fluoxetine /placebo +/- CBT
  • CBT improved pain scores
  • These improvements were maintained when drug therapy ceased and the pt had CBT
36
Q

Describe analgesic antidepressant drugs with regards to management, including dosage example (4)

A
  • As helpful with chronic pain with known pathology as with unknown pathology or aetiology
  • e.g.Chronic arthritis, post herpetic neuralgia
  • Mainstay of management of AFP/AO
  • Amitriptyline/nortriptyline 10-100mg nocte
37
Q

What are abnormal signs when assessing chronic facial pain? (1+2, 1)

A
  • Abnormal Cranial nerve testing results
  • Abnormal sensations
  • Abnormal responses
  • Vomiting/Headache - ICP

Oral Disease (9 decks)

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