Chronic Facial Pain Flashcards
What is chronic pain also known as? (3)
- Atypical facial pain
- Atypical odontalgia
- Burning mouth syndrome
What is the epidemiology of chronic facial pain? (2)
- 7 - 14% of the population MAY have chronic facial pain
- 10 million chronic pain sufferers in the UK
What are the stages of management of chronic pain? (1+1,2)
- Assessment and diagnosis
- Ensure no cause for concern
- Explanation and reassurance
- Discuss / suggest treatment options
What are the eight ways to characterise facial pain? (8)
- Location
- Localisation
- Duration
- Character
- Precipitating factors
- Signs
- Aetiology
- Treatment
Summarise TMJ facial pain with the eight indications (8)
- 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
Summarise Neuralgic facial pain with the eight indications (8)
- 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
Summarise Atypical facial pain with the eight indications (8)
- 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
Summarise Vascular facial pain with the eight indications (8)
- 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
What questionnaires are available for investigating chronic pain? (2)
- McGill Pain questionnaire
- Visual analogue scale
What is the theory behind biopsychosocial assessment? (1+3)
- Three parts to pain:
- Biological
- Psychological – anx/dep
- Social context – work/finance/family
What is oral dysaesthesia? Include reference (2)
- Burning pain in the tongue from any cause
- IASP 1994
What is the aetiology of oral dysaethesia? How is it diagnoses? What is the management and prognosis? (4)
- Aetiology: unknown
- Diagnosis: exclusion initially
- Management: CBT improved 6/12, oestrogen increased taste
- Prognosis: unknown
What local causes do you need to eliminate for burning mouth? How would you do this? (7)
- 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
What systemic causes are there for burning mouth? (5)
- Decreased Iron folate B12
- Diabetes
- Climacteric (menopause – in women)
- Psychogenic
- Cancerphobia
What is the management for burning mouth? (2)
- Correct deficiencies
- Alter medications
In what areas can controlled trials investigate pain improvement? (4)
- Topical
- Systemic
- Psychological
- Not all placebo
With what medication have positive trials have taken place for burning mouth? (5)
- Topical clonazepam
- Antidepressants
- Alpha-lipoic acid
- Capsaicin capsule
- Cognitive behavioral therapy -EB
What four symptoms are important in atypical facial pain? (4+1 reference)
- 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
What should laboratory investigations demonstrate in atypical facial pain? (1+1 reference)
- Laboratory investigations should not demonstrate relevant abnormalities
- Reference: IHS 1988
What are the associated features of atypical facial pain? (3)
- Facial swelling/flushing
- Altered sensation
- Lacrimation (tears)
What was Lascelles, 1966? (5)
- 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
Define and reference atypical odontalgia (1+reference)
- Severe throbbing pain in the tooth without major pathology
- IASP 1994
Describe atypical odontalgia (5)
- 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
Describe what happens after removal of a tooth with atypical pain (3)
- Pain remains same (with no tooth)
- Pain moves to adjacent teeth
- Pain in gingival tissue that previously surrounded tooth
