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Pain Control II > chronic orofacial pain > Flashcards

chronic orofacial pain Flashcards

1
Q

breakdown of neuropathic orofacial pain

A

trigemnial neuralgia (TN)

glossopharyngeal neuralgia (GN)

post-herpetic neuralgia (PHN)

atypical odontalgia (AO)

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2
Q

neurovascualr disorder breakdown

A

migraine

neurovascular orofacial pain - facial migraine

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3
Q

trigeminal autnomic cephalgias break dwn

A

cluster headache

paraxysmal hemicranias

SUNT - short lasting unilateral neuralgiform headache with conjunctival injection and tearing

hemicrania continua (HC)

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4
Q

peripheral sensitization

A

increased responsiveness and reduced threshold of nociceptors

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5
Q

allodynia

A

painful sensation caused by innocuous stimuli (non painful) such as light touch

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6
Q

when there is prolonged pain?

general

A

there is a second order neuron in CNS that can be HYPERSENSITIVE – CENTRAL SENSITIZATION

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7
Q

T/F pain is unresponsive to NSAIDs and low dose opioids

A

TRUE

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8
Q

all neuropathic pain begins with

A

nerve injury

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9
Q

compression in pain

A

blood vessel compression with trigeminal neuralgia

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10
Q

viral insult example

A

postherpetic neuralgia

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11
Q

what is trigeminal neuralgia

A

from seconds to 2 mins

UNILATERAL
INTENSE SHARP STABBING
- effecting on or more divisions of TN (v1, v2, v3)
- opthalamic (V1 is least effected branch)
- max and mand occuring together

periods of REMISSION (long time b/w)

PEAK AT 50-60 YEARS

MALE TO FEMALE (1:2)
- higher in female

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12
Q

causes of TN?

A

compressino of the trigemnical root at or near the dorsal root entry zone (DREZ) by blood vessel

seen with demyelinating lesions in brainstem caused by multiple sclerosis

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13
Q

trigger areas for TN?

A

talk chew touch - lip and gingiva

tic dolorex - tic like cramps / involuntary spasms

during day more

get MRI over CT

because of its location and paroxysmal (sudden) nature - TN has often been confused with dental pathologies, leading to unnecessary dental treatments

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14
Q

Treatment for TN?

A

pharmocological agents - anticonvulsants

surgery - microvascular decompression

medical conditions like MS should be treated as well

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15
Q

medications used for pain relief in TN?

A

Carbamazepine - 100 mg 2x daily max 1200 mg
INACTIVATE NA+ CHANNELS

alternatives
oxarcabezepine
gabapentine – blocks release of neurotrasnmitter by blocking Ca+ channels

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16
Q

glossopharyngeal neuralgia

A

unilateral

two branches affected

  • tympanic (auricular)
  • pharyngeal

SWALLOWING, CHEWING, TALKING, COUGHING, YAWNING, COLD WATER, TONGUE MOVEMT

onset 40-50

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17
Q

dx of glossopharyngeal neuralgia

A

confused with TMD due to triggers of swallowing, tongue movment, mand function - triggering

so IMMOBILIZE THE MANDIBLE and block masticatory function - give cold water and if pain percipitates more likely to be GN and not TMD

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18
Q

what is postherpetic neuralgia

A

viral disease characterized with painful skin rash with blisters due to reactivation of varciella zoster

rash can heal within 2-4 weeks but can have ongoing pain lasting for months to years

MAIN CHARACTERISTIC = CUTANEOUS ALLODYNIA - like non noxious stimulus to normal skin causing pain

OPTHALMIC BRANCH (80%) and worst prognosis

UNILATERAL - LASTING FOR AT LEAST 3 MONHTS

DEEP BURNING, ACHING, ITCHING can be constant or intermittent / fast

risk factors for reactivation is old age, poor immune functino

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19
Q

PHN treatment?

A

gabapentine 100-300 mg / max is 1800-3600 mg/ day

tricylic antidepressant

combination

antivials against herpes
- if less than 72 hours from onset of rash – decrease incidence of PHN
acyclovir - 800 mg , 5x 7-10 days
valacyclovir 1000mg 3x day 7 days

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20
Q

atypical odontalagia

A

persistent pain in apparently normal teeth or adjacent oral tissues
- alveolar bone, gingiva

21
Q

common complaint with atypical odontalagia

A

” i have seen multiple dentists and have had multiple procedures and still have pain on the tooth”

22
Q

pathophyiology of atypical odontalagia

A

deafferentation - partial or total loss of an afferent nerve supply from a particular area

  • transection or crush

new term - peripheral painful traumatic trigeminal neuropathy

23
Q

criteria for atypical odontalagia

A

PAIN DEVELOPS WITHIN 3 MONTHS OF A CLEAR TRAUMATIC EVENT

CONTINOUS or almost continous in a tooth or tooth site
(reoccuring daily for over 2 hours per day over 3 months)

DYSESTHESIA - a abnormal feeling accompanied by pain

no obvious local etiology / normal raiogrpahs

hyperesthesia - tooth tender to finger pressure

WOMAN 40-50’S

24
Q

diagnostic block with AO vs TN?

A

wont do anything to help with AO

- it will eliminate the pain in TN

25
Q

tx for atypical odontalagia

A

stop all dental - even prophys

tricylclic anti-depressants

26
Q

aura

A

sensory disturbances can include flashes of light, blind spots and other vision changes or tingling in your hand or face

migraine with aura is 30%

27
Q

migraine without aura

A

idiopathic
4-72 hours if left untreated

at least 5 attaacks in 4-72 hours

UNILATERAL
- pulsating throbbing pain, increases with routine physical activity

occurs with

  • nausea / vomit
  • phonophobia / photophobia
28
Q

attacks of migraine mostly

A

upon ARISING

29
Q

migraine with auro

A

reversible develop gradually over 5-20 mins and last for less than 60 minutes

at least 2 attacks with one or more fully reversible visual, sensory, motor aura

30
Q

migraines occur more in? triggers?

A

women > men

weather, loud noise, stress, foods, alcohol, sleep, TMJ pain, masitcaory

31
Q

aura last

A

5-60 minutes

32
Q

peak migraine time

A

4-72 hours and pain intensity increases with time

33
Q

rpid screening for migraine

A
  1. nauseated or sick to stomach with headache?
  2. has HA liited activitied for a day or more in last 3 months?
  3. when you have HA does light bother a lot more than when dont have HA?
34
Q

pathophysiology of migraine

A

trigemniovascular system
- neurons - mostly from opthalmic and blood vessels – usually cerebral

DILATED BLOOD VESSELS
- CALCITONIN GENE RELATED PEPTIDE – highly potent vasodilator – the swollen dilated and inflammed blood vessels are believed to be responsible for the throbbing pain and migraine

35
Q

midface / facial migrain / neurovascular orofacial pain

dx with irreversible pulpitis

A

V2 and V3 - throbbing pain in the mid facial regions – can CHANGE LOCATIONS TOO

both hypersensitive to cold!
but NVOP - midfacial is NOT tender to percussion and no sign of carious lesion, no response to endo tx and no diagnostic anesthesia

with pulpitis
- no change in location and diagnostic anesthesia can be used, tender to percussion

36
Q

onset age of migraine

A

20-40 years old

1:2 male : female

37
Q

migraine vs mifaial migraine

A

LOCATION

onset age migrain is 20-40 and it is 40-50 in midfacial migraine

midfacial – triggered by cold

both more female

38
Q

sumatriptan

A

25 mg tid considered confirmaotry evdence of a migraine pain disorder – diagnostic

causing vasoconistriction of dilated cranial blood vessels preventing neurogenic inflammation by blocking the release of neurotransmitter CGRP

39
Q

trigeminal autonmoic cephalgias

A

pain in trigemnial area on one side with AUTONOMIC SYMPTOMS
- tearing, redness, ptosis (drooping) , myosis - constriction

  1. trigemnial pain
  2. autonomc signs
  3. rhythmicity - particualr in cluster headache – relation between headache attacks and biological clock - circadian rhythm - HYPOTHALAMUS INVOLVMENT – REM SLEEP
40
Q

which has more prediliction in male?

A

cluster headache
30-40 years
5:1 male to female

+ SUNCT is 9:1
(short lasting unilateral neuralgiform headache) - attacks with conjunctival injection and tearing

41
Q

suicide headache

A

cluster headache - lasting usually 90 minutes after wake up

refers out but in the eye

lacrimal usually

42
Q

paroxysmal hemicrania

A

fronto orbital area
unilateral
conjuctiva and lacrimation

SHORTEST ONE
- max is 4 minutes

43
Q

gabapentine for

A

TN

44
Q

tx for cluster

A

sumatriptan

45
Q

indomethacrine responsive?

A

this is an NSAID

- can be used to treat paroxysmal hemicrania and hemicrania continua

46
Q

peripheral sensitization increases or decreases the pain?

A

increases

47
Q

if seems like TN but it is bilateral what are you assuming?

A

that there is a mass or tumor

48
Q

midfacial gets confused with

A

sinusitis and dental pain

49
Q

anticonvulsant / lamotrogine with?

A

SUNCT

- inactivated Na

Pain Control II (15 decks)

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