Defining OFP Flashcards
What is the definition of pain?
Pain is a distressing experience associated with actual or potential tissue damage, with sensory, emotional, cognitive, and social components.
Pain is best described as a multidimensional or multifactorial experience encompassing sensory, affective, motivational and cognitive dimensions.
What is perception?
Organisation, identification, and interpretation of sensory information
Understanding our environment
Stimulate our sensory nerves and also actively processing the information
Based on a number of factors including prevous experience and expectation
What are the dimensions of pain?
Sensory-discriminative (how the patient feels the pain)
Motivational-affective
Cognitive-interpretive (what does the pain mean)
How can the sensory-discriminative aspect of pain be determined?
Localisation, intensity discrimination, and quality of noxious stimulus
How does motivational dimension of pain affect overall experience of pain?
Emotion, arousal and pain behaviour
How the individual reacts
What influences the motivational aspect of pain?
Influenced by prior experience, expectations, and possible misconceptions
What factors influence pain behaviour?
Social class
Education
Occupation
Religious background
Past exp
Context (financial, medico-legal, etc)
Health professional’s attitude and reactions
Treatments
How common is chronic pain?
Rnage is between 0 - 24% with estimated overall prevalence of 9.6% to 11.8%
Leading cause of disability
Who more commonly gets orofacial pain?
Women more likely to be affected or more likely to report it.
Significant psych history leads to 4x more chance of reporting pain.
What is the difference between nociceptive and neuropathic pain?
Nociceptive is normal pain and is protective whereas neuropethic is not protective or reparative.
Nociceptive pain is a consequence of tissue injury or noxious stimuli whereas neuropathic pain is caused by a lesion or dysfunction of the PNS/CNS
Nociceptive pain is gone when noxious stimuli are removed whereas it persists in neuropathic pain
What is the pain called where there is no demonstrable tissue damage and no lesion/dysfunction of the PNS or CNS?
Nociplastic pain
What is neuralgia?
Pain in distribution of a nerve or nerves
What is neuritis?
Inflammation of the nerve/nerves
What is neuropathy?
A disturbance of the function or pathological change in a nerve. Neuritis is a type of neuropathy.
What is facial pain?
Pain that occurs below the orbitomeatal line. anterior to the pinnae and above the neck
What is axis 1 and axis 2 of orofacial pain?
Axis 1 are physical pain
Axis 2 is psychological
What is the difference between central and peripheral sensitization?
Central: Long term consequences of noxious stimuli result from central as well as peripheral changes.
Peripheral: A “damaged” axon/nerve cell undergoes structural and functional changes leading to a state of neuronal sensitization.
What are the hallmarks of central sensitization?
Decreased threshold firing
Firing from non-noxious stimuli
Pain spread
What is hyperalgesia?
Increased response to normally painful stimulus
What is hypoalgesia?
Diminished response to a normally painful stimulus
What is analgesia?
Absence of pain in response to stimulation that is normally painful
What is hyperesthesia?
Increased sensitivity to stimulation, excluding special senses
What is hypoesthesia?
Diminished sensitivity to stimulation excluding the special senses
What is dysesthesia?
An unpleasant abnormal sensation, whether spontaneous or evoked
What is paresthesia?
An abnormal sensation, whether spontaneous or evoked
What is allodynia?
Pain caused by stimulus which is not normally painful
When is pain considered chronic?
Generally, pain that lasts for more than 3 months is considered chronic pain.
In orofacial pain: Pain occuring >15 days a month and lasting for >2 hours a day for at least 3 months.
What are the types of pain fibers?
Adelta myelinated nociceptors which are relatively fast
C fibers that are unmyelinated
Wide dynamic range neurons are neurons which are responsive to all somatosensory modalities (thermal, chemical, and mechanical)
Silent nociceptors which are activated in pain states.
How do pain signals travel?
Injury triggers inflammatory mediators such as bradykinin, prostaglandins, and other cytokines.
These signals travel through nociceptive afferents to first order neurons in dorsal root ganglia.
The signal then is transmitted through the spinal cord through 2nd order neurons in rexed lamina of the spinal cord
These signals travel up the sponothalamic tract to the ventral posterolateral nucleus (VPL) of the thalamus
3rd order neurons lie within the VPL of the thalamus and project via posterior limb og the internal capsule to terminate in the ipsilateral postccentral gyrus (Primary somatosensory cortex)
How does pain get transmitted from the face?
Sensory nerves from V1, V2 and V3 travel to the trigeminal ganglion and from the trigeminal ganglion to the trigeminal spinal tract
Signals then travel to the subnucleus caudalis.
Ascending via anterolateral trigeminothalamic tract to the thalamus and then to the cortex (somatosensory cortex)
What are the “yellow flags” that lead to negative outcomes of pain?
Belief that pain is harmful or severely disabling
Belief that pain is due to progressive pathology
Believe that avoidance of activity will help recovery
A tendency to low mood and withdrawal from social interaction
Significant medicalisation
Expectation that passive treatments rather than active self management will help
