Defining OFP

Question 1

What is the definition of pain?

Answer 1

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.

Question 2

What is perception?

Answer 2

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

Question 3

What are the dimensions of pain?

Answer 3

Sensory-discriminative (how the patient feels the pain)

Motivational-affective

Cognitive-interpretive (what does the pain mean)

Question 4

How can the sensory-discriminative aspect of pain be determined?

Answer 4

Localisation, intensity discrimination, and quality of noxious stimulus

Question 5

How does motivational dimension of pain affect overall experience of pain?

Answer 5

Emotion, arousal and pain behaviour

How the individual reacts

Question 6

What influences the motivational aspect of pain?

Answer 6

Influenced by prior experience, expectations, and possible misconceptions

Question 7

What factors influence pain behaviour?

Answer 7

Social class

Education

Occupation

Religious background

Past exp

Context (financial, medico-legal, etc)

Health professional’s attitude and reactions

Treatments

Question 8

How common is chronic pain?

Answer 8

Rnage is between 0 - 24% with estimated overall prevalence of 9.6% to 11.8%

Leading cause of disability

Question 9

Who more commonly gets orofacial pain?

Answer 9

Women more likely to be affected or more likely to report it.

Significant psych history leads to 4x more chance of reporting pain.

Question 10

What is the difference between nociceptive and neuropathic pain?

Answer 10

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

Question 11

What is the pain called where there is no demonstrable tissue damage and no lesion/dysfunction of the PNS or CNS?

Answer 11

Nociplastic pain

Question 12

What is neuralgia?

Answer 12

Pain in distribution of a nerve or nerves

Question 13

What is neuritis?

Answer 13

Inflammation of the nerve/nerves

Question 14

What is neuropathy?

Answer 14

A disturbance of the function or pathological change in a nerve. Neuritis is a type of neuropathy.

Question 15

What is facial pain?

Answer 15

Pain that occurs below the orbitomeatal line. anterior to the pinnae and above the neck

Question 16

What is axis 1 and axis 2 of orofacial pain?

Answer 16

Axis 1 are physical pain

Axis 2 is psychological

Question 17

What is the difference between central and peripheral sensitization?

Answer 17

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.

Question 18

What are the hallmarks of central sensitization?

Answer 18

Decreased threshold firing

Firing from non-noxious stimuli

Pain spread

Question 19

What is hyperalgesia?

Answer 19

Increased response to normally painful stimulus

Question 20

What is hypoalgesia?

Answer 20

Diminished response to a normally painful stimulus

Question 21

What is analgesia?

Answer 21

Absence of pain in response to stimulation that is normally painful

Question 22

What is hyperesthesia?

Answer 22

Increased sensitivity to stimulation, excluding special senses

Question 23

What is hypoesthesia?

Answer 23

Diminished sensitivity to stimulation excluding the special senses

Question 24

What is dysesthesia?

Answer 24

An unpleasant abnormal sensation, whether spontaneous or evoked

Question 25

What is paresthesia?

Answer 25

An abnormal sensation, whether spontaneous or evoked

Question 26

What is allodynia?

Answer 26

Pain caused by stimulus which is not normally painful

Question 27

When is pain considered chronic?

Answer 27

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.

Question 28

What are the types of pain fibers?

Answer 28

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.

Question 29

How do pain signals travel?

Answer 29

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)

Question 30

How does pain get transmitted from the face?

Answer 30

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)

Question 31

What are the “yellow flags” that lead to negative outcomes of pain?

Answer 31

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