Facial pain Flashcards
How can you assess a patient pain
Physical symptoms
-PAIN scores (McGill)
Emotional symptoms
-Psychological scores (HAD)
QOL scores (OHIP)
How is pain felt
Nociception
Peripheral Nerve Transmission
Spinal Modulation
Central Appreciation
Cardiac pain can refer to where
Left shoulder
Under breast bone
Down arm
Below ribs
Right shoulder
Pain up to the neck, jaw and teeth
What is CRPS
Chronic Regional Pain
Delocalised pain
that spreads around ‘anatomical’ boundaries, may appear bilateral,
‘gripping’, tight, burning pain
What is the sensory somatic nerve supply of the face
V, VII, IX, X & Cervical 1-3
What is nociceptive pain and give examples
Cause by the activity in neural pathways i response to potentially tissue damaging stimuli
-Arthritis
- Mechanical lower back pain
- Sport injuries
What is neurpathic pain and give example
Pain initiated or caused by primary lesion or dysfunction in the nervous system
-CRPS
- trigeminal neuralgia
- Central post stroke pain
- Spinal cord injury
What is neuropathic pain like
Constant burning/aching pain
Fixed location
Often a fixed intensity
What are the 2 most common forms of neuropathic pain
Post-herpetic neuralgia
Diabetic peripheral neuropathy
What can cause neuropathic pain
Usually follows an injury
Can follow an extraction
Can follow Herpes Zoster (Shingles) episode
-Post Herpetic Neuralgia
How do you manage nueropathic pain
Systemic medication
-Pregabalin
-Gabapentin
-Tricyclic
-Duloxetine
Topical medication
-Capsaicin
-EMLA
-Benzdamine
-Ketamine
How does the systemic management of neruopathic pain work
They don’t stop the pain they but they reduce the afferent info to the CNS so slowing down pain signalisation
What physical and psychological management of neuropathic pain is there
Physical
-TENS
-Acupuncture
Psychological
-Distraction
-Correct abnormal illness behaviour
-Improve self esteem/positive outlook
What is atypical Odontalgia and what is the pattern of the pain
Dental pain without dental pathology
It has a distinct pattern of pain
-Equal sex distribution
-Pain free or mild between episodes
-Intense unbearable pain of 2-3 weeks duration that Settles spontaneously
If a patient presents with you with pain that you suspect is atypical odontalgia what do you do
If after all Tx the pain still persists perform an aesthetic test
If pain relieved= perform tests for peripheral or central sensitisation
If pain persists= Order MRI of brain and refer patient to appropriate specialist
What is oral dysaesthesia
Abnormal sensory PERCEPTION in ABSENCE OF ABNORMAL STIMULUS
What modes of oral sensation is involved in oral dysaesthesia
Burning or ‘nipping’ feeling
Dysgeusia
Paraesthesic feeling
Dry mouth feeling
What can be predisposing factors for oral dysaesthesia
Deficiency states
-haematinics
-zinc
-vit B1, B6
Fungal and Viral infections
Anxiety and stress
Gender – more women present to OM than men
What oral dysaesthesia is most likely if the patient has a haematic deficiency
Burning
if the patient has a parafunction or tongue thrust where is the burning oral dysaesthesia most liely to be
Lips and tongue tip/margin
What is dysgeusia
A bad taste/bad smell/Halitosis
What is the most common oral dysaesthia
Dry mouth dysaesthesia
How do you manage dysaesthesia
Explain the condition to the patient
Assess degree of anxiety
Anxiolytic based medication
-Nortriptyline
-Mirtazepine
-Vortioxetine
Neuropathic Medication
-Gabapentin/Pregabalin
-Clonazepam
If a patient is complaining of TMJ pain what is a sign that it does not involve the joint
When patient points to the pain they use multiple fingers or the palm of there hands to show instead of pointing directly to TMJ
What are the physical signs of TMD
clicking joint
locking with reduction
limitation of opening mouth
tenderness of masticatory muscles
tenderness of cervico-cranial muscles
