Facial Pain Flashcards
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Patient will usually describe their pain in relation to something they have already experiences- “worse than child birth”.
What modes of assessment could you use during the history process for a pain patient?
QOL scores- determines how the pain is affecting the patient’s every day life
McGill’s pain score- the patient ticks one in each box which most describes the patient’s pain.
Psychological scores- how does the pain make you feel?
- State- Trait anxiety inventory.
- Back depression inventory II.
Quality of sleep
- Pittsburgh sleep quality index
- Epwirth Sleepiness scale
How do we feel pain?
Peripheral nociceptors will detect a painful stimulus.
This is transmitted through the peripheral nerve to the spinal cord.
Then from the spinal cord, via the ascending pain C fibres.
What forms the head and neck?
Pharyngeal arches and pharyngeal clefts
What does the first pharyngeal arch give rise to?
Trigeminal nerve, structures supplied by this nerve- MOM, digastric, mylohyoid, etc.
What does the second pharyngeal arch give rise to?
Facial nerve, muscles of facial expression, stapedius, Digastric, stylohyoid muscle, styloid process.
Why is it important to know what arises from each pharyngeal arch, with regards to pain?
The pain the patient is describing might not make sense initially but think about the embryological origin and it might start to make sense.
Describe the branches of the facial nerve.
Sensory root- supplies the ear
Motor root- muscles of facial expression
Greater petrosal nerve- secretomotor to the lacrimal gland
Nerve to Stapedius- motor innervation to the stapedius muscle
Chorda Tympani- taste to anterior 2/3 of the tongue and secretomotor fibres to sublingual and submandibular.
Posterior auricular nerve- mastoid process and skin overlying the auricle.
Nerve to digastric- digastric muscle
Nerve to stylohyoid- stylohyoid.
Why is it important to understand the different branches of the facial nerve?
Patient symptoms can tell you which part of the facial nerve is damaged.
i.e. if they are very sensitive to loud noises, this would suggest the nerve to stapedius is damaged.
What nerves are involved in somatic nerve control?
CN V, VII, IX, X and Cervical 1-3.
What is referred pain?
Pain location is misinterpreted
Patient’s source of pain and the patient’s perceived location of the pain is different.
What is the anatomical basis of sensory referred pain?
Different nerves from different areas of the head and neck can synapse in the same place- i.e. trigeminal nucleus.
So this can cause pain to be felt at other locations.
What are autonomic nerves?
Sympathetic and parasympathetic nerves- cannot control autonomic nerves but they control you.
Why can pain transmitted to the brain via autonomic nerves be misinterpreted?
The nerve supply of a lot of different structures in the head and neck co-ales to one cervical ganglion in the spinal cord, which is then sent to the brain.
So the source of the pain and the feeling of pain can be coming from two different places.
Describe the somatic reflex arc?
Pain produces a change which causes damage to an ear of somatic nerve supply.
Signal will pass up the somatic nerve (afferent), through the interneuron and then to the CNS.
But also, at the level of the spinal cord, there is another neuron (motor), which is producing a synapse with the interneuron (efferent), which will pull the affected limb away from the sight of damage and cause muscle contraction.
