Facial Pain 2 Flashcards
Pain History SOCRATES
S - site
O - onset
C - character
R - radiation
A - associations
T - time course
E - exacerbating factors
S - severity
Assessment of Pain
Physical pain - PAIN scores (McGill)
Emotional - psychological scores (HAD)
QOL scores (OHIP)
Nociceptive vs Neuropathic pain
Nociceptive pain
- caused by activity in neural pathways in response to potentially tissue- damaging stimuli
- post- op pain
- mechanical low back pain
- sports exercise injury
- sickle cell crisis
- arthritis
Neuropathic pain
- initiated or caused by primary lesion/ dysfunction in the nervous system
- postherpetic neuralgia
- neuropathic low back pain
- distal polyneuropathy
- central post- stroke pain
- trigeminal enuralgia
- CRPS
How does neuropathic pain feels like?
- constant burning/ aching
- fixed location
- often a fixed intensity
- maybe genetic predisposition
- nerve ion channel that help badly after injury
- persisting inflow gives persisting info reporting
Common forms of neuropathic pain
- diabetic peripheral neuropathy
- postherpetic neuralgia
What causes neuropathic pain?
- usually a history of ‘injury’
- eg: facial trauma, XLA, routine tx without complications
- can follow Herpes Zoster episode / Shingles -> Postherpetic neuralgia
- can follow destructive tx for pain
4 categories causing neuropathic pain
Medication Neuropathic Pain Management
Systemic medication
- Pregabalin
- Gabapentin
- Tricyclic
- Duloxetine
- Valproate
- Mirtazepine
- Opioid analgesics
Topical Medication
- Capsaicin
- EMLA
- Benzdamine
- Ketamine
Alternative Neuropathic Pain Management
- TENS
- acupuncture
- distraction
- correct abnormal illness behaviour
- improve self-esteem/ positive outlook
What is Atypical Odontalgia?
- dental pain without dental pathology
- distinct pattern of pain
- equal sex distribution
- pain free/ mild between episodes
- intense unbearable pain for 2 -3 weeks/ settles spontaneously
What should a dentist do?
Primary care -> REFER
OM management
- chronic strategy
- reduce chronic pain experience
- reduce frequency of acute episodes
- acute strategy
- have a plan to control pain
- opioid analgesics
- high intensity/ short duration
** might extract tooth if needed
What is Persistent Idiopathic Facial Pain?
Pain which poorly fits into standard chronic pain syndromes
- neuropathic
- CRPS
- TMD
- TN
- Migrainous pain
- Atypical odontalgia
How to treat PIFP?
- believe the pt
- do not increase damage
- adopt hollistic strategy
- use QOL/ pain scores as tx monitor
