neuropathic pain Flashcards
How should pain be assessed?
Physical symptoms with pain scores (McGill)
Emotional symptoms with psychological scores (HAD)
Quality of life scores (OHIP)
What causes nociceptive pain?
Activity in neural pathways in response to potentially tissue damaging stimuli
Give 4 examples of nociceptive pain
Post-op pain
Mechanical back pain
Injury following exercise
Arthritis
What is neuropathic pain?
Pain initiated or caused by primary lesions of disease in the nervous system
Give 4 examples of neuropathic pain
Post herpetic neuralgia
Trigeminal neuralgia
Neuropathic low back pain
Diabetic peripheral neuropathy
Describe the sensation of neuropathic pain
A constant burning/aching pain in a fixed location, often with a fixed intensity
How may genetic disposition contribute to neuropathic pain?
Nerve ion channels that heal badly after injury and so persisting influx gives persisting information reporting
What is common to find in a history for neuropathic pain?
Injury eg - may follow facial trauma, extractions, an episode of Herpes Zoster virus
Give 4 examples of systemic medications used to treat neuropathic pain
Pregabalin
Gabapentin
Tricyclic
Duloxetine
Give 4 examples of topical medications used to treat neuropathic pain
Capsaicin
EMLA
Benzdamine
Ketamine
Give 2 examples of physical alternative treatment for neuropathic pain
TENS - transcutaneous electrical nerves stimulation
Acupuncture
Give 3 examples of psychological alternative treatment for neuropathic pain
Distraction
Correction of abnormal illness behaviour
Improve self esteem, a positive outlook
What is atypical odontalgia?
Dental pain without pathology
Describe the common pattern of atypical odontalgia
Intense and unbearable pain for 2-3 weeks that then settles spontaneously
Patients often present with acute pulpitis pain. After endodontic tx or extraction the pain settles then returns
What should you do in primary care if you suspect a patient has atypical odontalgia?
Refer to oral medicine
