Neuropathic Pain

Question 1

What is the neuropathic pain classification system?

Answer 1

1) Acute nociceptive - pulpal pain, periodontal pain, gingival pain, salivary gland pain
2) Acute chronic - pain in mastictory muscles
3) Acute chronic joint pain
4) Neuropathic pain - trigeminal neuralgia
5) Neurovascular pain - migraines
6) Nociocpetive pain - burning mouth, idiopathic pain)

Question 2

What are the main features of trigeminal neuralgia?

Answer 2

• Neuropathic pain
• Over 50-60 years
• Often with no other pain
• Patient cannot brush their teeth
• Hurts in the wind
• Short lasting and intense pain
• Pain affecting V3 and V2 region
• Usually unilateral
• Often starts as pain on brushing
• relieving = touch and anticonvulsants (carbamazepine)

Question 3

Give examples of trauma which can cause post traumatic neuropathic pain

Answer 3

• Damage due to LA, implants, endodontics, extractions including third molars
• Post viral e.g. post herpetic neuralgia

Question 4

What are the features of post traumatic neuralgia?

Answer 4

• Unilateral or bilateral oral pain following trauma to the trigeminal nerve
• Persists > 3 months
• Pain in distribution of trigeminal nerve
• Painful to touch

Question 5

What are the features of neuropathic pain?

Answer 5

• Multiple injuries, episodes of infection and pain
• No respondent to anti-inflammatory painkillers
• Better in morning
• Does not disturb sleep
• Worsens with tiredness, stress and illness

Question 6

What causes post-herpetic neuralgia and how do we treat it?

Answer 6

reactivation of the varicella zoster virus (HHV3)
treatment = acyclovir 800mg 5x daily for 7-10 days

Question 7

What are the main types of neurovascular headache pain?

Answer 7

1. Migraines
2. Cluster headaches (episodic pain lasting 15-180mins, orbital, supraorbital or temporal)
3. Tension type headaches
4. Medication over use headaches

Question 8

What type of pain is burning mouth syndrome?
What are the clincial features?

Answer 8

• Idiopathic orofacial pain

Oral burning, no known cause, spontaneous onset, usually affects tongue but can affect palate, buccal mucosa and lips, reoccuring more than 2 hours a day for 3 months, burning is superficial in the oral mucosa

Question 9

Who has a higher expression of pain?

Answer 9

women
PTSD
mood disorders
anxiety and stress
personality disorders
sleep disorders

Question 10

What is the diagnostic criteria for post-traumatic neuropathic pain?

Answer 10

• History of traumatic nerve injury or surgery associated with known risk of nerve injury
• Pain lasting > 3 months showing a temporal relation to nerve injury
• Mix of numbness and pain