neuropathic pain Flashcards
pain flow chart
* neuropathic vs nocioceptive
* forms?
episodic neuropathic pains
a. Trigeminal neuralgia
b. Glossopharyngeal neuralgia
c. Occipital neuralgia
d. Nervus intermedius neuralgia
continuous neuropathic pains
a. Persistent idiopathic facial pain
b. Painful post-traumatic trigeminal neuropathy
c. Trigeminal post-herpetic neuralgia
d. Burning mouth syndrome
e. Occlusal dysesthesia (phantom bite/occlusion
Superficial
somatic pains
a. Cutaneous pain
b. Muco-gingival pain
Deep somatic
pains
a. Muscoluskeletal pain
b. Visceral pain
Neuropathic Pain
Definition:
Pain initiated or caused by a primary lesion or dysfunction in the nervous system (1
Dysesthesia-
an unpleasant abnormal sensation, whether spontaneous or evoked (1
is neuropathic pain often diagnosed
Often misdiagnosed & mistreated by
doing multiple unnecessary dental
procedures (i.e. multiple root canals,
extractions
Neuropathic Pain
Dysfunction may be caused by:
- virus (i.e. herpes zoster, shingles)
- demyelinating disease (i.e. multiple sclerosis)
- trauma, injury, surgery
- dental extractions, root canal therapy, dental implant placement, restorative procedures
- Idiopathic
Inferior Alveolar Nerve (IAN) Injury incidence varies from?
most commonly injured nerve ?
Lingual nerve injury incidences is?
Inferior Alveolar Nerve (IAN) Injury incidence varies from 0-40%
IAN is the most commonly injured nerve 64.4%
Lingual nerve injury incidences is 28.8%
Etiologies of nn injury with dentistry
IAN injury due to traumatic local anesthesia injection
- % of the long beveled needles were barbed at their tips after the procedure
- % of the patients got an “electric shock type” sensation on IAN block
- % of the % suffer from prolonged neuropathy
- 78% of the long beveled needles were barbed at their tips after the procedure
- 1.3 – 8.6% of the patients got an “electric shock type” sensation on IAN block
- 57% of the 1.3-8.6% suffer from prolonged neuropathy
IAN injury due traumatic local anesthesia injection
- Local anesthetics safety for pain?
- Lidocaine, articaine, mepivicaine and bupivicaine irritation
IAN injury due traumatic local anesthesia injection
- Local anesthetics represent the safest and most effective
drugs in all medicine for the prevention and
management of pain
- Lidocaine being the least irritant followed by articaine,
mepivicaine and bupivicaine
IAN injury by implant drill
hematoma formation can occur as well impinging the nn
Neuropathic pain variable presentation
- can vary widely in clinical presentation in regard to pain quality and location
neuropathic pain can be caused by lesions where?
can be caused by either central
nervous system dysfunction
and/or by peripheral nerve
lesions
neuropathic pain may not repsond to what drugs? could respond to?
somewhat less responsive to
opioids and more likely to respond
to other drugs, such as
anticonvulsants (among others)
is neuropathic pain dependent on stimuli
can be stimulus-evoked or
stimulus-independent
(spontaneous).
CENTRAL CAUSES OF FACIAL PAIN
– Anesthesia dolorosa (pain in an area that is anesthetic)
– Central post-stroke pain
– Facial pain attributed to multiple sclerosis
– Persistent idiopathic facial pain
– Burning mouth syndrome
– Multiple sclerosis
NEURALGIAS – as a cause of a facial pain
NEURALGIAS – follows distribution of a nerve(s)
– Trigeminal neuralgia Geniculate neuralgia (Ramsay Hunt/Nervus
– Post-herpetic neuralgia intermediate neuralgia)- sensory of CN VII with lancinating pain
– in the auditory canal/middle ear
– Traumatic neuralgia Auriculotemporal neuralgia
– Glossopharyngeal neuralgia
– Occipital neuralgia
OTHER CAUSES of facial pain
– Cancer pain
– Dental pain
– Post-traumatic and post-surgical pain
– Primary headache
– Temporomandibular joint syndrome
Neuralgia
Definition:
“Paroxysmal or constant pain typically with sharp, stabbing,
itching, or burning character in the distribution of a nerve “
Neuralgia
* a form of neuropathic pain that is characterized by the following features:
1. timing, distribution?
2. neurologic deficit present?
3. Attacks can be provoked by?
4. refactory period?
- Paroxysmal, brief (seconds to a few minutes), shock-like or lightning-like pain that follows a peripheral or cranial nerve distribution and can spread to adjacent areas in the
course of the attack - Typically, there is no objective neurologic deficit in the distribution of the affected nerve
- Attacks can be provoked by non-painful stimulation (allodynia) of trigger zones (i.e. flossing elicits gingivalm pain)
- A refractory period follows attacks; the duration of the refractory period shortens as the disease progresses
Pre-trigeminal neuralgia
description
Dull, continuous, aching or burning pain in the oral cavity or teeth or jaw
evolving eventually into trigeminal neuralgia (TN)
Pre-trigeminal
neuralgia
Pain duration
Pain duration varies widely from hours to month
Pain may go into remission
Pre-trigeminal
neuralgia origin?
This brief, milder pain is
sometimes suspected to
have a dental origin and
unnecessary dental
procedures have been
performed in many cases
Trigeminal neuralgia (TN) defined
TN as sudden, usually unilateral, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the fifth cranial
(trigeminal) nerve
CN V neuralgia EPIDEMIOLOGY
* The annual incidence of TN is?
* ? new cases occur in the US each year.
* TN is one of the most frequently seen neuralgias in what population?
* incidence increases with?
* Onset after age ?, although may occur in?
* male to female ratio?
- The annual incidence of TN is 4 to 13 per 100,000
people - 15,000 new cases occur in the US each year.
- TN is one of the most frequently seen neuralgias in the
elderly. - incidence increases with age
- Onset after age 50, although may occur in the second
and third decades or, rarely, in children. - male to female ratio is about 1:1.5
TN Pathophysiology
- Most cases of trigeminal neuralgia (TN) are caused by compression of the trigeminal nerve root, usually within a few millimeters of entry into the pons
- Compression by an aberrant loop of an artery or vein is thought to account for 80 to 90 percent of cases.
superior cerebellar aa
Other causes of nerve compression in TN include
- vestibular schwannoma (acoustic neuroma)
- Meningioma
- epidermoid or other cyst,
- saccular aneurysm or AV malformation
Neuropathic Pain
Pathophysiology-Ephaptic
Transmission