oro-facial pain including chronic facial pain Flashcards

Question

Normal sinus functioning depends on (3)

Answer 1

- patent ostia - satisfactory ciliary functioning - appropriate amount of secretions

Answer 2

CBT improved 6/12 | Oestrogen increased taste

Answer 3

A sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve IASP 1994

Answer 4

I. present daily and persist for most or all of the day II. should be confined at onset to a limited area of one or both sides of the face, but may spread to the upper or lower jaws and a wider area of the face and neck III. should not be associated with sensory loss or other physical signs IV. Laboratory investigations should not demonstrate relevant abnormalities The pain may be initiated by trauma, but persist without any demonstrable local cause

Answer 5

Severe throbbing pain in the tooth without major pathology IASP 1994

Answer 6

``` Costens syndrome Temporomandibular joint dysfunction syndrome (TMD) Myofascial pain syndrome Facial arthromyalgia Oromandibular pain ```

Answer 7

Pain in the TMJ and muscles of mastication, which may worsen upon chewing, possibly leading to restricted jaw movement after IASP 1994

Answer 8

1. Assessment and diagnosis - ensure no cause of concern 2. Explanation and reassurance 3. Discuss/ suggest tx options

Answer 9

Biological Psychological - anxiety/ depression Social context - work/ finances/ family

Answer 10

Burning pain in tongue from any cause

Answer 11

``` Bacterial - oral swabs Fungal - oral rinse for candida Allergy - patch test Geographic tongue - observe over time Parafunction - dental examination Oesophageal reflux - tooth erosion Xerostomia - salivary flow rates ```

Answer 12

``` < iron folate B12 Diabetes Menopause Psychogenic Cancerphobia ```

Answer 13

``` TMJ Neuralgic Atypical Vascular Location Temple, ear, jaws, teeth Nerve distribution Diffuse, deep ?across midline Orbit or upper face Localisation Poor, but usually unilateral Fair to good Poor Usually good Duration Weeks to years Seconds Weeks to years Minutes to hours Character Dull, continuous Lancinating, paroxysmal Dull, boring, continuous Throbbing, deep Precipitating factors Chewing, yawning Touch, wind, vibration Stress, fatigue Alcohol Signs Limited mouth opening, ?click None None Lacrimation, eye injected Aetiology Stress, parafunction Idiopathic, MS Nerve injury, stress Vasomotor, ?allergic Treatment Physiotherapy, behavioural, antidepressants Tegretol, nerve block, neurosurgery Antidepressants, behavioural Triptans ```

Answer 14

Correct deficiencies Alter medications Manage symptoms

Answer 15

``` Topical clonazepam Antidepressants Alpha-lipoic acid Capsaicin capsule Cognitive behavioral therapy -EB ```

Answer 16

Severe throbbing pain in the tooth without major pathology

Answer 17

``` • Pain associated with a tooth or tooth socket without any major pathology • Precipitated by dental procedures • If the tooth is extracted the pain often recurs after a few weeks at a new site ```

Answer 18

``` • Toothache with no dental pathology • Constant throb or ache • Dental treatment – no difference – Improvement for a week ```

Answer 19

•Pain remains same (with no tooth) •Pain moves to adjacent teeth •Pain in gingival tissue that previously surrounded tooth

Answer 20

```  Sensitisation of nerves may occur after infection, extraction or even RCT  Changes within the CNS and possibly ongoing neural activity  ?? Female prevalence  Tends to be older patients  ?? Psychosocial factors ```

Answer 21

At the site of injury or no injury e.g. chronic pain, abnormal pain responses can occur e.g. phantom limb pain, AFP, traumatic lingual nerve dysaesthesia

Answer 22

Stimulation is more painful

Answer 23

Non painful stimuli are painful

Answer 24

Pain in absence of stimulus

Answer 25

* Induced by tissue injury * Increased spontaneous background firing * Hyperexcitability to other low threshold input * Increased size of receptive fields

Answer 26

central, enhanced responsiveness and increased AP firing rate leading to increased perceived pain intensity

Answer 27

Location Diffuse, deep ?across midline Localisation Poor, does not fit anatomical boundaries of Trigeminal Nerve Duration Weeks to years Character Dull, boring, continuous, can be throbbing, aching “like a toothache” Precipitating factors Stress, fatigue, nil Signs None Aetiology Nerve injury, stress Treatment Antidepressants, behavioural (CBT) LA block does not help

Answer 28

``` •stress management - ? through GMP •relaxation / hypnosis •cognitive behaviour therapy, CBT (probably includes both of above) •psychological help for other problems inc. talking therapy ```

Answer 29

It is a way of talking about: •how you think about yourself, the world and other people •how what you do affects your thoughts and feelings. CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better

Answer 30

• As helpful with chronic pain with known pathology as with unknown pathology or aetiology e.g.Chronic arthritis, post herpetic neuralgia • Mainstay of management of AFP/AO • Amitriptyline/nortriptyline 10-100mg nocte

Answer 31

• Abnormal cranial nerve testing results – Abnormal sensations – Abnormal responses • Vomiting/Headache - ICP