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BDS4 ORAL MEDICINE > Orofacial Pain > Flashcards

Orofacial Pain Flashcards

1
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

How are physical pain patients assessed?

A

PAIN scores (McGill)

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3
Q

How are emotional symptoms of patients pain assessed?

A

Pyschological scores (HAD)

Quality of life scores (OHIP)

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4
Q

What is involved in the feeling of pain?

A
  • nociception
  • peripheral nerve transmission
  • spinal modulation
  • central appreciated
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5
Q

What nerve is affected in a Bell’s Palsy?

A

Facial Nerve (VII)
- due to inflammation

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6
Q

What occurs in Bell’s Palsy?

A
  • problems with salivation on affected side
  • paralysis of muscles on affected side
  • things sound very loud on affected side
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7
Q

Where does the trigeminal nerve nucleus lie?

A

From pons all the way to cervical spinal nerves

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8
Q

If a patient presents with numbness in the face, how might damage to cervical spine region cause this?

A

Pressing on trigeminal nerve nucleus

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9
Q

What different nerves affect the head & neck?

A

Somatic =
- V, VIIm IX, X & cervical 1-3

Autonomic =
- sympathetic
- parasympathetic

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10
Q

Do autonomic nerves carry pain information?

A

YES

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11
Q

Why does pain via an autonomic nerve cause more distress?

A

Travels via the basal ganglion of the brain

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12
Q

What do efferent autonomic nerves control in the face?

A
  • sweating
  • blood flow
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13
Q

What is the gate theory of nerve transmission ?

A

Spinal cord can modulate what information in terms of pain gets to the brain ** RESEARCH

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14
Q

What is descending facilitation?

A
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15
Q

What is descending inhibition?

A
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16
Q

How can learned pain be prevented?

A
  • local anaesthetics
  • analgesics
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17
Q

What is CRPS?

A

Chronic Regional Pain
- delocalised pain that spreads around anatomical boundaries
- bilateral
- gripping, tight, burning

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18
Q

How does CRPS present?

A
  • colour change in overlying skin
  • autonomic changes
  • feeling of sweating & heat
19
Q

What is nociceptive pain?

A

Caused by activity in neural pathways in response to potentially tissue-damaging stimuli
- damage in the tissues

20
Q

What is neuropathic pain?

A

Initiated or caused by primary lesion or dysfunction in the nervous system
- damage to the structure of the nerve

21
Q

What are examples of nociceptive pain?

A
  • post-op pain
  • arthritis
  • sports injury
22
Q

What are examples of neuropathic pain?

A
  • postherpetic neuralgia
  • trigeminal neuralgia
  • CRPS
23
Q

What is postherpetic neuralgia?

A

Once viral problem is cleared, the nerve is permanently damaged and inflamed which causes pain even though there is technically nothing wrong

24
Q

What are signs/symptoms of neuropathic pain?

A
  • constant burning/aching pain
  • fixed location
  • often a fixed intensity
  • genetic predisposition (tends to get neuropathic pain elsewhere)
25
Q

what are the most common types of neuropathic pain?

A
  • diabetic peripheral neuropathy
  • postherpetic neuralgia
26
Q

What causes post herpetic neuralgia?

A

occurs after herpes zoster (shingles) episode

27
Q

What is a treatment in dentistry that can potentially cause neuropathic pain?

A
  • extractions of teeth
28
Q

Why is surgery not an option for patients with neuropathic pain?

A

it will make the problem worse !!!

29
Q

What systemic medication can help neuropathic pain?

A
  • pregabalin
  • gabapentin
  • tricyclic antidepressants
  • duloxetine (SSRIs)
30
Q

What topical medications can help neuropathic pain?

A
  • capsaicin
  • EMLA
  • benzydamine
  • ketamine
31
Q

What are the most common systemic medications used for fixed neuropathic pain?

A
  • gabapentin
  • pregabalin
32
Q

What is a negative side effect of systemic neuropathic pain medications?

A

Cause brain fog/difficulty thinking if dosage is high

33
Q

What physical management options are there for neuropathic pain?

A
  • TENS (sometimes helpful)
  • acupuncture (good results)
34
Q

What psychological management options are there for neuropathic pain?

A
  • distraction
  • correct abnormal illness behaviour
  • improve self esteem/positive outlook
35
Q

What is atypical odontalgia?

A

dental pain without dental pathology
- brain is misunderstanding information from teeth & presenting it as toothache!

36
Q

What are the factors of atypical odontalgia?

A
  • distinct pattern of pain
  • pain free or mild between episodes
  • intense unbearable pain
  • usually 2-3 weeks duration & settles spontaneously
  • affects males & females equally
37
Q

How does atypical odontalgia present?

A
  • similar to acute pulpitis pain
  • endontics / extractions relieve pain for a short time BUT pain returns after a short time always
  • you should always refer if patients have pain for seemingly no reason
38
Q

What is sometimes a clinical clue that a patient is suffering from atypical odontalgia?

A

pattern of tooth loss in the mouth (a lot of missing teeth in one area with seemingly no reason)

39
Q

What is the primary care option for patients with atypical odontalgia?

A

REFER to oral medicine
- they will implement a chronic strategy using gabapentin/pregabalin etc… to reduce overall pain experience/episodes
- acutely the only thing that works to relieve pain is opioids

40
Q

what is persistent idiopathic facial pain?

A

pain which poorly fits into standard chronic pain syndromes (NO IDEA WHY THEY HAVE PAIN)

41
Q

What is usually associated with persistent idiopathic facial pain?

A

Depression/psychiatric disorders

42
Q

What is most important in management of persistent idiopathic facial pain patients?

A

Adopt holistic strategy
- try to improve quality of life

43
Q

What is referred pain?

A

Pain felt elsewhere to where the actual pain is coming from

44
Q
A

BDS4 ORAL MEDICINE (21 decks)

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