Pain Flashcards
What is Pain?
An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage
How do you assess a pain patient?
Physical symptoms
–McGill questionnaire gets the patient a choice of words to describe their pain
Emotional symptoms
-Psychological scores
QoL score (OHIP- oral health impact profile)
-measures quality of life
-disability from pain or injury
What is Neuronal Plasticity?
Changes which happen in chronic pain which become less helpful
If you have chronic pain info passing from an area, you can get sprouting of spinal sensory nerves to connect to the interneuron in a stimulatory way which means that sensation makes it easier for pain signals to pass to the brain
Adaptations from the CNS to the pain make it easier for pain to continue to pass.
Even if the cause of pain is removed, patients can continue to feel pain because they have a connection in a positive way between normal sensation and the pain neurons. Pain will continue to be felt as long as there is normal sensation passing through the nerve
How can you prevent learned pain?
Early management of pain- using something to control the peripheral sensitisation such as LA or non steroidal anti-inflammatory’s
Use of LA on the primary afferent nerve can reduce sensations to pass which allow adaptations to occur
Inhibiting the dorsal root ganglion from processing in the cell body
Applying medications to change the neurotransmitters in the CNS to make adaptations less likely
What is Nociceptive pain?
Acute pain
How does neuropathic pain occur?
Occurs when pain stimulus is generated beyond the nociceptor, pain perception is occurring between the nociceptor and the CNS due to damage of the pathway sending that pain signal to the brain
The patient feels a pain but there is nothing wrong with the tissues
Neuropathic pain can mimic other pain because of the way the brain makes assumptions from stimuli coming from different pathways
What is post herpetic neuralgia?
Herpetic lesions caused by herpes zoster virus- the virus is neuropathic and damages the nerves in which it is living
Even when the herpetic lesions resolve the damage in the nerve remains and the patient still feels pain
What is neuropathic pain?
Constant burning/aching pain
–due to nerve damage being there all the time
Fixed location
Fixed intensity
Usually occurs after a history of ‘trauma’
i.e. extractions, facial trauma etc
What systemic medication could you prescribe for management of neuropathic pain?
Pregabalin
Gabapentin
Tricyclic
Duloxetine
Valproate
What topical medication could you prescribe for management of neuropathic pain?
Capsaicin (extracted from red peppers, causes a depolarisation of peripheral nerves)
EMLA
Benzdamine
How does topical medication work for neuropathic pain management?
Reduces the pain within the CNS by peripheral stimulation (gate control hypotheses)
Medication which causes sensory nerve activation over the area of pain which will help gate off the pain signal coming from neuropathic damage
What alternative methods are there for neuropathic pain management?
Physical
-Tens
-Acupuncture
Psychological
-Distraction
-Improve self esteem/positive outlook
-Correct abnormal illness behaviour
What is atypical odontalgia?
Dental pain without dental pathology
Has a distinct pattern of pain
-pain free or mild between episodes
-intense or unbearable pain (2-3 week duration), settles spontaneously without treatment
What is the strategy for managing chronic pain associated with atypical odontalgia?
Reduce chronic pain experience (with gabapentin or pregabalin)
Reduce frequency of acute episodes
What is the strategy for managing acute pain associated with atypical odontalgia?
Have a plan to control the pain
Opioid analgesics as required
High intensity/short duration
