pain Flashcards
give the 7 parts of ICOP
1 orofacial pain due to disorders of dentoalveolar and anatomically related structures
2 myofascial orofacial pain
3 TMJ pain
4 orofacial pain due to lesion/disease of cranial nerves
5 orofacial pain resembling primary headaches
6 idiopathic orofacial pain
7 psychosocial assessment of pts with orofacial pain
what is included in section 1 of the orofacial pain classification?
1 orofacial pain due to disorders of dentoalveolar and anatomically related structures
- dental = pulp, perio, gingiva
- oral mucosa
- salivary gland
- jaw bone
what is included in section 2 of the orofacial pain classification?
2 myofascial orofacial pain
- primary - acute and chronic
- secondary
– tendonitis
– myositis
– muscle spasm
what is included in section 3 of the orofacial pain classification?
3 TMJ pain
- primary - acute or chronic
- secondary
– arthritis
– disc displacement
– degenerative joint disease
– subluxation
what is included in section 4 of the orofacial pain classification?
4 orofacial pain due to lesion/disease of cranial nerves
- trigeminal neuralgia
- other trigeminal neuropathic pain
- glossopharyngeal neuralgia
- glossopharyngeal neuropathic pain
what is included in section 5 of the orofacial pain classification?
5 orofacial pain resembling primary headaches
- orofacial migraine - episodic or chronic
- tension-type orofacial pain
- trigeminal autonomic orofacial pain
– cluster attacks
– paroxysmal hemifacial pain
– short-lasting unilateral neuralgia facial attacks with autonomic symptoms (SUNFA)
– hemifacial continuous pain with autonomic symptoms
- neurovascular orofacial pain - short or long-lasting
what is included in section 6 of the orofacial pain classification?
6 idiopathic orofacial pain
- burning mouth syndrome
- persistent idiopathic facial pain (PIFP)
- persistent idiopathic dentoalveolar pain
^all above without or with somatosensory changes or probable
- constant unilateral facial pain with additional attacks (CUFPA)
describe trigeminal neuralgia (what, presentation, age, cause)
- recurrent brief lancing facial pain with characteristic trigger zones
- no associated sensory changes or facial weakness, no objective physical signs
- unilateral
- > 50yo
- commonly caused by vascular compression, or associated with MS
treatment for trigeminal neuralgia (4)
- vascular decompression surgery
- anticonvulsants (carbamazepine, oxcarbazepine, lamotrigine)
- LA injections (temporary)
- nerve ablation
describe glossopharyngeal neuralgia (what, areas, triggers, tx)
- paroxysmal pain in ear, base of tongue, tonsillar fossa or angle of jaw
- triggered by swallowing, chewing, talking, yawning, coughing
- similar treatment to TN
describe post-herpetic neuralgia (what, cause, demographic)
- paroxysmal shooting pain, steady and sustained, persisting for several months
- due to reactivation of herpes virus over a specific dermatome
- elderly and immunosuppressed
describe trigeminal autonomic cephalgias (presentation, demographic)
- similar history to trigeminal neuralgias but localised to V1/2 usually
- recurrent episodic headaches, periorbital pain, fast onset
- with autonomic features (red eye, tearing, stuffy nose)
- 20-50yo men
describe trigeminal neuropathic pain (what, presentation, tx)
- pain caused by insult to nerves
- following removal of painful stimulus, the pain/altered sensation persists (sometimes burning)
- often with associated metallic taste
- tx = low dose antidepressants (dampen), psychology, self-management
management of trigeminal neuropathic pain (2)
- low dose antidepressants (dampen) - amitriptyline, nortriptyline
- psychology, self-management
describe persistent idiopathic facial pain (PIFP) (what, presentation, tx)
- nagging dull throbbing/persecuting pain
- does not conform to anatomical boundaries and crosses midline
- prevents pts from falling asleep
- relieved by relaxation, rest, distractions
- tx = psychology, self-management, medication/antidepressants, stress/lifestyle modulation
