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Oral Med > Pain > Flashcards

Pain Flashcards

0
Q

What is hyperalgesia?

A

Increased pain from a stimulus that normally evokes pain

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1
Q

What is allodynia?

A

Pain due to stimulus that does not normally evoke pain

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2
Q

What is Parasthesia ?

A

Abnormal sensation which can be spontaneous or evoked

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3
Q

What is dysaesthesia?

A

An unpleasant abnormal sensation evoked or spontaneous

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4
Q

What is neuralgia?

A

Severe pain in the distribution of sensory nerves

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5
Q

Chronic pain?

A

Pain that persists beyond normal tissue healing for more than 3 months
It is real, subjective, influenced by past experiences

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6
Q

Neuropathic pain?

A

Pain that arises from a lesion of the somatosensory system

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7
Q

Patients with chronic pain disorder present with which features?

A

Somatization and catastrophizing

Somatization: physical symptoms as a manifestation of psychological stress)
Symptoms are medically unexplained

Catastrophizing: unbearable, horrible

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8
Q

What is Trigeminal neuralgia? And what is the pathology behind it?

A

Sudden, Unilateral, brief stabbing pains in the distribution of one or the V branches

Always involved peripheral trigeminal afferant neurone. Likely that patients have lesion pressing on where the nerve exists brain stem eg via superior cerebellar eatery which causes demyelination and hypermyelination

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9
Q

What are the causes of pain in the head and neck region?

A 
oral
facial (tmj, sinus, salivary glands)
vacular
neurological
psychogenic
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10
Q

What is the incidence of TN? Who is more common amongst?

A

2-5/100 000

More common in females than males

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11
Q

What is the peak age of onset for people with TN? What is this pain quality like in TN?

A

50-60
Sharp agonising electric shock felt superficially in skin or buccal mucosa which can be triggered by light, mechanical touch at the trigger zone which usually lasts a few seconds but occasionally 1-2 mins

Pain may occur at intervals followed by an interval free period

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12
Q

What are the two broad categories for management of TN?

A

Medical and surgical

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13
Q

What medications are implicated in TN?

A 
Carbamazepine 100mg 
Gabapentin
Phenytoin
Lamotrigene
Valproate 
Topirimate
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14
Q

Which medication can be used as a diagnostic aid for TN?

A

Carbamezapine

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15
Q

When taking carbamezapjne for TN what investigations are needed?

A

Blood pressure
FBC
Liver function
Plasma levels

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16
Q

What are the side effects to carbamezapjne?

A 
High blood pressure,
Ataxia
Drowsiness
Leukopania
Liver toxicity
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17
Q

How can you treat TN surgically ?

A

Local surgical treatment or central surgical treatment

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18
Q

Which local treatment methods for TN exist?

A

LA + bupivicane
LA + Glycerol block

Cryotherapy 
Peripheral neurectomy (alcohol phenol)
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19
Q

What are the disadvantages to local surgical treatment for TN?

A

Temporary sensory loss

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20
Q

How do you treat V neuralgia using central surgery?

A

Micro vascular decompression
Partial sensory rhizotomy
Radio frequency lesion or thermocoagulation
Retro gasserian glycerol injection

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21
Q

What is micro vascular decompression?

A

Separation sup cerebellar artery from Trigeminal nerve

No sensory loss

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22
Q

What is partial sensory rhizotomy?

A

Section sensory fibres off Trigeminal nerve

Leads to sensory loss

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23
Q

Radio frequency lesion or thermocoagulation involves what?

A

This is when the heat is applied to the sensory lesion behind ganglion

This leads to sensory loss, corneal anaesthesia and dysaesthesia

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24
Q

How do you perform a retro-gasserian glycerol block?

A

Glycerol is infected into the meckels cave

This doesn’t cause sensory loss and recurrs after 1 year

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25
Q

What is Glossopharyngeal neuralgia?

A

Sharp pain along distribution of CN9

Pain felt in the throat, Tonsillar fossa and adjacent fauces

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26
Q

What provokes the pain sensation felt in Glossopharyngeal neuralgia?

A

Can be spontaneous or evoked by mechanical stimulation of Tonsillar area eg coughing of swallowing

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27
Q

Where does the pain in Glossopharyngeal neuralgia radiate to?

A

External ear, angle of jaw and neck

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28
Q

How is the pain in Glossopharyngeal neuralgia relieved?

A

LA to trigger zone

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29
Q

What is the incidence of Glossopharyngeal neuralgia?

A

1/200 000

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30
Q

What is post herpetic neuralgia?

A

Chronic pain with skin changes in the distribution of a nerve following herpes zoster

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31
Q

What type of pain is characteristic of post her petic neuralgia?

A

Burning, dysaesthesia, Parasthesia, cutaneous pain

Usually moderate intensity but since content and intractable can be intolerable

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32
Q

Which nerve if usually involved in PHN?

A

Va

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33
Q

What mood disorder is associated with PHN?

A

Depression

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34
Q

T/F the area skin affected by herpes zoster shows no changes?

A

F

On occasion there may be cutaneous scarring and lack of pigmentation in that area

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35
Q

What is the prevention and treatment for PHN?

A

High dose Acyclovir during initial herpes zoster infection to prevent

Treatment
Amitryptulin 
Pregabalin
Topic LA
Capsaicin patches
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36
Q

What are tension headaches?

A

Dull aching head pain usually symmetrical in nature
Nausea occasional vomiting
Exacerbations with pounding headaches, but less intense than migraine

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37
Q

Where do tension headaches usually arise?

A

Frontal/orbital occipital whole scalp

Diffuse and band like usually bilateral and sometimes more on one side

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38
Q

Who is more commonly affected by tension headaches? Males or females?

A

Females 4:1

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39
Q

What age do tension headaches begin

A

Usually before 30 as young as 8

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40
Q

What are the precipitates to tension headaches ?

A

Emotional stress
Depression anxiety
Exercise
Alcohol (sometimes can relive it)

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41
Q

How so you manage tension headaches?

A

Relaxation techniques
Analgesics
Anxiolytics although should be avoided since some patients becomes depressed and others become dependant
TCA: amitrtiptyline

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42
Q

what is atypical atypical facial pain?

A

chronic facila pain of unknown aetiology

43
Q

what are the features of atypical facial pain? T/F midline is often crossed?

A

constant pain, dull, usually unilateral and maxilliary
poorly localised and doesnt have a single provoking factor

T midline often crossed

44
Q

what mood disorders is atypical facial pain associated with?

A

anxiety and depression

45
Q

What age group and sex does atypical facial pain usually affect?

A

Females>male

30 years +

46
Q

what type of diagnosis is atypical facial pain?

A

a diagnosis of exclusion, no organic cause

47
Q

how do you manage atypical facial pain?

A 
Reassurance 
topical: difflam, lignocain, 
TCA: ami
gapapentin 
psychoterapies
48
Q

what syndrome presents with a severe throbbing pain in a tooth and GINGIVAE which may be mild or severe pain and may move from tooth to tooth?

A

atypical odontolgia

Other features include: maybe wide spread or well localised and frequently precipitated by dental procedure may last for few minutes to couple of hours

49
Q

what other conditions is atypical odontalgia associated with?

A

TMJDS, oral dysaesthesia and pains of psychological origin and often excessive concern with OH

50
Q

what is oral dysaesthesia?

A

unpleasnt abnormal sensation in the mouth

51
Q

what is burning mouth syndrome?

A

burning pain in the tongue or other mucous membranes

52
Q

which areas of the tongue are most commonly affected?

A

tip and lateral borders of the tongue (anterior hard palate and lips often involved and any mucosal areas ) bilateral
increases intensity mid morning and late afternoon

53
Q

what is the demographics of BMS?

A

more common in females more than males and age of onset is 50

54
Q

what are the symptoms are assocated with BMS?

A 
dry mouth
thirst
denture intolerance
metallic taste
Burning increases with tension, fatigue, speaking and not food and decreases with sleeping
55
Q

what investigstions are asscoiated with BMS? And how do you mange it?

A

bloods: anaemia, Haamatiniic def, diabetes and CT disease
candida: swab

Management: correct any underlying path
Topical rinses: diff lam and Zn sulphate 
Vitamin B
TCA
Gabapatentin and pregabalin
Psychotherapists
56
Q

what are cluster headaches? What are the pain type?

A

Periodic migranous neuralgia
severe unilateral headache usually in ocular, frontal and temporal region

Constant stabbing burning or throbbing patient my pace floor and not usually able to lie down

57
Q

what is the prevelance of cluster headaches?

A

7/10000 more common ni males age 20-40

58
Q

what is the nature of attack for cluster headaches?

A

occur in bouts, lasting 4-12 weeks which last for 6-18 months
1-3 attacks lasting 2 hours each within 24 hours

Nocturnal attacks

59
Q

which two things being unbearbale during cluster headache onset?

A

altitude and alcohol

60
Q

what are the symptoms of cluster headache?

A 
ANS symtpoms 
Ipsilateral miosis, ptosis, 
lacrimation
photophobia
irreugular heart rate in severe attacks
Dysaesthesia when touching scalp in area of CNV1
61
Q

how do you manage cluster headaches?

A

Ergot preparation
oxygen inhalation
intransal lignocaine
steroids, verapamil, lithium or pizotifen
Serotonin 1Dreceptors antagonist eg sumatriptan

62
Q

what is the incidence of classic migraine?

A

females more than males

63
Q

what are the stimulants for classic migraine?

A

Stress, mood changes, dietary (bananas, chocolate, cheese, citrus, fruits) OCP, flashing lights, atmospheric change

64
Q

what are the features of classic migraines? And what is the frequency?

A

aura, 20-25 mins of sensory or motor disturbances usually visual changes
unilateral throbbing headache usually in front temporal region photophobia and phonophobia
nausea
Usually lasts for 4-72 hours if no medication used
Pulsating action increase with moderate physical activity or stooping

Frreuqncy: usually 1-4 during month reduced in pregnancy

65
Q

What deficiency can carbamezapjne cause?

A

Folate

66
Q

What are the side effects of using TCA?

A

Nausea
Analgesics
Sedation
Anticholinergic effect

67
Q

What percentage of TN affects the different decisions?

A

Opthalmic: 3%
Max: 35%
Man: 30%

68
Q

What percentage of TN is bilateral?

A

2%

69
Q

What percentage affects CNV1 and CNV2?

A

10%

70
Q

What percentage of TN affects CNV2 and CNV3?

A

20%

71
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage

72
Q

What are the pain pathways?

A

Anterolateral pathways ascending to cerebral cortex via thalamus

73
Q

What are the 3 dimensions of pain?

A

Sensory physiological
Motivational affective
Cognitive evaluative

74
Q

What are the neuralgias of the head an face?

A
  • Primary trigeminal neuralgia (Tic Doulourex )
  • post herpetic neuralgia
  • Glossopharyngeal neuralgia
75
Q

What are the Craniosacral pain of musculoskeletal origin?

A

Tension headache

TMJ

76
Q

What are the lesions of the ear nose and oral cavity that cause pain?

A

Odontalgia : tooth pain not associated with lesions (atypical)
Glossodynia and sore mouth also known as BMS and oral dysaesthesia

77
Q

What are the primary head ache syndromes, vascular disorders that cause chronic pain?

A

Classic migraine (migraine with aura)
Common migraine (migraine without aura)
Cluster headache
Temporal arteritis

78
Q

What percentage of people have unilateral TN?

A

95%

79
Q

T/F TN is strictly limited to CNV?

A

T

80
Q

Which branch is Trigeminal is affected most commonly and which is affected least?

A

CNV2 then 3 then 1

81
Q

Which side is pain more frequent?

A

Right

82
Q

What is the diff dx for trigeminal neuralgia?

A

Secondary TN aneurysm / trauma

MS

83
Q

What is TMJDS?

A

Aching pain in the mom and sometimes brief severe pain on chewing and associated with limited jaw movement and clicking and popping of jaw

84
Q

What type of pain is seen in TMJDS?

A

Intermittent
Unilateral dull and aching
But can be constant
Maybe exacerbated by jaw movement, chewing hard food or yawning and worse on waking often.

85
Q

What are the signs of TMJDS?

A

Restricted mandibular movement with or without deviation of the jaw to the affected side on opening
Tenderness to palpating of the MoM
Clicking or popping of the jaw on auscultation and palpatin
Changes in ability to occlude teeth fully

86
Q

How can you manage TMJDS?

A 
Occlusal splints
Heat pack
TMJ exercise and massage 
Medication eg NSAIDS, anxiolytics TCA
Psychotherapy
Surgical
87
Q

What is the age of onset for classic migraine?

A

Childhood until about 35 usually starts Late puberty

88
Q

What are the types of migraines?

A

Classic
Common
Complicated

89
Q

How do you manage classic migraine?

A 
NSAIDS paracetamol
Anti emetic 
Ergot prep
Prophylactic Bbblocker 
Serotin 1D receptor agonist
90
Q

What is the incidence of temporal arteritis?

A

3-9/100,000
F more than M
Age of onset 50-60

91
Q

What is temporal arteritis?

A

This is a vasculitis affecting the branches of the external carotid artery with resulting obliteration of the vessel lumen and ischsmis to suppled part

92
Q

T/F temporal arteries is unilateral?

A

F can be uni or bilateral

93
Q

What are the features of temporal arteritis pain?

A

Unilaterla or bilateral temporal headache which may be continuous with aching and throbbing

Systemic disturbances like malaise and low grade fever and wight loss

94
Q

T/F Temporal arteritis is associated with poly myalgia rheumatica?

A

T

95
Q

What is the complication with temporal arteritis and how does this happen?

A

Blindness due to involvemtn of the crntral retinal artery

96
Q

What is the treatment for temporal arteries?

A

Titrre ESR with high dose steroids

97
Q

What may happen to the tongue in temporal arteritis?

A

Ischamic necrosis and gangrene

98
Q

What investigations would you do for temporal arteritis?

A

Biopsy: Giant cell arteritis
Bloods: raised ESR

99
Q

How do you treat temporal arteritis?

A

Steroids and immunosuppressants eg azothiarpine

100
Q

What are the names of the common medications used in pain?

A 
Carbamezapine
Oxycarbamezapine
Gabapentine
Pregabalin
Lamotrigene
Baclofen
TCA
SSRI
101
Q

What is the usually dose for carbamazepine? And what are the side effects?

A

Initially 100-200mg od/bd

Max dose : 1.6g/24 hours

Nausea vomiting
Headache 
Blood dyscrasia
Hepatitis
Hypertension 
Actute renal failure 
Stevens Johnson
102
Q

What is the dose of oxycarbamzapine and what are the side effects?

A

300mg bd
Max dose is 46mg/kg/day

Same side effects as carbamezapine but better tolerated

103
Q

What are the dose and side effects of gabapentine?

A

Day 1: 300mg
Day 2: 300mg bd
Day 3: 300mg tds

Max dose: 3.6g/24 hours

104
Q

When does the pain sensation felt in BMS become worse?

A

Mid morning

Late afternoon

105
Q

T/F. In cluster headaches, you can suffer from nocturnal attacks .

A

T

Oral Med (31 decks)

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