Orofacial Pain

Orofacial Pain

"An unpleasent sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage"
Pain is Multi dimensional
1. Feel location
2. Feel intensity
3. Feel type
4. If Pt feels it, it's real!
Clinical terms
1. Analgesia
  1. Absence of pain in responce to stimuli, when it should hurt
  2. Lack of pain
2. Hyperalgesia
  1. Exacerpated pain produced by stimuli, when pain should be mild
3. Allodynia
  1. Painful on stimulation when it shouldn't
4. Sedation
  1. Reduction in irritabilty/aggitation
5. Anaethesia
  1. Lack of feeling
  2. Analgesia
  3. Amnesia
  4. Immobilisation
Acute Pain
1. <30 days
Cronic Pain
1. > 6 months
2. Or, Pain that lasts longer than the expected period of healing
Subacute Pain
1. 30 days-6 months
Acute Nociceptive
1. Nocicoreceptors
  1. are pain receptors
2. Pain is localised, constant, aching, throbing
3. Treat with painkillers
Cronic Neuropathic Pain
1. 1 in 10 of pupulation
2. Treat with antidepresents
Pain Transduction
1. Primary afferent Axons
  1. C fibres
    1. Unmylenited
      1. Pain, temerature and itch related
  2. Mylenated
    1. A-Alpha
      1. Fastest/Thickest
        Proprioceptive (muscle sense)
    2. A-Beta
      1. Touch related
    3. A-Delta
      1. Pain and temerature related
  3. Noxious/Nocioreceptors
2. Propagation of Pain
  1. Specificity
    1. From stimuli, along one pathway to brain
  2. Pattern Thoery
    1. Any sensory receptor, over time/area. Touch,pressure, vibration could over stimulate the small pain fibres, hense rubbing the site
  3. Gate controled Theory?
    1. Stimuli of T-cells?T-cells 'Gate of pain'?
  4. Dimensions
    1. Cognitive reasoning/pscological aspect
  5. Thoery today
    1. still not sure, Specificity and Dimensions still hold strong
  6. Theories on pain
3. Sensitisation
  1. Progressivly amplified stimulus will start warm, the pain
  2. Peripheral sensation
    1. First stimulus, activates high threshold receptors that lead to pain
      1. After tissue damage, nerve endings are in a 'soup' of stimulating chemicals, which then lower threshold and cause pain
  3. Central Sensitisation
    1. Stimulation from surrounding areas (of injury) excite the spinal cord, resulting in pain. Analgesics after surgery will help this.
Stimulus evoke pain
1. Mechanical Stimuli
  1. Pressure (pain threshold)
2. Thermal Stimuli
  1. C-Fibres
    1. Hot 42oC
      1. Cold will hurt after while
3. Chemical stimuli
  1. Chemicals in cooking
    1. Stimulate Noxious
      1. Results in pain
4. Electrical stimuli
  1. Pain varies with intesity
Clinical presentations of pain
1. Transient orofacial pain
  1. richly innervated
    1. Can have pain easily
2. Pain from tissue injury
  1. Peridontitis
    1. Tooth pulp etc
3. Nervous system pain
  1. Trigeminal Neuralgia
4. Idiopathic Pain
  1. TMJ/Muscle/aches
5. Migraines

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	Created by Caroline Oxford almost 11 years ago