Pain Management Flashcards

What is 'central sensitisation' and how does it contribute to chronic orofacial pain?

Answer: Increased responsiveness of the central pain-processing neurons (in the trigeminal nucleus and higher centres) following prolonged nociceptive input — leads to amplified pain processing and expansion of pain areas

Central sensitisation (CS) develops when sustained nociceptive input causes 'wind-up' in the trigeminal nucleus and supraspinal centres, increasing synaptic efficacy. CS contributes to chronic orofacial pain by amplifying and expanding pain beyond the original site.

What is the role of intraosseous anaesthesia (e.g., Stabident) in managing difficult-to-anaesthetise mandibular teeth?

Answer: Delivers anaesthetic directly into the medullary bone adjacent to the tooth, bypassing limitations of conventional blocks — effective supplement for irreversible pulpitis of lower molars where IDB is insufficient

Intraosseous injection delivers LA directly into the cancellous bone adjacent to the tooth root apex, achieving local anaesthesia even when conventional IDB fails (common in irreversible pulpitis due to lowered inflammatory pH reducing LA efficacy).

What is 'burning mouth syndrome' (BMS) and how is it managed?

Answer: Chronic burning oral pain without identifiable organic cause — predominantly in post-menopausal women; managed with cognitive-behavioural therapy, clonazepam, alpha-lipoic acid, and amitriptyline

BMS is a chronic neuropathic pain condition with no identifiable cause, affecting tongue/lips/palate. Management includes reassurance, CBT, low-dose clonazepam topically, alpha-lipoic acid, and tricyclic antidepressants. Ruling out organic causes (candida, nutritional deficiency, diabetes) is essential.

What is the clinical presentation of 'atypical facial pain' (chronic idiopathic facial pain)?

Answer: Constant, dull, diffuse, poorly localised deep facial pain not following nerve distribution, not triggered by touch, not responding to dental treatment — a central sensitisation/psychosocial disorder

Atypical facial pain (chronic idiopathic facial pain) presents as constant, dull, non-anatomical, poorly defined pain, often with psychological comorbidity. It does not respond to standard dental or surgical treatments, indicating central rather than peripheral aetiology.

What assessment tool is used to screen for depression and anxiety in patients with chronic orofacial pain?

Answer: PHQ-9 (Patient Health Questionnaire) for depression; GAD-7 for anxiety — recommended in chronic pain assessment

Validated psychiatric screening tools (PHQ-9 for depression, GAD-7 for anxiety) are recommended in chronic orofacial pain management because psychological comorbidity significantly impacts pain experience and treatment outcomes.

What is the role of tricyclic antidepressants (TCAs) in managing neuropathic orofacial pain?

Answer: TCAs (e.g., amitriptyline, nortriptyline) reduce central sensitisation and modulate descending pain inhibition — effective in low doses (10–75 mg) for neuropathic pain independently of antidepressant effect

Low-dose TCAs (amitriptyline 10–25 mg nightly) are first or second-line for neuropathic pain (PDAP, burning mouth, post-herpetic neuralgia). They modulate descending pain inhibitory pathways and reduce central sensitisation.