Pain Management Flashcards

What is the pharmacological management of post-herpetic neuralgia (PHN) affecting the trigeminal nerve?

Answer: Amitriptyline (TCA), gabapentin/pregabalin (calcium channel modulators), lidocaine patches, or capsaicin cream — NICE-recommended neuropathic pain treatments

PHN (persisting pain after herpes zoster/shingles) affecting the trigeminal distribution is managed with NICE-recommended neuropathic pain agents: amitriptyline, gabapentin or pregabalin, topical lidocaine, or capsaicin 8% patch.

What is the specific indication for using IV paracetamol (Perfalgan) in dental/oral surgical settings?

Answer: When oral route is unavailable or rapid onset analgesia is needed peri- or post-operatively under general anaesthesia — achieves therapeutic levels in 15 minutes

IV paracetamol (Perfalgan) is used in hospital oral surgical settings when patients cannot take oral medication (post-GA) or rapid onset is needed. IV route achieves peak concentrations faster than oral, providing prompt perioperative analgesia.

What is the evidence base for using low-level laser therapy (LLLT) in orofacial pain management?

Answer: Emerging evidence for benefit in TMD myofascial pain, oral mucositis, and dentine hypersensitivity — but evidence quality is currently insufficient to make strong recommendations in most guidelines

LLLT uses low-power lasers to modulate tissue healing and pain. There is emerging evidence for benefit in TMD myofascial pain, post-irradiation mucositis, and dentine hypersensitivity, but the evidence base is still developing and guidelines do not yet recommend it as a mainstream standard of care.

What is the oral surgical management of trigeminal neuralgia when pharmacological treatment fails?

Answer: Microvascular decompression (MVD), Gamma Knife radiosurgery, percutaneous rhizotomy (glycerol/balloon/radiofrequency) — specialist neurosurgical referral required

When carbamazepine/pharmacotherapy fails, surgical options for TN include: MVD (decompresses the trigeminal root from a vascular loop — most durable), Gamma Knife stereotactic radiosurgery (non-invasive), and percutaneous rhizotomy procedures. All require specialist neurosurgical referral.

What local anaesthetic technique is used for maxillary anterior teeth?

Answer: Infiltration (supraperiosteal) injection buccally adjacent to the apex of each tooth — due to the thin buccal bone and cancellous structure of the maxilla allowing LA diffusion

In the maxilla, infiltration anaesthesia (injecting above the root apex under the mucoperiosteum) is effective for most teeth due to the thin, porous buccal cortical bone allowing diffusion of the LA to reach the root and surrounding periodontium.

What is the management of an acute dentoalveolar abscess with facial swelling, raised temperature, and trismus?

Answer: Urgent incision and drainage (I&D) of fluctuant swelling; extraction or pulp extirpation to remove source; antibiotics (amoxicillin) if systemic features; hospital referral if airway concern

Acute abscess with systemic features requires surgical drainage (I&D if fluctuant swelling) as the primary treatment, removal of the source (extraction or RCT), and antibiotics for spreading infection with systemic features. Airway compromise (trismus, floor of mouth swelling) requires immediate hospital referral.