ORE Part 1 Pain Management 3

Question 1

What is the pharmacological basis of topical benzydamine hydrochloride (Difflam) for oral mucosal pain?

Accepted Answer

An NSAID with local anaesthetic properties applied topically to oral mucosa — inhibits prostaglandin synthesis and has analgesic effect on inflamed mucosal surfaces

Answer

Benzydamine (Difflam) is a topical NSAID/local analgesic mouthwash effective for painful oral mucositis (from radiotherapy, chemotherapy, or surgery) and aphthous ulcers. It inhibits prostaglandin synthesis and provides surface anaesthesia.

Question 2

What is 'allodynia' and when does it occur in dental/orofacial pain?

Accepted Answer

Pain from a stimulus that does not normally cause pain (e.g., light touch, air, cold water causing pain in irreversible pulpitis) — indicates sensitisation of the pain pathway

Answer

Allodynia is pain elicited by normally non-painful stimuli (e.g., touch, temperature, air). It indicates sensitisation of the pain pathway (peripheral or central). In irreversible pulpitis, allodynia explains pain from non-noxious stimuli like cool water.

Question 3

What is the mechanism of paracetamol's analgesic action?

Accepted Answer

Not fully understood — proposed mechanisms include inhibition of COX-3 in the CNS, enhancement of endocannabinoid pathways, and serotonergic modulation — predominantly central analgesic action

Answer

Paracetamol's precise mechanism remains incompletely understood. Unlike NSAIDs, it has minimal anti-inflammatory effect peripherally. It acts centrally, possibly via COX-3 inhibition, endocannabinoid/serotonergic modulation, and reducing descending pain facilitation.

Question 4

What is 'dry socket' (alveolar osteitis) and how is it managed?

Accepted Answer

Painful loss of blood clot from extraction socket exposing bare bone — managed by gentle irrigation, zinc oxide eugenol/Alvogyl dressing, and analgesia (NSAIDs + paracetamol)

Answer

Dry socket is painful exposure of the extraction socket bone after premature clot loss or failure, typically occurring 3–4 days post-extraction in lower molar sites. Management is palliative: socket irrigation, zinc oxide eugenol or Alvogyl dressing, and adequate analgesia.

Question 5

What is the rationale for combining paracetamol and ibuprofen for post-operative dental pain?

Accepted Answer

They act via different mechanisms (central COX inhibition vs. peripheral prostaglandin reduction), providing additive/synergistic analgesia superior to either drug alone — multimodal approach

Answer

Paracetamol (central mechanism) and ibuprofen (peripheral/anti-inflammatory) target different components of the pain pathway, providing better combined analgesia than either alone, allowing lower doses of each while reducing side effects.

ORE Part 1 Practice Test

ORE Part 1 Practice Test

ORE Part 1 Pain Management 3