ORE Part 1 Pain Management 1 — Questions and Answers
Question 1: What is the definition of 'nociceptive pain' versus 'neuropathic pain'?
- Nociceptive: pain arising from tissue damage activating nociceptors (normal protective function); Neuropathic: pain arising from damage or dysfunction of the somatosensory nervous system itself (Correct answer)
- They are synonymous — both describe tooth pain
- Nociceptive pain is always acute; neuropathic pain is always chronic
- Neuropathic pain only affects the trigeminal nerve
Correct answer: Nociceptive: pain arising from tissue damage activating nociceptors (normal protective function); Neuropathic: pain arising from damage or dysfunction of the somatosensory nervous system itself
Nociceptive pain (e.g., from dental pulpitis, infection) results from activation of specialised pain receptors responding to tissue damage. Neuropathic pain (e.g., trigeminal neuralgia, PDAP) arises from abnormal processing in the pain pathway itself.
Question 2: What are A-delta and C fibres in the context of dental pain?
- A-delta fibres: myelinated, fast-conducting (sharp, well-localised pain); C fibres: unmyelinated, slow-conducting (dull, burning, poorly localised, thermal pain) — both transmit nociceptive signals in dental pulp (Correct answer)
- A-delta and C are both types of motor nerve fibres
- C fibres only carry proprioception from the PDL
- A-delta fibres carry light touch only
Correct answer: A-delta fibres: myelinated, fast-conducting (sharp, well-localised pain); C fibres: unmyelinated, slow-conducting (dull, burning, poorly localised, thermal pain) — both transmit nociceptive signals in dental pulp
Both nerve types carry nociceptive signals from dental pulp and periodontium. A-delta fibres produce the sharp, well-localised 'first pain' response. C fibres produce the dull, burning, poorly localised 'second pain' response.
Question 3: What is 'referred pain' in dentistry and give an example?
- Pain perceived at a location distant from the actual source — e.g., mandibular molar pain referred to the ear, or maxillary sinus pain felt in upper posterior teeth (Correct answer)
- Pain that involves two adjacent teeth simultaneously
- Pain that travels along the nerve after injection
- Pain that is intermittent rather than continuous
Correct answer: Pain perceived at a location distant from the actual source — e.g., mandibular molar pain referred to the ear, or maxillary sinus pain felt in upper posterior teeth
Referred pain in dentistry occurs because convergence of sensory inputs causes mislocalization. Classic examples: lower molar pain referred to the ear or temple; upper premolar/molar pain referred to/from the maxillary sinus.
Question 4: What is 'hyperalgesia' in the context of acute pulpitis?
- Increased sensitivity to painful stimuli — in pulpitis, inflammation sensitises C fibres lowering their threshold, causing disproportionate pain responses to normally painful stimuli (Correct answer)
- Reduced pain sensitivity caused by inflammation
- Normal pain response to dental caries
- A type of referred pain
Correct answer: Increased sensitivity to painful stimuli — in pulpitis, inflammation sensitises C fibres lowering their threshold, causing disproportionate pain responses to normally painful stimuli
Hyperalgesia is an exaggerated pain response to a normally painful stimulus. In irreversible pulpitis, inflammatory mediators (bradykinin, prostaglandins) sensitise C fibres, lowering their threshold and causing heightened pain responses.
Question 5: What is the WHO analgesic ladder and how does it apply to dental pain?
- A 3-step escalating framework: Step 1 = non-opioids (paracetamol, NSAIDs); Step 2 = mild opioids (codeine); Step 3 = strong opioids (morphine) — applied to dental pain starting at the appropriate step (Correct answer)
- A classification of dental pain only
- Only applicable to cancer pain
- A prescribing protocol for antibiotic use
Correct answer: A 3-step escalating framework: Step 1 = non-opioids (paracetamol, NSAIDs); Step 2 = mild opioids (codeine); Step 3 = strong opioids (morphine) — applied to dental pain starting at the appropriate step
The WHO analgesic ladder provides a framework for pain management, starting with non-opioids then escalating to mild, then strong opioids if needed. For most dental pain, step 1 (NSAIDs + paracetamol) is sufficient. Dental pain should guide prescribing at the appropriate step.
Question 6: What is 'balanced analgesia' (multimodal analgesia) in dental pain management?
- Using different analgesic classes with different mechanisms simultaneously (e.g., paracetamol + ibuprofen) to achieve better pain control with lower doses of each, reducing side effects (Correct answer)
- Using only the strongest analgesic available
- Alternating opioids and non-opioids
- Taking all analgesics at exactly the same time only
Correct answer: Using different analgesic classes with different mechanisms simultaneously (e.g., paracetamol + ibuprofen) to achieve better pain control with lower doses of each, reducing side effects
Multimodal (balanced) analgesia combines agents acting at different points in the pain pathway (e.g., paracetamol reduces central sensitisation; NSAIDs reduce peripheral inflammation), achieving superior analgesia with lower doses of each drug individually.
ORE Part 1 Pain Management 1
What is the definition of 'nociceptive pain' versus 'neuropathic pain'?