ORE Part 1 Pain Management

Question 1

What is the definition of 'nociceptive pain' versus 'neuropathic pain'?

Accepted 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

Answer

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?

Accepted 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

Answer

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?

Accepted 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

Answer

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?

Accepted Answer

Increased sensitivity to painful stimuli — in pulpitis, inflammation sensitises C fibres lowering their threshold, causing disproportionate pain responses to normally painful stimuli

Answer

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?

Accepted 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

Answer

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.

ORE Part 1 Practice Test

ORE Part 1 Practice Test

ORE Part 1 Pain Management