25 - Neuropathic pain

Question 1

What is the benefit of a linear analogue pain scale?

Answer 1

Can be compared between appointments to assess patient’s pain

Question 2

Define nociceptive pain.

Answer 2

Caused by activity in neural pathways in response to potentially tissue-damaging stimuli

Question 3

Define neuropathic pain.

Answer 3

Initiated or caused by primary lesion or dysfunction in the nervous system (ie injury)

Question 4

Give examples of nociceptive pain.

Answer 4

• post-operative pain
• sports injuries
• arthritis

Question 5

Give examples of neuropathic pain.

Answer 5

• post-herpetic neuralgia
• distal polyneuropathy (ie diabetes or HIV)
• trigeminal neuralgia
• central post-stroke pain
• CRPS

Question 6

How is neuropathic pain report by patients?

Answer 6

• constant burning/aching pain
• fixed location
• often fixed intensity

Question 7

What initiates neuropathic pain?

Answer 7

• usually follows history of ‘injury’
• injury can be a true trauma, XLA or routine tx when the nerve heals in such a way that causes pain
• can follow herpes zoster episode
• can follow destructive tx for pain

Question 8

Why does destructive treatment for pain not cure neuropathic pain?

Answer 8

• area will typically become numb for some time after treatment
• nerve can regenerate and this further damage can make the neuropathic pain worse

Question 9

What is the genetic predisposition for neuropathic pain?

Answer 9

• inherited neurodegeneration
• some nerve ion channels that heal badly after injury (persisting in flow gives persisting information)

Question 10

What topical medication can be used for the management of neuropathic pain?

Answer 10

• capsaicin
• EMLA
• benzdamine
• ketamine
• lidocaine

Question 11

What systemic medication can be used for the management of neuropathic pain?

Answer 11

• pregabalin
• gabapentin
• tricyclic antidepressants
• duloxetine

Question 12

What physical therapy can be used for the management of neuropathic pain?

Answer 12

• TENS
• acupuncture

Question 13

What psychological therapy can be used for the management of neuropathic pain?

Answer 13

• distraction
• correction of abnormal illness behaviour
• improvement of self-esteem and outlook

Question 14

How do topical medications improve neuropathic pain?

Answer 14

Work to cause irritation to skin/mucosa and this gates off the pain

Question 15

What is atypical odontalgia?

Answer 15

• dental pain without dental pathology
• distinct pattern of pain
• pain free/mild between episodes
• intense unbearable pain 2-3 weeks which settles spontaneously

Question 16

When should you suspect atypical odontalgia?

Answer 16

• is the patient reports symptoms of pulpitis with no clinical findings
• if RCT/XLA undertaken, pain relieved initially but then returns in adjacent tooth/mucosa

Question 17

What is the management of atypical odontalgia in primary care?

Answer 17

Refer

Question 18

What is the management of atypical odontalgia in specialist care?

Answer 18

• chronic management involves reducing frequency of episodes
• acute management can involve opioids
• 2y care are prepared to XLA if required

Question 19

What is persistent idiopathic facial pain?

Answer 19

• pain that does not fit into standard chronic pain syndromes
• often associated with high degree of disability and autonomic symptoms
• diagnosis can sometimes be all that you can provide patient, adopt holistic approach