Neuropathic & Intraoral Pain Flashcards
Neuropathic
pain
Pain caused by a lesion or disease of the
somatosensory nervous system
Episodic
(Paroxysmal)
(4)
a. Trigeminal neuralgia
b. Glossopharyngeal neuralgia
c. Occipital neuralgia
d. Nervus intermedius neuralgia
skipped
Continuous
(5)
a. Persistent idiopathic facial pain
b. Painful post-traumatic trigeminal
neuropathy
c. Trigeminal post-herpetic neuralgia
d. Burning mouth syndrome
e. Occlusal dysesthesia (phantom
bite/occlusion)
Nociceptive
(somatic) pain
Pain that arises from actual or
threatened damage to non-neural
tissue and is due to the activation
of nociceptors
Superficial
somatic pain
(2)
a. Cutaneous pain
b. Muco-gingival
pain
Deep somatic
pain
(2)
a. Muscoluskeletal
pain
b. Visceral pain
Neuropathic
Pain
Definition:
Pain initiated or caused by a primary
lesion or dysfunction in the nervous
system (1)
Dysesthesia-
an unpleasant
abnormal sensation, whether
spontaneous or evoked (1)
Neuropathic Pain
Dysfunction may be caused by:
(5)
- virus (i.e. herpes zoster, shingles)
- demyelinating disease (i.e. multiple sclerosis)
- trauma, injury, surgery
- dental extractions, root canal therapy, dental
implant placement, restorative procedures - Idiopathic
Neuropathic Pain
Often misdiagnosed & mistreated by
doing multiple unnecessary dental
procedures (i.e. multiple root canals,
extractions)
Inferior Alveolar Nerve
(IAN) Injury incidence
varies from –%
IAN is the most
commonly injured
nerve —%
Lingual nerve injury
incidences is —%
0-40
64.4
28.8
Etiology
- Intra-operative
(5)
- Post-operative
(2)
- Mechanical
- Injection needle
- Implant Drill
- Thermal
- Chemical
- Thermal Stimuli
- Peri-implant infection and hematoma
IAN injury due to traumatic local anesthesia injection
- –% of the long beveled needles were barbed at
their tips after the procedure
- –% of the patients got an “electric shock
type” sensation on IAN block
- –% of the –% suffer from prolonged
neuropathy
78
1.3 – 8.6
57
1.3-8.6
IAN injury due traumatic local anesthesia injection
- Local anesthetics represent the safest and most effective
drugs in all medicine for the prevention and
management of pain
- — being the least irritant followed by (3)
Lidocaine
articaine,
mepivicaine and bupivicaine
Neuropathic pain
* can vary widely in clinical
presentation in regard to
* can be caused by either —
and/or by —
* somewhat less responsive to
— and more likely to respond
to other drugs, such as
— (among others)
* can be —evoked or
—independent
(spontaneous).
pain
quality and location
central
nervous system dysfunction
peripheral nerve
lesions.
opioids
anticonvulsants
stimulus
- CENTRAL CAUSES OF FACIAL PAIN
(6)
– Anesthesia dolorosa (pain in an area that is anesthetic)
– Central post-stroke pain
– Facial pain attributed to multiple sclerosis
– Persistent idiopathic facial pain (previously known as atypical face pain)
– Burning mouth syndrome
– Multiple sclerosis
skipped
NEURALGIAS – follows distribution of a nerve(s)
(9)
– Trigeminal neuralgia
– Post-herpetic neuralgia
– Traumatic neuralgia
– Glossopharyngeal neuralgia
– Occipital neuralgia
– Superior laryngeal neuralgia (from branch of CN X)
Geniculate neuralgia (Ramsay Hunt/Nervus
intermediate neuralgia)- sensory of CN VII with lancinating pain
– in the auditory canal/middle ear
Auriculotemporal neuralgia
- OTHER CAUSES
(5)
– Cancer pain
– Dental pain
– Post-traumatic and post-surgical pain
– Primary headache
– Temporomandibular joint syndrome
Neuralgia
Definition:
“Paroxysmal or constant pain typically with sharp, stabbing,
itching, or burning character in the distribution of a nerve “
Neuralgia
* a form of neuropathic pain that is characterized by the
following features:
1. …
2. Typically, there is no objective — in the
distribution of the affected nerve
3. Attacks can be provoked by …
4. A — period follows attacks; the duration of the
— period shortens as the disease progresses
Paroxysmal, brief (seconds to a few minutes), shock-like or
lightning-like pain that follows a peripheral or cranial
nerve distribution and can spread to adjacent areas in the
course of the attack
neurologic deficit
non-painful stimulation
(allodynia) of trigger zones (i.e. flossing elicits gingival
pain)
refractory
Pre-trigeminal
neuralgia
…
Pain duration varies widely
from —
Pain may go into —
This brief, milder pain is
sometimes suspected to
have a dental origin and
unnecessary dental
procedures have been
performed in many cases
Dull, continuous, aching or
burning pain in the oral
cavity or teeth or jaw
evolving eventually into
trigeminal neuralgia (TN)
hours to months
remission
Trigeminal neuralgia
(TN)
The International Association for
the Study of Pain (IASP) defines TN
as sudden, usually unilateral,
severe, brief, stabbing or
lancinating, recurrent episodes of
pain in the distribution of one or
more branches of the fifth cranial
(trigeminal) nerve
EPIDEMIOLOGY
* The annual incidence of TN is — per 100,000
people
* — new cases occur in the US each year.
* TN is one of the most frequently seen neuralgias in the —.
* incidence increases with —
* Onset after age —, although may occur in the second and third decades or, rarely, in children.
* male to female ratio is about —
4 to 13
15,000
elderly
age
50
1:1.5
Pathophysiology
* Most cases of trigeminal neuralgia (TN) are caused
by
compression of the trigeminal nerve root, usually
within a few millimeters of entry into the pons
* Compression by an aberrant loop of an artery or vein is
thought to account for 80 to 90 percent of cases.
* Other causes of nerve compression include
* vestibular schwannoma (acoustic neuroma)
* Meningioma
* epidermoid or other cyst,
* saccular aneurysm or AV malformation
