3- Cronic Pain
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Questions and Answers

What is the role of receptors?

  • To open ion channels in response to chemical signals (correct)
  • To reduce the threshold of nociceptors
  • To create a chronic pain sensation
  • To respond to non-painful stimuli

What is peripheral sensitization?

  • The opening of ion channels in response to noxious stimuli
  • Increased responsiveness and reduced threshold of nociceptors (correct)
  • Reduced responsiveness and increased threshold of nociceptors
  • A painful sensation caused by non-painful stimuli

What is allodynia?

  • Increased responsiveness and reduced threshold of nociceptors
  • A painful sensation caused by noxious stimuli
  • A sensation caused by the opening of ion channels
  • A painful sensation caused by innocuous stimuli (correct)

What is the term used to describe the alteration of neural impulses as they travel up to the higher centers?

<p>Central modulation (A)</p> Signup and view all the answers

Which factor can contribute to the 2nd order neuron in the central nervous system becoming hypersensitive?

<p>Negative pain experience (D)</p> Signup and view all the answers

Which approach can enhance outcomes in chronic pain management?

<p>A multidisciplinary team approach (A)</p> Signup and view all the answers

What type of treatment is an example of complementary and alternative medicine for chronic pain management?

<p>Acupuncture (C)</p> Signup and view all the answers

What can cause injuries to the Trigeminal Nerve?

<p>Traumatic crush (C)</p> Signup and view all the answers

Which condition can lead to neurodegenerative disease-induced nerve injury in the somatosensory system?

<p>Multiple Sclerosis (B)</p> Signup and view all the answers

How can compression injuries to the Trigeminal Nerve occur?

<p>Blood vessel compression (B)</p> Signup and view all the answers

Which type of pain is unresponsive to NSAIDs and low dose of opioids?

<p>Neuropathic pain (C)</p> Signup and view all the answers

What is the quality of pain associated with neuropathic pain?

<p>Sharp and stabbing (D)</p> Signup and view all the answers

Who is most likely the first clinician to see a patient with neuropathic pain?

<p>Dentist (B)</p> Signup and view all the answers

What is the typical distribution pattern of Trigeminal Neuralgia (TN) pain?

<p>Does not cross the midline of the face (B)</p> Signup and view all the answers

Which activities are most likely to trigger Trigeminal Neuralgia (TN) pain?

<p>Talking and chewing (D)</p> Signup and view all the answers

What is the common accompaniment to a pain attack in Trigeminal Neuralgia (TN)?

<p>Tic-like cramps or involuntary spasms of the facial muscles (B)</p> Signup and view all the answers

What is the peak incidence age for Trigeminal Neuralgia (TN)?

<p>50-60 years (A)</p> Signup and view all the answers

What is the ratio of male to female in Trigeminal Neuralgia (TN)?

<p>1:2 (B)</p> Signup and view all the answers

Why is MRI preferred over CT for diagnosing Trigeminal Neuralgia (TN)?

<p>MRI is more sensitive to intracranial lesions and MS (B)</p> Signup and view all the answers

What is the most common cause of Trigeminal Neuralgia (TN)?

<p>Compression of the trigeminal root by a blood vessel near the dorsal root entry zone (DREZ) (A)</p> Signup and view all the answers

What is a common misconception that can lead to unnecessary dental treatments in Trigeminal Neuralgia (TN) patients?

<p>The paroxysmal nature of TN being confused with dental pathologies (C)</p> Signup and view all the answers

How does TN differ from dental pathologies?

<p>It involves compression of the trigeminal root by a blood vessel near the dorsal root entry zone (DREZ) (C)</p> Signup and view all the answers

What is the next step if pain in a vital tooth without periapical lucency is found to have a crack upon close inspection?

<p>Extract the tooth if it already has root canal treatment (B)</p> Signup and view all the answers

What should be done if an occlusal splint shows positive results for excessive tooth loading during sleep and the pain reduces?

<p>Adjust the device to reduce heavy contact on the painful area and continue use (A)</p> Signup and view all the answers

What is the recommended action if there is no evidence of excessive tooth loading on the occlusal guard and the pain continues?

<p>Refer for proper diagnosis of other possible orofacial pain conditions (A)</p> Signup and view all the answers

What is the course of action if there is no evidence of crack on close inspection of a vital tooth with pain that continues?

<p>Restore the tooth filling if no evidence of crack is found (D)</p> Signup and view all the answers

What is the first-line pharmacological treatment for pain relief in Trigeminal Neuralgia?

<p>Carbamazepine (300mg once daily) (A)</p> Signup and view all the answers

In refractory cases of Trigeminal Neuralgia, which medication is used for pain relief?

<p>Gabapentin (300mg) (C)</p> Signup and view all the answers

What is the maximum daily dosage of Carbamazepine for pain relief in Trigeminal Neuralgia?

<p>1200mg (D)</p> Signup and view all the answers

What are the two main sensory branches of the Glossopharyngeal Nerve?

<p>Tympanic and pharyngeal branches (B)</p> Signup and view all the answers

Which activities are known to precipitate intense, sharp, stabbing pain in Glossopharyngeal Neuralgia?

<p>Tongue movement (A)</p> Signup and view all the answers

At what age does Glossopharyngeal Neuralgia typically onset?

<p>40-50 (B)</p> Signup and view all the answers

What symptom may lead to confusion between Glossopharyngeal Neuralgia (GN) and Temporomandibular Disorder (TMD)?

<p>Sensitivity to cold liquid (A)</p> Signup and view all the answers

How can the pain attack of Glossopharyngeal Neuralgia (GN) be triggered?

<p>Tongue movement (D)</p> Signup and view all the answers

What action should be taken if a patient experiences a pain attack triggered by swallowing cold liquid?

<p>Initiate mandible immobilization (D)</p> Signup and view all the answers

What is the main characteristic of Postherpetic Neuralgia (PHN)?

<p>Constant, deep, burning, aching, and itching pain (B)</p> Signup and view all the answers

Which branch of the trigeminal nerve has the worst prognosis for symptoms of Postherpetic Neuralgia (PHN)?

<p>Ophthalmic branch (D)</p> Signup and view all the answers

What is the first-line pharmacotherapy for treating Postherpetic Neuralgia (PHN)?

<p>Gabapentin (min 100-300mg/d- max 1800-3600mg/d) (D)</p> Signup and view all the answers

When do antivirals decrease the incidence of Postherpetic Neuralgia (PHN)?

<p>When initiated within 72 hours from onset of rash (A)</p> Signup and view all the answers

What is the most likely mechanism involved in Atypical Odontalgia (AO)?

<p>Deafferentation (D)</p> Signup and view all the answers

Which procedure is NOT typically associated with the pathophysiology of Atypical Odontalgia (AO)?

<p>Orthodontic treatment (D)</p> Signup and view all the answers

What is a common story associated with Atypical Odontalgia (AO), as mentioned in the text?

<p>&quot;I have seen multiple dentists and have had multiple procedures and still have pain on the tooth&quot; (D)</p> Signup and view all the answers

What is the characteristic quality of pain associated with Atypical Odontalgia (AO)?

<p>Throbbing and burning pain (C)</p> Signup and view all the answers

What is the recommended treatment for Atypical Odontalgia (AO) according to the text?

<p>Tricyclic antidepressants (B)</p> Signup and view all the answers

What is the typical gender distribution for Atypical Odontalgia (AO) according to the text?

<p>Mostly women in 40-50s (B)</p> Signup and view all the answers

What type of pain attack is characteristic of Atypical Odontalgia (AO)?

<p>Constant dull ache with occasional sharp pain (D)</p> Signup and view all the answers

Which type of pain is characterized by a recurring, paroxysmal sharp, stabbing pain lasting for a maximum of 2 minutes?

<p>Trigeminal Neuralgia (A)</p> Signup and view all the answers

What diagnostic block will be equivocal (ambiguous) in Atypical Odontalgia (AO)?

<p>Block to eliminate pain (C)</p> Signup and view all the answers

What should be checked to determine the origin of pain in the case of Odontogenic toothache?

<p>Vitality of the tooth and x-ray (D)</p> Signup and view all the answers

What is a common characteristic of migraine without aura?

<p>Pain increases with routine physical activity (D)</p> Signup and view all the answers

How long can a migraine without aura attack last if left untreated?

<p>4 to 72 hours (A)</p> Signup and view all the answers

What percentage of migraine without aura cases experience unilateral pain?

<p>60% (D)</p> Signup and view all the answers

What is the typical duration of reversible focal neurological symptoms in cases of migraine with aura?

<p>Between 5 to 60 minutes (D)</p> Signup and view all the answers

Which of the following is an example of a sensory disturbance associated with aura in migraine with aura?

<p>Flashes of light (B)</p> Signup and view all the answers

How many attacks with reversible visual, sensory, and motor aura are required for the diagnosis of migraine with aura?

<p>At least 2 attacks (C)</p> Signup and view all the answers

What is the main characteristic of the trigeminovascular system?

<p>Consists of trigeminal neurons and the blood vessels they innervate (D)</p> Signup and view all the answers

What is the role of CGRP (calcitonin gene-related peptide) in migraine pathophysiology?

<p>Highly potent vasodilator (D)</p> Signup and view all the answers

Which symptom helps in rapid screening for migraine?

<p>Nausea or sickness when experiencing a headache (D)</p> Signup and view all the answers

What is the confirmatory evidence of a migraine pain disorder according to the text?

<p>Sumatriptan (25 mg tid) (C)</p> Signup and view all the answers

Which division of the trigeminal nerve supplies the maxillary sinus, teeth, and masticatory throbbing pain?

<p>V2 (A)</p> Signup and view all the answers

What is the main artery that supplies the maxillary sinus, teeth, and masticatory throbbing pain according to the text?

<p>Maxillary artery (C)</p> Signup and view all the answers

What are the three major features of Trigeminal Autonomic Cephalgias (TACs) according to the text?

<p>Trigeminal pain, autonomic signs, and vasodilation of blood vessels (A)</p> Signup and view all the answers

Which symptom is typically associated with Trigeminal Autonomic Cephalgias (TACs)?

<p>all of the above (D)</p> Signup and view all the answers

Which sensory disturbance is characteristic of TACs according to the text?

<p>Hyperalgesia (A)</p> Signup and view all the answers

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