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</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</p> Signup and view all the answers

    Which approach can enhance outcomes in chronic pain management?

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

    What can cause injuries to the Trigeminal Nerve?

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

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

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

    How can compression injuries to the Trigeminal Nerve occur?

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

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

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

    What is the quality of pain associated with neuropathic pain?

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

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

    <p>Dentist</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</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    At what age does Glossopharyngeal Neuralgia typically onset?

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

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

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

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

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

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

    <p>Deafferentation</p> Signup and view all the answers

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

    <p>Orthodontic treatment</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;</p> Signup and view all the answers

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

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

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

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

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

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

    What is a common characteristic of migraine without aura?

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

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

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

    What percentage of migraine without aura cases experience unilateral pain?

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

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

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

    Which symptom helps in rapid screening for migraine?

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

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

    <p>V2</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</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</p> Signup and view all the answers

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

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

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

    <p>Hyperalgesia</p> Signup and view all the answers

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