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(14) Orofacial Pain (Vital Signs (1) Temperature, 2) Blood Pressure, 3)…
(14) Orofacial Pain
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Pain
- Sensory activated
- Conscious
- Non-primitive
Extent
Chronic
- (>3 months)
- Driven by Sensitization
- Have allodynia / hyeralgesia
- Pain & Source Different
- No obvious tissue damage
- Affect CVS/Psycho/Sleep/Behaviour
- Mostly Neuropathic
Acute:
- Acute (<2 weeks)
- Acute/Subacute (<3 months)
- Pain & Source Same
- Increase inflammation/swelling/temperature
- Mostly Nociceptive
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Definition: Unpleasant sensory & emotional; associated with tissue damage
Threshold: Minimum intensity of stimulus
Type
Nociceptive Pain (Pain from tissue damage / potential damage)
- Location:
- Musculoskeletal
- Internal organs
- Descriptor: Burning/Heavy/Numbness
- Pattern: Pain intensity decreases after injury/inflammation
- Response Opoids: Effective
- Response NSAIDs: Effective
- Response Tricylic Anti Depressants/Convulsants & LA: Ineffective
- Mechanical Allodynia: Uncommon
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Neuropathic Pain (Abnormal processing of stimuli by PNS/CNS)
- Location: Nervous system damage / malfunction
- Descriptor: Sharp/Ache/Throbbing/Painful numbness
- Pattern: Intensity persist / intensify after injury
- Response Opoids: Resistant
- Response NSAIDs: Rarely Effective
- Response Tricylic Anti Depressants/Convulsants & LA: Effective
- Mechanical Allodynia: Common
(PNS):
- Trigeminal Neuralgia (Idiopathic / Neurologically dependent)
- Diabetic Neuropathy (Cell death at peripheral neurons; sharp pain from extremities)
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Examples: Diabetes, Sclerosis, Stroke, Cancer, Cytomegalovirus, Amputation
Pain States
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Sensitization: Increased responsiveness of nociceptive neurons; normally subthreshold input
Central Sensitization:
- CNS
- eg. Trigeminal Nuclei Tract
Peripheral Sensitization:
- PNS
- eg. Trigeminal ganglion afferents
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Nociception
- Sensory activated
- Never conscious
- Primitive
- Processing of Noxious Stimulus
Eg Autonomic Response
- Pallor
- Tachycardia
- Hypertension
- Nausea
- Fainting
Noxious Stimuli
- Damaging
- Potentially damaging
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Mandibular (5c)
- Lower lip
- Lower teeth & gums
- Chin
- Jaw (Excluding angle; C2-C3)
- External ear
Others: Meninges
Maxillay (5b)
- Lower Eyelid
- Nares/Nasal Mucosa
- Sinuses (M/E/S)
- Pharynx/ Palate
- Upper lip
- Upper teeth & gums
- Cheek
Others: Meninges
Opthalmic (5a)
- Sculp
- Forehead
- Upper Eye Lid
- Tip of nose
- Nasal Mucosa
Others: Conjunctiva, Cornea, Frontal Sinuses, Meninges
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Head & Neck 
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