HeadWise HeadWise: Volume 6, Issue | Page 17

“ Patients need to be aware that there are plenty of medical and surgical options available and not to become discouraged .”
the transmission of pain . One patient with non-responsive pain due to surgical injury of the great auricular nerve after parotid tumor resection , reported burning electric shock-like sensations in the region of the scar that could be provoked by wind or light touch . The patient was treated with various drugs such as pregabalin , gabapentin , carbamazepine , oxcarbazepine , amitriptyline , and duloxetine – in singular therapy and in combination . The patient was pre-treated with lidocaine cream 4 % for 60 minutes . With the application of the capsaicin 8 % patch for 60 minutes in the location of the pain , his pain decreased within 12 hours . The decrease in pain lasted 8 to 12weeks and the treatment was repeated four times with the same effect .
Orofacial pain includes pain within the oral cavity ( mouth ). Often , patients are referred to specialized headache centers when in reality their pain stems from an intraoral cause . Rare disorders such as pulpitis ( inflammation of the pulp of a tooth ), cracked tooth syndrome , burning mouth syndrome , and atypical toothache are some of the rare causes of dental pain . Due to the significant nerve convergence in the jaw and face , the pain may be referred , poorly localized , or misdiagnosed . Dental pulp and periodontal ligaments contain nociceptors ( pain receptors ) which are triggered by pressure in response to inflammatory mediators . Pulpitis is typically due to dental caries ( destruction or death of a tooth ) and may be reversible in response to specific stimuli such as hot , cold , or sweets . The pain may be described as fleeting , shooting , or stabbing . Cracked tooth syndrome occurs when a crack has occurred in the dental hard tissues and reaches the pulp chamber but the crack is not visible to the naked eye . The pain is intermittent , provoked by biting or releasing biting on a hard object , and notoriously difficult to diagnose . It may be described as sharp or sensitive and is usually related to chewing .
Burning mouth syndrome is a collection of symptoms affecting the oral cavity described as a “ burning ” pain in the mouth associated with an alteration in taste and altered perception in the quality and quantity of saliva . The symptoms are most commonly localized to the tongue , and is most commonly seen in peri-menopausal or postmenopausal females . It is strongly associated with psychological conditions , such as anxiety and depression , and the symptoms are typically worsened during periods of psychological stress .
Cranial neuralgias and other facial pains can wear many different disguises , making them very difficult to diagnose and treat . Even when the appropriate diagnosis is established , there is often a mismatch between patient ’ s expectations of a “ cure ” for their pain and the reality that many of these neuralgic pains may become chronic . Many of these sufferers have been passed along from physician to physician without answers , leaving them to feel abandoned or neglected . Many of the symptoms are difficult for patients to describe . Shephard et al suggests that health care practitioners should not be “ taking ” a history but “ receiving ” it . In other words , a physician ’ s concern is to translate the subjective experience of illness into the recognizable discourse of medicine . Patients need to be aware that there are plenty of medical and surgical options available and not to become discouraged . It is imperative that physicians are sensitive , especially to patients suffering from painful cranial neuralgias and other facial pains . HW
Recommended Reading
1 . Gaul C , Resch S . Application of the capsaicin 8 % cutaneous patch in neuropathic pain of the head and face : A case series . Cephalalgia 2015 ; 35:545-550 . doi : 10.1177 / 0333102414550107 http :// www . ncbi . nlm . nih . gov / pubmed / 25217483 ? dopt = Abstract
2 . Shephard MK , MacGregor EA , Zakrzewska JM . Orofacial pain : A guide for the headache physician . Headache 2014 ; 54:22 – 39 . doi : 10.1111 / head . 12272 http :// onlinelibrary . wiley . com / doi / 10.1111 / head . 12272 / full
www . headaches . org | National Headache Foundation 17