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Orofacial pain  - a neuropathic pain syndrome? dr shabeel pn [email_address] www.hi-dentfinishingschool.blogspot.com
Which specialist should treat facial pain? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differential diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dental pain
Atypical odontalgia--a form of neuropathic pain that emulates dental pain ,[object Object],[object Object],[object Object]
Oral and maxillofacial surgery in patients with chronic orofacial pain.  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral and maxillofacial surgery in patients with chronic orofacial pain. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral and maxillofacial surgery in patients with chronic orofacial pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral and maxillofacial surgery in patients with chronic orofacial pain ,[object Object],[object Object],[object Object],[object Object]
What is neuropathic pain (NP)? ,[object Object]
Some characteristics of NP: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
From simple sensory testing to Quantitative sensory testing (QST ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Thermorollers ” Von Frey hair” – Nylon filaments
Thermo test Heat pain tolerance Heat pain Neutral  Cold Cold pain Heat Patients respond  to standardized thermal  stimuli
Diagnostic dilemma: ,[object Object],[object Object]
Phenotypic mapping: ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuropathic pain  based on complex mechanisms! Central and peripheral mechanisms
Animal pain research - nerve injury models provide new insight to the mechanisms
Mechanisms after a nerve injury: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
New insight: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Lysophosphatidic acid (LPA) ,[object Object],[object Object],[object Object],[object Object]
 
Evidence for  activated glia cells ,[object Object],[object Object]
A close interplay Glutamate
Marchand F et al Nature 2005
Are the activated glica cells neurodestructive? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Marchand F et al Nature 2005
Opioids activate glia cells ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Marchand F et al Nature 2005 ,[object Object],[object Object]
Glia activation - neurodestructive or neuroprotective?
Glia cell activation – neuroprotective? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gene implantation  – the future treatment? ,[object Object],[object Object],Milligan 2009
At the time being ,[object Object],[object Object],[object Object]

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orofacial pain