List 3 possible aetiologies associated with trigeminal neuropathic pain
Post dental/ surgical trauma (Post traumatic trigeminal neuropathy)
third molar surgery , dental implants, local anesthetic injections
Post-macrotrauma
road traffic accident/blunt facial truams
Painful trigeminal neuropathy attributed to acute herpes zoster
Describe the key clinical features that distinguish trigeminal neuropathic pain from other orofacial pain conditions
Anatomically confined and unilateral
maps to the dermatome of the affected nerve
rarely crosses the midline though it may diffuse over time
Peristence of pain beyond the expected healing period (> 3 months post procedure)
Mixed positive and negative sensory signs
Positive: allodynia , hyperalgesia, paraestheis
negative : hypoesetheis/ numpness or hyopalgesia
Describe the diagnostic approach and investigations required
Detailed pain history — onset/timeline relative to the procedure, character/quality, severity (NRS 0–10), distribution, and aggravating/relieving factors.
Comprehensive intraoral examination — inspect the extraction socket for infection/dry socket/healing complications and assess adjacent teeth and soft tissues.
Cranial nerve sensory examination — bedside testing of the IAN and lingual nerve territories using light touch, pin-prick, and two-point discrimination.
3 pharmacological managements
Tricyclic antidepressants like amitriptyline, nortriptyline
Gabapentinoids
gabapentin, pregabalin
Anticonvulsants like carbamazepine
Identify 3 psychosocial factors relevant to the management of this patient
Depression/ low mode
Pain catastrophising (thiking of the worst-case scenario)
Reduced quality of life and coping efficacy
List 3 non-pharmacological strategies that may be used in the management of trigeminal neuropathic pain
Patient education and reassurance
explain the neuropathic mechnism and set realistic expectatoins (a 50% pain reduction is a success; 100% cure is rare )
Cognitive behavioural therapy and pain neuroscience eduction