UNDERSTANDING CHRONIC FACIAL PAIN
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UNDERSTANDING CHRONIC FACIAL PAIN
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Purpose; to review the psychological and neurophysiological components of pain so as to provide a background for understanding chronic facial pain. The dynamics of the joint and its inherent instability lead to the subject of temporomandibular dysfunction. Case histories are used to illustrate the application of a relatively new approach to diagnosis, the Research Diagnostic Criteria, from the University of Washington in Seattle.
Duration; Full day course of three sessions including lectures, group work and practical exercises.
Date
; Please leave a contact address at robwilding@eclipse.co.uk and you will be notified of the date for the next course .Seminar Venue
; Dartington Estate, Totnes, Devon.Seminar Fee
. The fee for the day course is £ 150 day course, payable 14 days before the course date. A reduced fee of £ 100 for each course is available for participants registering 30 days before the course dateAccreditation
. Application has been made for PGEA approval .The course will earn participants certification for 6 hours verifiable CPD and 3 hours (preparatory reading) for non-verifiable hours.
PROGRAMME FOR CHRONIC FACIAL PAIN
08.30 Lecture"The puzzle of pain"
The paradox of pain without injury and injury without pain is reviewed. The relationship between psychological factors and chronic pain are discussed.
9.30 Small group discussion Personal experience of pain.This group work helps participants to recognise the influence of factors such as past experience, cultural background, stress, anxiety on pain threshold.
10.00 Lecture - The neurophysiology of pain A brief history of pain theories is given so as to understand the principle of specialisation rather than specificity of receptors and fibre types. Interaction at sensory synapses and the Gate theory are reviewed. The role of higher centres of the brain and the strong influence of the cortex on pain perception helps to understand that all pain is of the body and mind.
11.00 Tea/Coffee
11.30 Lecture - Stress and Pain The role of the hypothalmic-pituitary-adrenal axis on the pain threshold is explained. Anxiety and fear contribute to stress.
12.00 Lecture- The Temporomandibular Joint The evolution of the human joint as a load bearing device to allow high masticatory forces and its robust design is reviewed. The distinction between power muscle and stabilising muscles, as suggested by Barragar and Osborn is presented. The influence of the load position on the joint reaction is explained. The consequences of posterior tooth loss, excessive tension in the lateral pterygoid and muscle spasm are explained The wide distribution of referred pain from muscle trigger points is related to both diagnosis and treatment of chronic face and neck pain of myogenic origin
01.00 Lunch
02.00 Lecture- Introduction to Case Histories Two case histories are introduced
02.15 Small group discussion period- Case Diagnosis The contribution of psycho-social and tissue-damage factors should be discussed in each cases study. The difficulty of determining the exact contribution of each contributory factor should emerge.
03.00 Lecture- Research Diagnositic Criteria The criteria for diagnosis proposed by the group from the university of Washington in Seattle lead by Dworkin will be reviewed. The benefit of quantifying both Axis 1 Factors (signs) and Axis II factors (chronic pain levels, non-specific symptoms and depression) is that it provides insight into appropriate treatment.
03.30 Lecture- An Approach to Management
04.00 Small Group Discussion - What would constitute appropriate management of each case ?
Recommended Course Preparation