Analgesic agents Flashcards
What would be the appropriate treatment of dental pain?
What is pain? Can pain always be cured? If not, what % of people in the UK suffer from persistent pain?
An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of tissue damage or both (IASP definition).
Inadequate pain relief is a global concern for patients and practitioners. Pain is not always cured and requires continuous medical management, the same as any other disease process.
About 40%, or as many as 28 million people, in the UK suffer from persistent pain.
What is congenital insensitivity to pain? Why is it dangerous?
Can’t feel pain - on the pic the fingers are completely burnt as the pt couldnt feel pain so didnt retract the hand fast enough.
Congenital insensitivity to pain is caused by SCN9A gene mutation in humans.
Children with this condition don’t survive very long.
What are the 2 main sources of pain?
INJURY - via sport, surgery damage, etc
DISEASE - migraine, osteomalacia, psoriasis
How do we feel pain?
Receptors in our nerve endings are activated in response to certain stimuli. They activate a cascade of different signals along sensory fibres.
They send the info to higher regions of the brain like the thalamus / cortex.
What are some factors that can modulate pain?
Emotion and attention profoundly modulate nociception.
The amount of pain experienced does not necessarily relate to the severity of tissue damage
Anxiety increases pain transmission
Complex cultural and contextual influences
What can we generally use to relieve pain? When is this not always effective?
In normal circumstances we have an injury that produces pain.
Can generally use NSAIDs / opioids.
But in chronic pain patients, we dont have the perfect analgesic treatment. Some NSAIDs/opioids are not always enough to relieve the pain.
What different types of dental pain can we have?
infection - acute inflammation
exposed nerve endings = neurogenic pain
swelling in confined space = pressure effects
fear and anxiety
What are the different ways in which we can treat pain involving:
nerve block?
spinal cord?
CNS?
Nerve block - local anaesthetics
Spinal cord - opioids
CNS - opioids / psychological factors
How can we reduce tissue damage and therefore pain?
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Steroids
- Cooling
What are the WHO 1996 pain relief guidelines for managing a patient presenting with pain?
- Believe the patient
- History of symptoms
- Assessment of severity
- Physical examination
- Appropriate pain management
What is the WHO analgesic ladder from step 1 (mild pain) to step 3 (severe pain)?
step 1 = MILD pain
- non-opioids (e.g. paracetamol)
- +/- NSAIDs
step 2 = MODERATE pain
- weak opioid (e.g. tramadol, dihydrocodeine)
- +/- non-opioid (e.g. paracetamol and/or NSAID)
step 3 = SEVERE pain
- strong opioid (e.g. morphine, diamorphine, fentanyl patch)
- +/- non-opioid (e.g. paracetamol and/or NSAID)
What are the co-analgesics that could be involved in the WHO analgesic ladder?
other drugs, nerve blocks, surgery, radiotherapy, complementary therapies, addressing psychosocial issues
What are some analgesic ladder ASSUMPTIONS?
Synergism
Overall philosophy assessing severity, starting at lowest level and increasing if necessary
Joint Royal Colleges Report (1988) quality of analgesia in hospital practice is inadequate
What is a placebo and what is the placebo effect?
A placebo is anything administered which is pharmacologically and physiologically inert
Placebo is not ineffective therapeutically. Can have a measurable effect
Reassurance and confidence in one’s therapy may also have an effect.
