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FreakinLOCALanesthesia!!! > Day 2-PAIN and PAIN control > Flashcards

Day 2-PAIN and PAIN control Flashcards

1
Q

Pain perception and pain reaction to perception of pain are not necessarily proportional to􏰀 _______ of physical injury 􏰀 ______ of harm

A

Intensity… Degree

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2
Q

Pain: An unpleasant sensory and emotional

experience associated with actual or _______ tissue damage, or described in terms of such damage

A

POTENTIAL!!!

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3
Q

Pain: An unpleasant sensation created by a _______ stimulus that is mediated along certain nerve pathways to the CNS where it is interpreted as such”

A

noxious

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4
Q

Are pain threshold and tolerance synonymous?

A

NO

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5
Q

What is the POINT at which a stimulus FIRST produces pain sensation?

A

Threshold

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6
Q

Is someones pain threshold acquired or innate?

A

INNATE

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7
Q

Does someone’s threshold change or have little variance over time?

A

Has LITTLE variance over time

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8
Q

___________: an individual’s reaction to painful stimuli

A

Tolerance

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9
Q

________: the amount of pain someone is WILLING/ABLE to endure.

A

Tolerance

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10
Q

Does tolerance in a person stay pretty constant or vary with time?

A

varies significantly

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11
Q

What are three ways a clinician can manage Tolerance?

A

1.Behavior modification 2. Distraction 3.Meds!

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12
Q

What are three classes of meds a dentist can do to help keep a patient’s tolerance at a maximum?

A

1.Anti-anxiety (benzo’s) 2.Local Anesthetics 3.Anti-inflammatory meds (NSAIDS, aspirin)

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13
Q

What is the dual nature of pain?

A

1.Pain Perception and 2.Pain reaction

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14
Q

_________ The physiologic and anatomic process by which pain is received and transmitted

A

Pain reaction

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15
Q

_______ The actual process by which the body perceives pain

A

Pain reaction

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16
Q

________ : The manifestation of the perception of pain

A

Pain PERCEPTION

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17
Q

What are 3 physiological factors involved in pain PERCEPTION?

A
  1. previous experience 2.emotional state 3. sex
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18
Q

Can pain perception be quantified?

A

NO

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19
Q

Is pain perception objective or subjective? How is it rated?

A

Subjective…on rating scales (1-10…etc)

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20
Q

What are the three things we need to consider when getting a pain perception rating scale?

A

Age, literacy, previous experiences

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21
Q

What is the name of the FACES pain perception rating scale?

A

Wong-Baker

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22
Q

What type of pain is less than 6 months and is caused by tissue damage from injury or disease?

A

ACUTE pain

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23
Q

In acute pain the patient ______ to get better and adopts ______ to ease or eliminate pain

A

expects….behaviors

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24
Q

For acute pain the hope is that the patient has a strong ________ to seek treatment!

A

motivation!

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25
Q

What is pain for longer than 6 months?

A

chronic pain

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26
Q

What is the biggest fear for a patient with chronic pain?

A

lose hope of getting better and becoming DEPRESSED

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27
Q

Why do so many people equate dental treatment with pain? (4)

A

1.past experience 2.toothache 3.anxiety/fear 4.oral environment is very innervated

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28
Q

What is the ability of a stimulus to be detected by a specific receptor?

A

Sensory modality

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29
Q

Sensory modalities is a ______ specific theory

A

receptor

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30
Q

What is the key for sensory modalities like thermoreceptors, mechanoreceptors, and chemoreceptors?

A

they ADAPT with stimulation (you block things out that are not important)

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31
Q

What are the receptors that detect injury?

A

NO-CI-ceptors

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32
Q

What is the term for when nociceptors respond to all types of injury?

A

polymodal

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33
Q

What is a key aspect of nociceptors, but probably gives us trouble…?

A

Nociceptors NEVER ADAPT to stimulus…hence chronic pain. FML.

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34
Q

What is the physiological reaction to pain stimulus?

A

PROTECTIVE (rapid, reflexive, subconscious)

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35
Q

Which pain reflex never reaches the higher processing centers?

A

withdrawal reflex

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36
Q

Protective response is also linked to _______

A

behavior

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37
Q

What are the 4 type ‘A’ fibers involved in the transmission of pain? What are three characteristics of them?

A

Alpha, beta, gamma, delta….myelinated,large, and fast

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38
Q

What are three characteristics of ‘B’ type fibers in the transmission of a pain signal?

A

myelinated, medium, and slow

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39
Q

What are three characteristics of ‘C’ type fibers in the transmission of pain?

A

unmyelinated, small, and very slow (like walking speed)

40
Q

What is the theory of distracting the site of pain with massaging or rubbing to have faster fibers block the pain sensation?

A

gate theory

41
Q

The __________ of the spinal cord modulates (gate control) the synaptic transmission of nerve impulses from ________ fibers to _______ transmission

A

substantia gelatinosa….peripheral fibers to central transmission

42
Q

Inhibitory effect by the SG in afferent nerve terminals INCREASED with _____ fiber activity ______ the gate!

A

LARGE…closes

43
Q

Inhibitory effect by the SG in afferent nerve terminals DECREASED with ______ fiber activity (C fibers) _____ the gate = perceive pain

A

small…OPENS

44
Q

When do we perceive pain- open gate or closed gate?

A

OPEN gate

45
Q

Types of Nociceptive pain: ______ = arises from superficial structures (skin, muscles)

A

somatic

46
Q

Which type of nociceptive pain is caused by trauma and is sharp, aching, and throbbing?

A

SOMATIC

47
Q

Types of Nociceptive Pain: ______ = gut pain

A

visceral

48
Q

Which type of nociceptive pain is caused by compression, expansion, stretching, infiltration and is squeezing or gnawing sensations?

A

visceral

49
Q

Types of Nociceptive Pain: Caused by NERVE injury or dysfunction in CNS or PNS

A

Neuropathic

50
Q

Which type of pain is complex and OFTEN CHRONIC?

A

neuropathic

51
Q

What type of pain is phantom pain?

A

neuropathic

52
Q

What was the name for the neuropathic pain associated with DIABETES again??

A

Peripherally generated polyneuropathy

53
Q

What is the name of a single nerve injury? What are 3 examples?

A

Mono-neuropathy…1.trigeminal neuralgia 2.carpal tunnel syndrome 3.Post-herpetic neuralgia (shingles)

54
Q

In response to pain, CNS simultaneously activates the _________

A

SYMPATHETIC nervous system

55
Q

Pain stimulates the _________ = release of epinephrine and norephinephrine

A

adrenal medulla

56
Q

_________ of pain and perception of pain both stimulate the fight or flight SNS response

A

ANTICIPATION!!!

57
Q

HOLY S! ___% report some level of anxiety related to dental tx!!

A

40%

58
Q

Too bad….___% avoid dentistry c/o fear of INJECTIONS

A

5%

59
Q

Pain control needs to address these three areas:

A

pain reaction….pain perception…individual needs

60
Q

Pain control can be achieved by _______ the cause

A

Removing

61
Q

Pain control can be achieved by _______ the pain pathway

A

blocking

62
Q

Pain control can be achieved by Raising the pain ______

A

threshold

63
Q

Pain control can be achieved by ______ somatic methods

A

Psycho

64
Q

Pain control can be achieved by _______ the pain reaction (General Anesthesia)

A

PREVENT

65
Q

Pain Control Modalities: Establish ______

A

rapport

66
Q

Pain Control Modalities: try this wacky alternative!!

A

hypnosis…the shit works!

67
Q

Pain Control Modalities: these common dental clinic methods ______ and ______

A

LA and N2O

68
Q

Pain Control Modalities: Analgesics, oral ______, intramuscular ______, intravenous _______, general anesthesia, combos

A

sedation,sedation,sedation

69
Q

addressing pain typically involves good interpretation of __________ of each patient

A

individualization

70
Q

Dental Pain Control: Establishing a ______ with patients is critical to your success in treating them

A

rapport

71
Q

Dental Pain Control: It is vital to have _______ and understanding

A

COMPASSION

72
Q

Dental Pain Control: _______ and assessment of the patient will allow for the development of appropriate treatment strategies to control pain

A

evaluation

73
Q

Pre-op pain: toothache, abscess, trauma are examples of pain ______

A

reaction

74
Q

Pre-op pain: emotional state, age, health, past experience are examples of pain _______

A

perception

75
Q

Post-op pain: the procedure will determine pain ______

A

reaction

76
Q

post-op pain: pain ______ should be addressed PRE-op!

A

perception

77
Q

Preoperative Assessment What is the pain mechanism? 􏰀 preexisting condition - abscess 􏰀 psychological - phobia, age
􏰀 procedure - invasive surgery…devise a _______!!!

A

STRATEGY!!!

78
Q

Pre-op pain- consider rapport
􏰀 distraction- TV, music, etc. 􏰀 suggestion
􏰀 hypnosis…these are all examples of ______ techniques

A

psychosomatic techniques

79
Q

What are the four terms of the PREP acronym?

A

Prepare, Reherse, Empower, and Praise

80
Q

PREP: _______ by utilizing relaxation techniques 􏰀 Focused breathing, distraction (music,
visualization), muscle relaxation

A

PREPARE

81
Q

PREP: _______ procedures allowing patients to practice control and self-calming techniques

A

REHEARSE

82
Q

PREP: _______ patients with strategies that give them CONTROL during procedures… Raise hand to ask clinician to stop

A

EMPOWER

83
Q

PREP: ______ patients for using specific coping

techniques that are helpful to them

A

PRAISE

84
Q

What are the 3 pre-op medical weapons we have to address both pain reaction and pain perception?

A

Local Anesthesia (PR)…Sedation modalities (PP) (PO,IM,IV,GA)….Analgesics (PR/PP)

85
Q

A special consideration for pre-op pain control…________!! indicated for infection only and NO analgesic properties

A

Antibiotics!!!

86
Q

Post-op pain control: LA 1.length of procedure (3 LA’s) 2.Post-op pain control (1 LA)

A

length: mepivacaine, lidocaine, articaine…..post of pain control bupivacaine

87
Q

Post-op pain: _______ analgesia BEFORE the pain is present, maintain blood level for ___ hours after procedure

A

preemptive…48 hrs

88
Q

That dose, above which, there is no further: _______

A

ceiling dose (in mg)

89
Q

The degree of analgesia achieved at the ceiling analgesic dose: _______

A

ceiling analgesic EFFECT (subjective)

90
Q

What are the 4 NON-opioid drugs and their ceiling doses (mg)????

A

1.acetaminophen 1000mg 2.aspirin 1000mg 3.ibuprofen 400mg 4.ketoprofen 50mg

91
Q

What are the 3 opioid (narcotic) drugs and their ceiling doses?

A

1.codeine 60mg 2.hydrocodone 10mg 3.oxycodone 10mg

92
Q

Ceiling analgesic effect: mild to moderate..what drug(s)?!?!

A

Aspirin or Acetaminophen

93
Q

Ceiling analgesic effect: moderate…what drug(s)?!?!?

A

ibuprofen/codeine

94
Q

Ceiling analgesic effect: moderate to severe…what drug(s)?!?!?

A

ketoprofen/hydrocodone

95
Q

Ceiling analgesic effect: SEVERE…what drug(s)?!?!?

A

oxycodone

96
Q

What is the drug we prescribe that has codeine and tylenol? how much of each?

A

WOOOO PHARM 1!!!!! Most widely prescribed codeine product by dentists is TYLENOL #3!!!! (acetaminophen 300mg, codeine 30mg) (not even getting close to ceiling for either of these!)

FreakinLOCALanesthesia!!! (11 decks)

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