Pain Management

Question 1

What are the three types of pain?

Answer 1

1. Nociceptive
2. Neurogenic/Neuropathic
3. Psychogenic

Question 2

1. What are nociceptors?

2. Describe 2 types found within the dental tissues.

Answer 2

1. Nociceptors - sensory neurones that respond to potentially noxious/damaging stimuli.
2. A-delta fibres (found primarily in periphery of pulp in close association with odontoblasts and extend processes within many dentinal tubules) - myelinated, fast-conducting, responsible for sharp, transient and well-localised pain

C- fibers (found within the centre of the pulp tissue) - unmyelinated, slow-conducting, responsible for prolonged, aching and poorly localised pain

Question 3

What kinds of stimuli can stimulate nociceptors and cause pain?

Answer 3

1. Thermal -hot/cold
2. Mechanical - trauma
3. Chemical - e.g. hydrogen peroxide, phosphoric acid
4. Chemical mediators: Bradykinin, Prostaglandins, Histamine, H+, 5-HT (serotonin), ATP [see DeAngelis lec]

Question 4

Which analgesic medication would you recommend for a pregnant patient in the 1st trimester that has just undergone extraction of a severely broken down tooth?

Answer 4

1st line - Paracetamol - pregnancy category (pc): A
2nd - Paracetamol/Codeine - pc: A
3rd - Ibuprofen/Aspirin (NSAIDs) - pc: C - can be used but only short term (48-72 hours) - avoid using in 1st and 3rd trimester [see: Oral Health Care During Pregnancy: A National Consensus Statement 2012]

Question 5

Describe non-dental, non-pharmacological management of pain.

Answer 5

1. Explain and announce planned actions to patient
2. Demonstrate empathy (show & demonstrate that their comfort is important to you)
3. Distraction techniques
4. Calm environment - avoid unnecessary noise
5. Outwardly calm and confident

The above is effective as it depresses the patient’s pain reaction and raises their pain threshold [DeAngelis lec]