W11: Analgesia and Anaesthesia Flashcards

1
Q

Pain serves as a protective funciton and yeilds a learning oppitunity (conditioning).
Provide the definition of pain according to the International Association for the Study of Pain

A

An unpleasant sensory and emotional experience associated with or resempling that associated with, actual or potential tissue damage

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2
Q

Explain the biopsycho social model of pain

A

What influences pain…

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3
Q

Why do we need to manage it in dentistry?

A

The only surgery mainly undertaken on Conscious patients
* Makes treatment possible
* Reduces stress for patient and staff
* Prevents development of dental anxiety (and missed appointments), thus promoting regular preventative attendance.
* Practice-builder
* Early management prevents hyperalgesia during recovery

Failure to control pain is currently the most common cause for litigation

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4
Q

Amount of stimulus to provoke pain is the same for everyone, but the response depends on…?

A
  • Culture
  • Personal history
  • Sleep
  • Personality
  • Emotions e.g anxiety may reduce tolerance or increase pain ex. battle
  • Cognition: Voluntary control is possible, Knowledge about what to expect, Relaxation techniques
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5
Q

How can you measure Pain?

A
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6
Q

Describe the catagories for the types of Pain ie. classification of orofacial pain

TEST

A
Dental pain tends to be inflammatory in nature and acute Chronic = neurological (transmission/nerve affected) or sensitisation (change within brain)
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7
Q
A
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8
Q

List and describe the 3 types of pain

N’s…

TEST

A
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9
Q

Compare the three types of pain, specifically referring to origin of stimulus, localisation to site of stimulus, description and examples of each

A

Examples:
* Nociceptive- Periapical abscess & Dentine sensitivity
* Neuropathic- Trigeminal neuralgia & Phantom limb pain
* Nociplastic- Irritable Bowel syndrome & Low back pain

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10
Q

Describe the link between the physiology of pain and analgesics to manage the pain

A
  • Sensory function - Nerve selectively detects the relevant stimulus (i.e. nociceptors are stimulated by anything that might cause damage… Stimulus needs to be intense enough to potentially cause tissue damage - so normally high threshold)
  • BUT sensitivity/selectivity can be influences (e.g. with inflammation or mood ect.)
  • The brain interprets the nociceptive signal as pain
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11
Q

List some pain management strategies

A

A continuum from purely psychological to purely pharmacological (usually a combination)
* Explaining honestly and preparing the patient for what might happen – reduces anxiety
* Empathy
* Distraction - music, chatting, D.A ect.
* Hypnosis
* Acupuncture
* Cognitive Behavioural techniques (by psycologist)
* Biofeedback (e.g. progressive muscle relaxation)
* Effective LA
* Sedation
* GA
* Effective analgesics perioperatively with clear (written) advice
* Availability for patient contact

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12
Q

Describe the three key stimulators of Nociceptors

A
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13
Q

Describe Sensitization briefly (include 2 causes)

A

Causes:
* Peripheral (mediators such as prostaglandins and bradykinin)
* Central (progressively increasing amplitude of synaptic potentials – known as “wind-up”)

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14
Q

Compare the two types of altered sensitivity

A
  • Hyperalgesia - ↑pain with mild stimulus
  • Allodynia – pain with non-noxious stimulus
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15
Q

Compare Anaesthesia and Analgesia

A
Analgesia can be Pre- Peri- or Post- & is often associated with Inflammation- so we need to know about inflammation, its role and how we can target it to manage pain
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16
Q

List and describe three inflammatory mediators that contribute to pain

A
17
Q

Describe where some typical analgesics (lidocaine, capsacin, NSAIDS, Opiods, Tricyclic antidepressents, SNRI’s, gabapentin, NMDA blockers) act.

A
18
Q

Give examples of, and describe how non-steroidal anti-inflammatories, Opioid analgesics and Aniline analgesic work.

TEST

A
Avoid opioid analgesics - rarely effective for inflammatory pain (besides 3rd molar surgery).
19
Q

Describe the MOA and uses of NSAIDS

TEST

A
  • Reduction of prostaglandin synthesis with significant duration of action.
  • Most widely used for dental pain (e.g. Ibuprofen) and more effective that paracetamol or opioids, due to predominant role of inflammation in dental pain
  • Analgesic effects are limited and are less effective in severe or chronic pain
20
Q

Describe the MOA and uses of Paracetamol

TEST

A
  • Useful for mild to moderate pain where inflammation is not primary cause.
  • Mechanism complex and not fully understood but CNS effect (believed that a metabolite acts on receptors in the brain and alsoterminals of C-fibres in the spinal dorsal horn, which modulates nociceptive transmission)
  • Weak inhibitor of prostaglandins - mild anti-inflam
  • Antipyretic (similar efficacy to Ibuprofen)
  • Better tolerated than NSAIDs, so safer alternative for a mild analgesic)
21
Q

List some potential problems with oral analgesics such as NSAID’s and paracetamol

A
22
Q

Describe the MOA and uses of Opiods

A
23
Q

List the potential problems with Opiods

A
24
Q

List the symptoms, cause and treatment for Trigeminal neuralgia

A
25
Q

Describe where each drug sits on the WHO three step ladder for pain relief

A
26
Q

List some influences on pain

A
27
Q

List some factors that could affect/influence Local Anaesthetic duration/effectiveness

A
28
Q

List the techniques for improving LA acceptability

A
29
Q
A