W11: Analgesia and Anaesthesia Flashcards
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
An unpleasant sensory and emotional experience associated with or resempling that associated with, actual or potential tissue damage
Explain the biopsycho social model of pain
What influences pain…
Why do we need to manage it in dentistry?
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
Amount of stimulus to provoke pain is the same for everyone, but the response depends on…?
- 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
How can you measure Pain?
Describe the catagories for the types of Pain ie. classification of orofacial pain
TEST
List and describe the 3 types of pain
N’s…
TEST
Compare the three types of pain, specifically referring to origin of stimulus, localisation to site of stimulus, description and examples of each
Examples:
* Nociceptive- Periapical abscess & Dentine sensitivity
* Neuropathic- Trigeminal neuralgia & Phantom limb pain
* Nociplastic- Irritable Bowel syndrome & Low back pain
Describe the link between the physiology of pain and analgesics to manage the pain
- 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
List some pain management strategies
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
Describe the three key stimulators of Nociceptors
Describe Sensitization briefly (include 2 causes)
Causes:
* Peripheral (mediators such as prostaglandins and bradykinin)
* Central (progressively increasing amplitude of synaptic potentials – known as “wind-up”)
Compare the two types of altered sensitivity
- Hyperalgesia - ↑pain with mild stimulus
- Allodynia – pain with non-noxious stimulus
Compare Anaesthesia and Analgesia
List and describe three inflammatory mediators that contribute to pain
Describe where some typical analgesics (lidocaine, capsacin, NSAIDS, Opiods, Tricyclic antidepressents, SNRI’s, gabapentin, NMDA blockers) act.
Give examples of, and describe how non-steroidal anti-inflammatories, Opioid analgesics and Aniline analgesic work.
TEST
Describe the MOA and uses of NSAIDS
TEST
- 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
Describe the MOA and uses of Paracetamol
TEST
- 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)
List some potential problems with oral analgesics such as NSAID’s and paracetamol
Describe the MOA and uses of Opiods
List the potential problems with Opiods
List the symptoms, cause and treatment for Trigeminal neuralgia
Describe where each drug sits on the WHO three step ladder for pain relief
List some influences on pain
List some factors that could affect/influence Local Anaesthetic duration/effectiveness
List the techniques for improving LA acceptability
