Intro to Pain Management medium

Introduction to Pain Management

• The presentation covers pain management in dentistry, specifically focusing on pain, anxiety, and management techniques.
• It outlines learning outcomes for students, including defining pain, understanding pain reaction, threshold and tolerance, factors impacting pain, and methods for pain control in dentistry.
• Practical issues and challenges concerning management of patient anxiety and pain are presented.

Intended Learning Outcomes

• Students will define pain per the International Association for the Study of Pain (IASP).
• Students will define pain reaction, pain threshold, and pain tolerance.
• Students will describe factors impacting pain threshold.
• Students will explain the relationship between anxiety and pain, and related management approaches for supporting patients.
• Students will identify when pain management is needed in dentistry and anticipate consequences of poor pain control.
• Students will describe methods of pain control in dentistry.
• Students will apply GDC Learning Outcomes concerning assessing patient anxiety/experience/expectations, managing patient anxiety/pain, and managing patient pain with analgesia.

GDC Learning Outcomes

• Students will assess patient levels of anxiety, experience, and expectations concerning dental care.
• Students will manage patient anxiety and pain using effective communication, reassurance, and relevant techniques.
• Students will manage patient pain using appropriate analgesia techniques.

History of Pain

• The Latin word "poena" means "punishment from god".
• Plato associated pain with a body-based concept.
• Aristotle linked pain to "passion of the soul".

What is Pain?

• The International Association for the Study of Pain (IASP) introduced a revised definition of pain in 1979.
• This involved a two-year process aimed at improving pain assessment methods.

IASP - July 2020 Definition of Pain

• Pain is defined as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage".
• A broader understanding of pain is suggested incorporating psychological and social factors.

Further Key Notes of Defining Pain

• Everyone experiences pain differently.
• Personal experience and various factors can affect pain.
• Patient pain reports should be respected – sensitivities differ.
• Pain and nociception are distinct experiences.
• The impact of pain on daily function, well-being, emotional state, and mental health should be considered.
• Verbal expression isn't the only way patients communicate pain.

Four Decades Later: Revision of the IASP Definition of Pain and Notes

• The 1979 definition of pain focused on unpleasant sensations and emotional experience associated with actual or potential tissue damage.
• The 2020 revised definition broadens the understanding to include sensory, emotional experience and resemblance that is associated with actual or potential tissue damage.
• Key aspects of the 2020 definition noted the importance of patient narrative, biological, psychological, and social factors influencing pain.

Reactions to Pain, Pain Threshold and Pain Tolerance

• Pain response involves the sympathetic nervous system, neuro-endocrine and immune processes, and emotional factors.
• Pain threshold is the minimum stimulus that causes pain.
• Pain tolerance is the maximum level of pain a person can endure.
• Pain reactions can fluctuate hourly, weekly, and monthly according to individual factors.

Factors Affecting Pain Threshold

• Age plays a role in pain tolerance.
• Emotional factors and psychological makeup, such as emotional instability, anxieties, phobias, and coping mechanisms can affect individuals’ pain tolerance.
• Experiences from life, including previous pain experiences, also significantly impact pain threshold.
• Fatigue and increased stress can lead to reduced pain thresholds.

Relationship Between Anxiety and Pain

• Anxiety can impact pain perception.
• Holistic patient care, addressing both anxiety and pain, is crucial.
• Anxiety could be an expected factor in dental settings.

Management of Anxiety Linked to Pain Management

• Appropriate chairside manner, calming procedures, and reassuring the patient about the dental procedure can reduce anxiety.
• The patient should be informed about the procedure.
• Explaining anxiety as a normal response will help the patient.
• Evaluating a patient's emotional state and allowing them to communicate discomfort is crucial.
• Appropriate techniques like precise and gentle tissue manipulation can help reduce pain.

Strategies to Reduce Fear Of Pain

• Creating a calm start to the dental procedure can lessen pain fears.
• Dealing with pain concerns before they intensify is valuable.
• Evaluating the patient and preparing them appropriately for the procedure will reduce anxiety.
• Employing good tissue manipulation techniques effectively.
• Constant monitoring of the patient during treatment is important.

When Do We Need to Consider Pain Management in Dentistry?

• Pain management is necessary before, during, and after a dental procedure.
• Consider local anesthetic procedures, the need for emergency measures, and pain management advice after treatment.

Methods of Pain Control in Dentistry

• Techniques like anxiety control, behavior management, local analgesia (infiltration or inferior dental block), NSAIDs, paracetamol/ibuprofen, checking medical history, conscious sedation (inhalation or drugs), and computer controlled local anesthetic delivery are applied.

Technologies for Reducing Pain from Dental Injections

• Needle-free technologies like C-CLAD systems and jet injectors offer options for dental injections.
• The efficacy of these methods may vary.

Consequences of Poor/Limited Pain Management

• Patients may experience adverse consequences due to limited pain management (e.g., refusal of local anaesthetic, patient discomfort during prolonged procedure).
• Effective communication and strategies are crucial to alleviate and manage pain.

This quiz explores pain management techniques in dentistry, focusing on factors affecting pain perception, reaction, and tolerance. It covers the relationship between anxiety and pain, methods of pain control, and the significance of effective management for patient outcomes. Ideal for dental students looking to enhance their understanding of pain management.