Introduction To Pain Management PDF

Introduction to Pain Management Intended Learning Outcomes By the end of the session students should be able to:  Define pain as per the International Association for the Study of Pain  Define the terms pain reaction, pain threshold and pain tolerance  Describe the factors that affect pa...

Introduction to Pain Management Intended Learning Outcomes By the end of the session students should be able to:  Define pain as per the International Association for the Study of Pain  Define the terms pain reaction, pain threshold and pain tolerance  Describe the factors that affect pain threshold  Explain the links between anxiety and pain and management techniques associate to support patients  Describe when we need to consider pain management in dentistry and the consequences of poor pain control  Explain methods of pain control in dentistry 2 GDC Learning Outcomes 1.2.6 Assess patients’ levels of anxiety, experience and expectations in respect of dental care 1.7.4 Manage patient anxiety and pain through effective communication, reassurance and relevant behavioural techniques 1.7.5 Manage patient pain through the appropriate use of analgesia 3 History of pain Plato said pain and pleasure arose from the Latin word ‘poena’ body thinking pain is an Meaning ‘punishment emotional experience from god’ more than a localised body disturbance Artistole said pain ‘is passion of the soul’ 4 What is pain?  For the first time since 1979, IASP introduced a revised definition of pain, the result of a two-year process that the association hopes will lead to revised ways of assessing pain. 5 IASP – July 2020 Definition of Pain ‘An unpleasant sensory and It is further expanded upon emotional experience by the addition of six key associated with, or notes and the etymology of resembling that associated the word pain for further with, actual or potential valuable context tissue damage,” 6 Further key notes of defining pain Pain & Pain is a learnt Personal nociception are concept through experience different life experience phenomena Can have adverse Verbal is only Patient reporting impact on one way of of pain should function and communicating respected well-being pain 7 8  Revise nervous system  Links to local anaesthetic lectures 9 Reactions to pain, pain threshold and pain tolerance Reaction to pain Pain threshold  Minimum point at which something,  The body responds to pain through such as pressure or heat, causes you numerous and interconnected pain. physiological processes via the sympathetic nervous system (SNS), neuro-endocrine system and immune system, but also via emotions. Pain Tolerance  Maximum level of pain that a person is able to tolerate. 10 Factors affecting pain threshold Psychological Age make up Fear and Fatigue apprehension 11 Relationship between anxiety and pain  Patient anxiety can have impact on pain perception  We need to consider holistic are – dealing with anxiety as well as pain management  Is anxiety to be expected in the dental surgery? Why?  What will be your first steps to manage this? 12 Management of anxiety linked to pain management  Chairside manner is one key element in keeping the patient calm during any dental procedure  Have a calm and confident chairside manner  Inform patient about what to expect with dental treatment  Reassure that some anxiety is normal  Tell patient to signal you when experiencing discomfort  Evaluate patient’s emotional status prior to procedure  Help patient reduce tissue inflammation with improved self-care  Use precise and gentle tissue manipulation 13 Strategies that can be used to allay fear of pain Deal with pain before you Evaluate commence patient before and avoid treatment midway Select Good tissue appropriate manipulation instruments Monitor the patient 14  When do we need to consider pain management in dentistry? Emergency After During Before Can you give examples of each of these? 15  Methods of pain control in dentistry Anxiety control Local analgesia NSAIDS Conscious sedation Linked to: Behaviour management LA lecture series Pharmacology Year 2 Conscious/unconscious Unconscious sedation *Computer controlled sedation Year 2 LA delivery 16 Technologies designed to reduce pain from dental injections -C-CLAD systems Works with GATE -Jet injectors THEORY Efficacy is mixed 17  Consequences of poor / limited pain management Imagine you are delivering care: 1.) Non-surgical periodontal therapy to pocket of 6mm+. Your patient has declined LA. What challenges can you forsee with this? How would you manage it? 2.) You have delivered LA to your patient (who has angina) for restoration, the patient has advised they have a meeting after the appt so asked you only place a ‘little bit of LA’, you agree. You place rubber dam and start to complete the restoration, as you continue you find the restoration is deeper than you anticipated and the patient starts moan, grips the handle bars of the car and sweat. 18 19 Image references  Is My Physical Pain a Punishment From God For My Past Sins? (brianrushing.net)  https://www.yourdentistryguide.com/dental-anxiety/  https://dentistry.co.uk/2020/01/16/communication-the-patient-and-the-orthodontic- therapist/  https://www.dentalcare.com/en-us/professional-education/ce-courses/ce325/basic-injection- technique  https://marcpro.com/blog/painkiller-harm-good-recovery/  https://parkerwestdental.com/blog/what-to-expect-from-oral-conscious-sedation  https://www.researchgate.net/figure/The-Wand-R-STA-Milestone-Scientific-a-computer- controlled-local-anesthesia-delivery_fig4_323759238  http://www.injex.com.my/dental-anaesthesia.html 20