References

International Association for the Study of Pain [IASP] 1994. https://www.iasp-pain.org/
Woolf CJ. What is this thing called pain?. J Clin Invest. 2010; 120:3742-3744
Carr DB, Goudas LC. Acute pain. Lancet. 1999; 353:2051-2058
Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am. 2005; 23:21-36
Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. Pain Manag Nurs. 2008; 9:11-21
Kalenderian E, Obadan-Udoh E, Maramaldi P, Etolue J, Yansane A, Stewart D, White J, Vaderhobli R, Kent K, Hebballi NB, Delattre V, Kahn M, Tokede O, Ramoni RB, Walji MF. Classifying adverse events in the dental office. J Patient Saf. 2017; https://doi.org/10.1097/PTS.0000000000000407
Maramaldi P, Walji MF, White J, Etolue J, Kahn M, Vaderhobli R, Kwatra J, Delattre VF, Hebballi NB, Stewart D, Kent K, Yansane A, Ramoni RB, Kalenderian E. How dental team members describe adverse events. J Am Dent Assoc. 2016; 147:803-811 https://doi.org/10.1016/j.adaj.2016.04.015
Hiivala N, Mussalo-Rauhamaa H, Tefke HL, Murtomaa H. An analysis of dental patient safety incidents in a patient complaint and healthcare supervisory database in Finland. Acta Odontol Scand. 2016; 74:81-89 https://doi.org/10.3109/00016357.2015.1042040
Hiivala N, Mussalo-Rauhamaa H, Murtomaa H. Can patients detect hazardous dental practice? A patient complaint study. Int J Health Care Qual Assur. 2015; 28:274-287
Gupta A, Daigle S, Mojica J, Hurley RW. Patient perception of pain care in hospitals in the United States. J Pain Res. 2009; 2:157-164
Maggirias J, Locker D. Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol. 2002; 30:151-159
Adult Dental Health Survey. 2009;
American Society of Anesthesiologists. 2004;
Renton T. Challenges of exodontia in an ageing patient. Fac Dent J. 2011; 2:110-117
Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc. 1993; 134:115-121
Locker D, Grushka M. The impact of dental and facial pain. J Dent Res. 1987; 66:1414-1417
Tracey I. Getting the pain you expect: Mechanisms of placebo, nocebo and reapprasial effects in humans. Nat Med. 2010; 16:1277-1283
Foreman PA. Practical patient management: the integrated approach. Anesth Prog. 1988; 35:19-25
Louw A The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011; 92:2041-2056
Sullivan MJ Catastrophizing and perceived injustice: risk factors for the transition to chronicity after whiplash injury. Spine (Phila Pa 1976). 2011; 36:(25 Suppl)S244-249
Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother. 2009; 9:745-758
Powers A, Fani N, Pallos A, Stevens J, Ressler KF, Bradley B. Childhood abuse and the experience of pain in adulthood: the mediating effects of PTSD and emotion dysregulation on pain levels and pain-related functional impairment. Psychosomatics. 2014; 55:491-499
Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, Koeppe RA, Stohler CS, Goldman D. COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor. Science. 2003; 299:1240-1243
Diatchenko L, Slade GD, Nackley AG, Bhalang K, Sigurdsson A, Belfer I, Goldman D, Xu K, Shabalina SA, Shagin D, Max MB, Makarov SS, Maixner W. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet. 2005; 14:135-143
Mogil JS, Ritchie J, Smith SB, Strasburg K, Kaplan L, Wallace MR, Romberg RR, Bijl H, Sarton EY, Fillingim RB, Dahan A. Melanocortin-1 receptor gene variants affect pain and m-opioid analgesia in mice and humans. J Med Genet. 2005; 42:583-587
Fotedar S, Bhardwaj V, Fotedar V. Dental anxiety levels and factors associated with it among patients attending a dental teaching institute in Himachal Pradesh. SRM J Res Dent Sci. 2016; 7:153-157
Humphris GM, King K. The prevalence of dental anxiety across previous distressing experiences. J Anxiety Disord. 2011; 25:232-236 https://doi.org/10.1016/j.janxdis.2010.09.007
Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993; 31:659-666
Vickers A Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach. Curr Med Res Opin. 2009; 25:2557-2569
Petrie KJ Effect of providing information about normal test results on patients' reassurance: randomised controlled trial. Br Med J. 2007; 334:(7589)
Louw A The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011; 92:2041-2058
Stewart M. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. 1995; 152:1423-1433
Suhonen R, Leino-Kilpi H, Välimäki M. Development and psychometric properties of the Individualized Care Scale. J Eval Clin Pract. 2005; 11:7-20
Oates A, Benedict KA, Sun K, Brakeman PR, Lim J, Kim C. Laser acupuncture reduces pain in pediatric kidney biopsies: a randomized controlled trial. Pain. 2017; 158:103-109
Bauer B Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study. Altern Ther Health Med. 2011; 17:16-23
Jason T, Buhle JT, Bradford L, Lew MW, Kravits K, Garberoglio C, Williams AC. Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects. Int J Clin Exp Hypn. 2011; 59:406-423
Friedman JJ, Wager TD. Distraction and placebo: two separate routes to pain control. J Abnorm. 2010; 74:363-371
Jalali S, Moradi Majd NM, Torabi S, Habibi M, Homayouni H, Mohammadi N. The effect of acupuncture on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a triple-blind randomized clinical trial. J Endod. 2015; 41:1397-1402
Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc. 2011; 142:19S-24S
Dionne RA Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen, and acetaminophen plus codeine. J Clin Pharmacol. 1983; 23:37-43
Zacharias M, Hunter KM, Baker AB. Effectiveness of preoperative analgesics on postoperative dental pain: a study. Anesth Prog. 1996; 43:92-96
Bidar M, Mortazavi S, Forghani M, Akhlaghi S. Comparison of effect of oral premedication with ibuprofen or dexamethasone on anesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, randomized, controlled, double-blind study. Bull Tokyo Dent Coll. 2017; 58:231-236 https://doi.org/10.2209/tdcpublication.2016-0050
Bauer HC, Duarte FL, Horliana AC, Tortamano IP, Perez FE, Simone JL, Jorge WA. Assessment of preemptive analgesia with ibuprofen coadministered or not with dexamethasone in third molar surgery: a randomized double-blind controlled clinical trial. Oral Maxillofac Surg. 2013; 17:165-71 https://doi.org/10.1007/s10006-012-0360-7
Leong SL, Coulthard P. Pain after surgery: can protective analgesia reduce pain? A clinical randomised study. Int J Surg. 2010; 8:283-289
Hawamdeh S, Awad M. Dental anxiety: prevalence and associated factors. Eur J Gen Dent. 2013; 3:270-273
Coulthard P, Bridgman CM, Gough L, Longman L, Pretty IA, Jenner T. Estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) – a novel assessment tool. Br Dent J. 2011; 211
Pretty IA, Goodwin M, Coulthard P, Bridgman CM, Gough L, Jenner T, Sharif MO. Estimating the need for dental sedation. 2. Using IOSN as a health needs assessment tool. Br Dent J. 2011; 211
Humphris G, Crawford JR, Hill K, Gilbert A, Freeman R. UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results. BMC Oral Health. 2013; 13
Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993; 31:659-666
Naik PN, Kiran RA, Yalamanchal S, Kumar VA, Goli S, Vashist N. Acupuncture: an alternative therapy in dentistry and its possible applications. Med Acupunct. 2014; 26:308-314 https://doi.org/10.1089/acu.2014.1028
Bauer B Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study. Altern Ther Health Med. 2011; 17:16-23
Vassend O. Anxiety, pain and discomfort associated with dental treatment. Behav Res Ther. 1993; 31:659-666
Oosterink FMD, de Jongh A, Hoogstraten J. Prevalence of dental fear and phobia relative to other fear and phobia subtypes. Eur J Oral Sci. 2009; 117:135-143
Muschik S, Kallow J. The impact of dental phobia on patient consent. Br Dent J. 2015; 219:183-185 https://doi.org/10.1038/sj.bdj.2015.648
Malamed SF. Is the mandibular nerve block passé?. J Am Dent Assoc. 2011; 142:3S-7S
Bucknall T, Manias E, Botti M. Nurses' reassessment of postoperative pain after analgesic administration. Clin J Pain. 2007; 23:1-7
Skoglund LA. Good evidence for effectiveness of analgesics most commonly prescribed by UK dentists. What is the relative efficacy of single-dose oral analgesics after third molar extraction?. Evid Based Dent. 2005; 6
Oxford League Table of Analgesia. 2007;
Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013; 144:898-908
Simpson M Effect of combination of preoperative ibuprofen/acetaminophen on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod. 2011; 37:593-597
Ong CK Combining paracetamol (acetaminophen) with nonsteroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010; 110:1170-1179
Hargreaves KM, Goodis HE, Tay FR. Seltzer and Bender's Dental Pulp, 2nd edn. London: Quintessence Books; 2012
Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008; (4)
Derry S, Moore RA, McQuay HJ. Single dose oral codeine, as a single agent, for acute postoperative pain in adults. Cochrane Database Syst Rev. 2010; (4)
Seymour RA, Hawkesford JE, Sykes J, Stillings M, Hill CM. An investigation into the comparative efficacy of soluble aspirin and solid paracetamol in postoperative pain after third molar surgery. Br Dent J. 2003; 194:153-157
Derry S, Wiffen PJ, Moore RA. Relative efficacy of oral analgesics after third molar extraction – a 2011 update. Br Dent J. 2011; 211:419-420
Moore RA, Straube S, Paine J, Derry S, McQuay HJ. Minimum efficacy criteria for comparisons between treatments using individual patient meta-analysis of acute pain trials: examples of etoricoxib, paracetamol, ibuprofen, and ibuprofen/paracetamol combinations after third molar extraction. Pain. 2011; 152:982-989
Averbuch M, Katzper M. Severity of baseline pain and degree of analgesia in the third molar post-extraction dental pain model. Anesth Analg. 2003; 97:163-167
Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2013; (12)
Crawford FI, Armstrong D, Boardman C, Coulthard P. Reducing postoperative pain by changing the process. Br J Oral Maxillofac Surg. 2011; 49:459-463
Gordon DB, de Leon-Casasola OA, Wu CL, Sluka KA, Brennan TJ, Chou R. Research gaps in practice guidelines for acute postoperative pain management in adults: findings from a review of the evidence for an American Pain Society Clinical Practice Guideline. J Pain. 2016; 17:158-166
Briggs E, Battellie D, Gordon D, Kopf A, Riberio S, Puig MM, Kress HG. Current pain education within undergraduate medical studies across Europe: advancing the provision of pain education and learning (APPEAL) study. Access BMJ. 2015; 5
Watt-Watson J An integrated undergraduate pain curriculum, based on IASP curricula for six Health Science Faculties. Pain. 2004; 110:140-148
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17:131-157

Prevention and Optimal Management of Peri-Surgical Pain in Dentistry

From Volume 45, Issue 10, November 2018 | Pages 935-946

Authors

Tara Renton

BDS, MDSc, PhD

Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London

Articles by Tara Renton

Abstract

It is every patient's right to expect optimal pain management in relation to routine elective surgery. Dentistry is a profession predicated upon causing and/or managing pain in patients. Poorly managed pain, or severe pain, peri-operatively, is the predominant cause of complaints in NHS dentistry, often leading to legal or GDC scrutiny. Whether the unexpected or persistent pain initiates the patient's suspicions about possible sub-optimal treatment, which then precipitates a complaint, is a possible hypothesis. For now, however, focusing on managing the patient holistically using up-to-date pain management should be a priority for all dental teams. Recent evidence highlights the risks of opiate and opioid dependence and mortality. In addition, the minimal benefit these medications provide for peri-operative pain management compared with other over-the-counter (OTC) analgesics is recognized. Competent patient management, optimal local anaesthetic techniques and intelligent prescription of non-steroidal anti-inflammatories and paracetamol are the mainstay for odontogenic and surgical pain management.

CPD/Clinical Relevance: It is imperative that dental teams are familiar with current optimal peri-surgical pain management to optimize the patient's experience and minimize complaint.

Article

The definition of pain is that it is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (International Association for the Study of Pain, IASP).1 Please dwell on this definition, it proposes that pain can potentially occur with no physical damage (for example, have any of you been dumped by text?) or at the prospect of impending pain (for example a forthcoming visit to the dentist). Your brain is the ‘boss’ of pain, as without a brain you won't feel pain! Your little finger or tooth doesn't feel the pain, it's the brain's somatosensory cortex that overlays the pain experience on the digit or tooth that is in danger, to effect appropriate protective behaviours (including removing your digit from harm or escaping the dental chair!). The brain tells whatever part of your body that's getting hurt to move away from the cause. When this system is disconnected, that is when healthy healed tissue continues to ‘feel‘ pain, which is due to the brain continuing to overlay the pain to the healthy tissues. This is the cause of chronic or pathological (also suspected to be due to central sensitization) pain.

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