The reaction component of pain is the message of pain carried through the nerves to the brain.

The sensory/perception component of pain is the emotional response to the pain.

1. If there is a ________ in pain threshold, you will feel more pain

2. If there is a ________ in pain threshold, you will feel less pain

The processing of pain and the responses to stimuli that are damaging or potentially damaging to normal tissue.

This type of pain arises from an injury to tissue outside of the CNS.

Select the types of nociceptive pain.

This type of pain results from skin and deep tissue: lacerations, torn, and stretched muscles. It is easy to identify, and it feels like a sharp sensation.

This type of pain results from the organs: feels like throbbing, aching, squeezing.

It is difficult to identify, and it may radiate to other areas in the body, making it even harder to pinpoint its exact location. "phantom pain"

Select examples of nociceptive pain we may find with patients in a dental office.

1. Neuropathic pain is caused by damage to the nerve tissues. It originates anywhere in the nervous system PNS or CNS.

2. Neuropathic pain is often chronic, and has complicated pain control compared to nociceptive pain. The cause is also poorly understood.

Select examples of neuropathic pain we may find with patients in a dental office.

1. Prostaglandin Prostacyclin PGI2 1. __________ platelet aggregation and 2. ________ pain and inflammation.

1. Prostaglandin PGE2 _______ gastric mucus and a reduced production of gastric acid.

2. Thromboxane A2 ________ platelet aggregation.

Contributes to the synthesis of prostaglandins that decrease platelet aggregation

Contributes to the synthesis of prostaglandins that increase gastric mucus and decrease gastric acid

Contributes to the synthesis of Thromboxane that increases platelet aggregation

Platelet effects of prostaglandins and Thromboxane balance each other

Contributes to the synthesis of prostaglandins that create pain and inflammation

1. Pain medications work by blocking the production of prostaglandins by blocking the effect of COX enzymes.

2. Some pain meds block both COX 1 and Cox 2, and other pain meds block just COX 2.

1. If Non-Narcotics block all COX enzymes they are termed Selective COX Inhibitors.

2. If Non-Narcotics block just certain one COX enzyme they are termed Nonselective COX Inhibitors.

1. The best COX enzyme to block is ________.

What would be a negative result of blocking COX 1?

1. Aspirin has an enteric coating (buffered tablets) because it allows for it to pass through the acidic stomach into the small intestine before fully dissolving.

2. The goal of the enteric coating is to prevent stomach bleeding and ulcers.

1. Aspirin’s antiinflammatory effect is derived from its ability to inhibit prostaglandin synthesis (COX 1 & COX 2).

2. The prostaglandins are potent vasodilating agents that also increase capillary permeability. Therefore, aspirin causes decreased erythema and swelling of the inflamed area.

The indications for aspirin are reduction of pain, inflammation, and fever. It is used as a prophylactic treatment for preventing MI and strokes.

The doses of aspirin range from ___ mg to 325 mg a day.

Select contraindications to taking aspirin.

1. Aspirin has many drug to drug interactions, especially with anticoagulant drugs such as Warfarin (Coumadin), which can result in an increase in bleeding.

2. They bind to the same proteins, but Aspirin has more affinity; Warfarin when not protein bound is more active.

________ differ from Aspirin in that they do NOT irreversibly effect platelet function as aspirin does.

1. NSAIDS do NOT inhibit platelet aggregation for the lifetime of the platelet & are not used for prevention of MI & stroke.

2. NSAIDS are the anti-inflammatory drug of choice in dentistry assuming no contraindications.

Select contraindications to taking NSAIDS.

1. Celebrex is a prescription nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed for many types of joint pain and inflammation.

2. Celebrex is a selective COX-2 inhibitor, and through another mechanism it causes vasoconstriction.

__________ has an unclear mechanism of action. Pain is reduced through the CNS, not prostaglandin synthesis. It is NOT an effective anti-inflammatory because of the limited effect on COX enzymes.

A major advantage of acetaminophen compared to aspirin and non-selective NSAIDs is a lack of effect on platelet function & less or no gastric irritation.

The maximum dose of acetaminophen is _____ mg/day with higher doses increasing the risk of liver damage.

1. Acetaminophen is almost completely absorbed from the GI tract into the bloodstream. After ingestion, it reaches peak blood levels in about 30 to 60 minutes.

2. It is extensively metabolized in the small intestine and distributed to most tissues

With high doses of opioids, it may result in a major toxic effect causing death because no tolerance is developed to _________ depression.

Select adverse reactions for opioids.

Morphine in doses of 5 to 10 mg will reduce severe pain or eliminate pain. Morphine is a _______ drug.

1. Most dental pain can be managed better with NSAIDs.

2. Patients with chronic pain should be managed with non-opioid therapies and be referred to appropriate specialist.

Opioid high = pupil constriction

Cocaine high = pupil dilation

______ increases the production of dopamine. It increases heart rate and vascular blood flow.

If it is used with alcohol, it masks the symptoms of alcohol, potentially causing alcohol poisoning.

Select some opioid alternatives for pain management in dentistry.