Pain Management in Oral Surgery Part 1

Dr. KEYVAN ABBASZADEH, Oral Maxillofacial Surgeon, London ON

Dentists have to deal with pain all the time, especially when it comes to any kind of surgical intervention. In this continuing series of discussions on oral surgery for the general dentist, Dr. John O’Keefe invites Dr. Keyvan Abbaszadeh, oral and maxillofacial surgeon from London ON, to unpack the principles of pain management.

In part 1 of a two-part discussion, Dr. Abbaszadeh focusses on the science of pain management, stressing the importance of understanding why pain occurs and what type of pain is being managed.

Here are the key takeaways from the presentation:

• Pain is essential to survival. It acts as a warning sign for actual or impending tissue damage.
• It is important to remember that pain is not just physical but also contains a psychological/emotional component. It may be unreasonable and disproportionate to the experience the patient is going through.

ACUTE VS CHRONIC PAIN

• Acute Pain
  • Caused by tissue damage
  • Lasts minutes to weeks
  • Self-limiting
  • Should resolve with resolution of cause
  • May cause anxiety or stress
  • Can be an emergency
• Chronic Pain
  • Extends beyond period of healing (3-6 months)
  • Persistent
  • May happen de novo with no apparent cause
  • Disrupts sleep/normal living
  • Ceases to serve as a protective function and has no adaptive purpose

PHYSIOLOGICAL PROCESS OF PAIN

• TRANSDUCTION – conversion of energy into nerve impulse
• TRANSMISSION – from periphery to CNS
• PERCEPTION – appreciation of signal as pain
• MODULATION – descending inhibitory input from brain

MEDIATORS OF PAIN

• Serotonin (5-HT)
• Bradykinin
• Histamine
• Cytokines
• Substance P

KEY ASPECTS OF PAIN MANAGEMENT

• Prevent pain from arising
• Block signals
• Prescribe peripheral analgesia
• Prescribe central analgesia

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team