Day 2-PAIN and PAIN control

Question 1

Pain perception and pain reaction to perception of pain are not necessarily proportional to􏰀 _______ of physical injury 􏰀 ______ of harm

Answer 1

Intensity… Degree

Question 2

Pain: An unpleasant sensory and emotional

experience associated with actual or _______ tissue damage, or described in terms of such damage

Answer 2

POTENTIAL!!!

Question 3

Pain: An unpleasant sensation created by a _______ stimulus that is mediated along certain nerve pathways to the CNS where it is interpreted as such”

Answer 3

noxious

Question 4

Are pain threshold and tolerance synonymous?

Answer 4

NO

Question 5

What is the POINT at which a stimulus FIRST produces pain sensation?

Answer 5

Threshold

Question 6

Is someones pain threshold acquired or innate?

Answer 6

INNATE

Question 7

Does someone’s threshold change or have little variance over time?

Answer 7

Has LITTLE variance over time

Question 8

___________: an individual’s reaction to painful stimuli

Answer 8

Tolerance

Question 9

________: the amount of pain someone is WILLING/ABLE to endure.

Answer 9

Tolerance

Question 10

Does tolerance in a person stay pretty constant or vary with time?

Answer 10

varies significantly

Question 11

What are three ways a clinician can manage Tolerance?

Answer 11

1.Behavior modification 2. Distraction 3.Meds!

Question 12

What are three classes of meds a dentist can do to help keep a patient’s tolerance at a maximum?

Answer 12

1.Anti-anxiety (benzo’s) 2.Local Anesthetics 3.Anti-inflammatory meds (NSAIDS, aspirin)

Question 13

What is the dual nature of pain?

Answer 13

1.Pain Perception and 2.Pain reaction

Question 14

_________ The physiologic and anatomic process by which pain is received and transmitted

Answer 14

Pain reaction

Question 15

_______ The actual process by which the body perceives pain

Answer 15

Pain reaction

Question 16

________ : The manifestation of the perception of pain

Answer 16

Pain PERCEPTION

Question 17

What are 3 physiological factors involved in pain PERCEPTION?

Answer 17

1. previous experience 2.emotional state 3. sex

Question 18

Can pain perception be quantified?

Answer 18

NO

Question 19

Is pain perception objective or subjective? How is it rated?

Answer 19

Subjective…on rating scales (1-10…etc)

Question 20

What are the three things we need to consider when getting a pain perception rating scale?

Answer 20

Age, literacy, previous experiences

Question 21

What is the name of the FACES pain perception rating scale?

Answer 21

Wong-Baker

Question 22

What type of pain is less than 6 months and is caused by tissue damage from injury or disease?

Answer 22

ACUTE pain

Question 23

In acute pain the patient ______ to get better and adopts ______ to ease or eliminate pain

Answer 23

expects….behaviors

Question 24

For acute pain the hope is that the patient has a strong ________ to seek treatment!

Answer 24

motivation!

Question 25

What is pain for longer than 6 months?

Answer 25

chronic pain

Question 26

What is the biggest fear for a patient with chronic pain?

Answer 26

lose hope of getting better and becoming DEPRESSED

Question 27

Why do so many people equate dental treatment with pain? (4)

Answer 27

1.past experience 2.toothache 3.anxiety/fear 4.oral environment is very innervated

Question 28

What is the ability of a stimulus to be detected by a specific receptor?

Answer 28

Sensory modality

Question 29

Sensory modalities is a ______ specific theory

Answer 29

receptor

Question 30

What is the key for sensory modalities like thermoreceptors, mechanoreceptors, and chemoreceptors?

Answer 30

they ADAPT with stimulation (you block things out that are not important)

Question 31

What are the receptors that detect injury?

Answer 31

NO-CI-ceptors

Question 32

What is the term for when nociceptors respond to all types of injury?

Answer 32

polymodal

Question 33

What is a key aspect of nociceptors, but probably gives us trouble...?

Answer 33

Nociceptors NEVER ADAPT to stimulus...hence chronic pain. FML.

Question 34

What is the physiological reaction to pain stimulus?

Answer 34

PROTECTIVE (rapid, reflexive, subconscious)

Question 35

Which pain reflex never reaches the higher processing centers?

Answer 35

withdrawal reflex

Question 36

Protective response is also linked to _______

Answer 36

behavior

Question 37

What are the 4 type 'A' fibers involved in the transmission of pain? What are three characteristics of them?

Answer 37

Alpha, beta, gamma, delta....myelinated,large, and fast

Question 38

What are three characteristics of 'B' type fibers in the transmission of a pain signal?

Answer 38

myelinated, medium, and slow

Question 39

What are three characteristics of 'C' type fibers in the transmission of pain?

Answer 39

unmyelinated, small, and very slow (like walking speed)

Question 40

What is the theory of distracting the site of pain with massaging or rubbing to have faster fibers block the pain sensation?

Answer 40

gate theory

Question 41

The __________ of the spinal cord modulates (gate control) the synaptic transmission of nerve impulses from ________ fibers to _______ transmission

Answer 41

substantia gelatinosa....peripheral fibers to central transmission

Question 42

Inhibitory effect by the SG in afferent nerve terminals INCREASED with _____ fiber activity ______ the gate!

Answer 42

LARGE...closes

Question 43

Inhibitory effect by the SG in afferent nerve terminals DECREASED with ______ fiber activity (C fibers) _____ the gate = perceive pain

Answer 43

small...OPENS

Question 44

When do we perceive pain- open gate or closed gate?

Answer 44

OPEN gate

Question 45

Types of Nociceptive pain: ______ = arises from superficial structures (skin, muscles)

Answer 45

somatic

Question 46

Which type of nociceptive pain is caused by trauma and is sharp, aching, and throbbing?

Answer 46

SOMATIC

Question 47

Types of Nociceptive Pain: ______ = gut pain

Answer 47

visceral

Question 48

Which type of nociceptive pain is caused by compression, expansion, stretching, infiltration and is squeezing or gnawing sensations?

Answer 48

visceral

Question 49

Types of Nociceptive Pain: Caused by NERVE injury or dysfunction in CNS or PNS

Answer 49

Neuropathic

Question 50

Which type of pain is complex and OFTEN CHRONIC?

Answer 50

neuropathic

Question 51

What type of pain is phantom pain?

Answer 51

neuropathic

Question 52

What was the name for the neuropathic pain associated with DIABETES again??

Answer 52

Peripherally generated polyneuropathy

Question 53

What is the name of a single nerve injury? What are 3 examples?

Answer 53

Mono-neuropathy...1.trigeminal neuralgia 2.carpal tunnel syndrome 3.Post-herpetic neuralgia (shingles)

Question 54

In response to pain, CNS simultaneously activates the _________

Answer 54

SYMPATHETIC nervous system

Question 55

Pain stimulates the _________ = release of epinephrine and norephinephrine

Answer 55

adrenal medulla

Question 56

_________ of pain and perception of pain both stimulate the fight or flight SNS response

Answer 56

ANTICIPATION!!!

Question 57

HOLY S! ___% report some level of anxiety related to dental tx!!

Answer 57

40%

Question 58

Too bad....___% avoid dentistry c/o fear of INJECTIONS

Answer 58

5%

Question 59

Pain control needs to address these three areas:

Answer 59

pain reaction....pain perception...individual needs

Question 60

Pain control can be achieved by _______ the cause

Answer 60

Removing

Question 61

Pain control can be achieved by _______ the pain pathway

Answer 61

blocking

Question 62

Pain control can be achieved by Raising the pain ______

Answer 62

threshold

Question 63

Pain control can be achieved by ______ somatic methods

Answer 63

Psycho

Question 64

Pain control can be achieved by _______ the pain reaction (General Anesthesia)

Answer 64

PREVENT

Question 65

Pain Control Modalities: Establish ______

Answer 65

rapport

Question 66

Pain Control Modalities: try this wacky alternative!!

Answer 66

hypnosis...the shit works!

Question 67

Pain Control Modalities: these common dental clinic methods ______ and ______

Answer 67

LA and N2O

Question 68

Pain Control Modalities: Analgesics, oral ______, intramuscular ______, intravenous _______, general anesthesia, combos

Answer 68

sedation,sedation,sedation

Question 69

addressing pain typically involves good interpretation of __________ of each patient

Answer 69

individualization

Question 70

Dental Pain Control: Establishing a ______ with patients is critical to your success in treating them

Answer 70

rapport

Question 71

Dental Pain Control: It is vital to have _______ and understanding

Answer 71

COMPASSION

Question 72

Dental Pain Control: _______ and assessment of the patient will allow for the development of appropriate treatment strategies to control pain

Answer 72

evaluation

Question 73

Pre-op pain: toothache, abscess, trauma are examples of pain ______

Answer 73

reaction

Question 74

Pre-op pain: emotional state, age, health, past experience are examples of pain _______

Answer 74

perception

Question 75

Post-op pain: the procedure will determine pain ______

Answer 75

reaction

Question 76

post-op pain: pain ______ should be addressed PRE-op!

Answer 76

perception

Question 77

Preoperative Assessment What is the pain mechanism? 􏰀 preexisting condition - abscess 􏰀 psychological - phobia, age 􏰀 procedure - invasive surgery...devise a _______!!!

Answer 77

STRATEGY!!!

Question 78

Pre-op pain- consider rapport 􏰀 distraction- TV, music, etc. 􏰀 suggestion 􏰀 hypnosis...these are all examples of ______ techniques

Answer 78

psychosomatic techniques

Question 79

What are the four terms of the PREP acronym?

Answer 79

Prepare, Reherse, Empower, and Praise

Question 80

PREP: _______ by utilizing relaxation techniques 􏰀 Focused breathing, distraction (music, visualization), muscle relaxation

Answer 80

PREPARE

Question 81

PREP: _______ procedures allowing patients to practice control and self-calming techniques

Answer 81

REHEARSE

Question 82

PREP: _______ patients with strategies that give them CONTROL during procedures... Raise hand to ask clinician to stop

Answer 82

EMPOWER

Question 83

PREP: ______ patients for using specific coping | techniques that are helpful to them

Answer 83

PRAISE

Question 84

What are the 3 pre-op medical weapons we have to address both pain reaction and pain perception?

Answer 84

Local Anesthesia (PR)...Sedation modalities (PP) (PO,IM,IV,GA)....Analgesics (PR/PP)

Question 85

A special consideration for pre-op pain control...________!! indicated for infection only and NO analgesic properties

Answer 85

Antibiotics!!!

Question 86

Post-op pain control: LA 1.length of procedure (3 LA's) 2.Post-op pain control (1 LA)

Answer 86

length: mepivacaine, lidocaine, articaine.....post of pain control bupivacaine

Question 87

Post-op pain: _______ analgesia BEFORE the pain is present, maintain blood level for ___ hours after procedure

Answer 87

preemptive...48 hrs

Question 88

That dose, above which, there is no further: _______

Answer 88

ceiling dose (in mg)

Question 89

The degree of analgesia achieved at the ceiling analgesic dose: _______

Answer 89

ceiling analgesic EFFECT (subjective)

Question 90

What are the 4 NON-opioid drugs and their ceiling doses (mg)????

Answer 90

1.acetaminophen 1000mg 2.aspirin 1000mg 3.ibuprofen 400mg 4.ketoprofen 50mg

Question 91

What are the 3 opioid (narcotic) drugs and their ceiling doses?

Answer 91

1.codeine 60mg 2.hydrocodone 10mg 3.oxycodone 10mg

Question 92

Ceiling analgesic effect: mild to moderate..what drug(s)?!?!

Answer 92

Aspirin or Acetaminophen

Question 93

Ceiling analgesic effect: moderate...what drug(s)?!?!?

Answer 93

ibuprofen/codeine

Question 94

Ceiling analgesic effect: moderate to severe...what drug(s)?!?!?

Answer 94

ketoprofen/hydrocodone

Question 95

Ceiling analgesic effect: SEVERE...what drug(s)?!?!?

Answer 95

oxycodone

Question 96

What is the drug we prescribe that has codeine and tylenol? how much of each?

Answer 96

WOOOO PHARM 1!!!!! Most widely prescribed codeine product by dentists is TYLENOL #3!!!! (acetaminophen 300mg, codeine 30mg) (not even getting close to ceiling for either of these!)