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MANAGEMENT OF PAIN

September 28, 2011  by: ANIL PATEL  Points: 12   Category: Medical  Earning $0.30   Views: 856

"Pain is defined as an unpleasant sensory and emotional experience resulting from a stimulus causing, or likely to cause, tissue damage or expressed in terms of that damage. This is affected by emotional factors."

         

=> DEFINITION AND ETIOLOGY OF PAIN



=>

DEFINITION


"Pain is defined as an unpleasant sensory and emotional experience resulting from a stimulus causing, or likely to cause, tissue damage or expressed in terms of that damage. This is affected by emotional factors."

=>

ETIOLOGY OF PAIN



-Patient
-The instruments, materials and armamentarium
-The Pulp- Dentin Organ
-Improper handling of tissues

=> METHODS TO CONTROL PAIN IN OPERATIVE DENTISTRY



1. LOCAL ANAESTHESIA



"It is the most widely used and popular technique of effective pain control. It is defined as a transient regional loss of sensation to a painful or potentially painful stimulus resulting from a reversible interruption of peripheral conduction along a specific neural pathway to its central integration and perception in the brain."
Before administering local anesthetic agent certain patient factors should be evaluated.
-Systemic health
-Allergy
-Psychology

=> ALTERNATIVE METHODS



1.PRE MEDICATION
As adjunct to local anesthesia
To control anxiety
AGENTS
Diazepam(2 to 10 mg orally 1 hr prior to apt.)
Alprazolam(0.25 to 0.5 mg 1 hr prior)
Midazolam(2 to 5 mg 1 hr prior)

2. INHALATION SEDATION

Conscious sedation and inhalational analgesia are now accepted modalities of pain control. Various pharmacotherapeutic agents have been advocated. Myriad chemicals that have been proposed are barbiturates, psycho sedative drugs like phenothiazine derivatives, propyl alcohol derivatives, benzodiazepine derivatives, and narcotics like morphine but the most popular and widely used is nitrous oxide and oxygen inhalational analgesia. This technique basically relies on elevation of pain threshold.
Nitrous oxide and oxygen in a controlled combination produce highly effective sedation. Concentrations of 35-40% produce enhanced sedative effects and are the recommended concentrations and produce its peak effect in 3-5 minutes. Being inert, it does not combine with any body tissue and is eliminated unchanged through the lungs is less than 5 minutes. However, the use of this technique requires elaborate equipment and care during administration.

3. HYPNOSIS

Hypnosis is a sleep-like state with persistence of certain behavioral responses. The subject is susceptible to and may respond to the hypnotic suggestions concerning aspects of behavior, environment, memory etc. It has been used in various modalities in medicine and dentistry to alter responses to pain. It is currently used to define an area of research and treatment that employs suggestion. The long history of hypnosis with various contributions is testimony to its effectiveness. Combined with other techniques, it is a powerful tool.

4.ELECTRONIC DENTAL ANAESTHESIA

It works on the gate control of pain transmission.
High frequency - 120hz
EDA produces sensation that may be described as vibrating, throbbing, pulsing, or twitching.
EDA stimulates larger diameter A-fibers
inhibits smaller A-delta fibers & C-fibers
INDICATION
-Needle phobic patients
-Allergy to L.A. agent
-Pain control prior to L.A. adm.
CONTRAINDICATION
-Patients with cardiac pacemakers
-Neurological disorders like EPILEPSY
-Very young or Very old patients
-Pregnancy
ADVANTAGES
-No need for injection
-Effect of anesthesia only for required time
-Residual analgesic effect
DISADVANTAGES
-Highly expensive
-Learning curve
-Intra oral electrodes are weak link in system
5.GENERAL ANESTHESIA
This technique involves complete transient reversible of consciousness. Various agents like ether, halothane, Fentanyl etc are utilized. It is employed as the last report and this finds rare application in dental pain control.
STAGES OF ANESTHESIA
Stage I - Analgesia.
Stage II - Excitement.
Stage III - Surgical anesthesia
Stage IV Overdose

6.USE OF COOLING DEVICE
Coolants minimize pain and maximize efficiency with high speed. The commonly used coolants are:
Air.Water.
Combination of both which is the most popular and highly effective.
Also, the use of chilled burs is said to diminish pain. CO2 and ethyl chloride have also been experimented with.




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