| Nociceptive pain | Caused by stimulation of peripheral nerve fibres responding to stimulus near or exceeding harmful intensity |
| Neuropathic pain | Caused by abnormal somatosensory activity due to damage or disease affecting the PNS or CNS |
| Psychogenic pain | No apparent organic basis for pain |
| WHO pain ladder | 1. non opoid e.g. paracetamol, 2. weak opoid e.g. code+non opoidine 3. srong opoid e.g. morphine +non opoid |
| What beneficial side effect can ibu or para have | Antipyretic |
| Paracetamol facts 4 | Analgesic- inhibits PGs, antipyretic useful for dental , not anti inflam. little interactions/adverse affects |
| Para dosing | for >50 kg 2 tablets 1g every 4-6 hours max 8 daily usually for 5 days post op |
| NSAIDs and COX | COX1- protects gastric mucosa, COX-2 inducible inflammatory and renal |
| Why are NSAIDs good for dental pain | Reduced inflamm. e.g. pulpitis |
| Common NSAIDs used and note | Ibuprofen, diclofenac and aspirin |
| Ibuprofen dosing | Ibu tablets 400mg 1 tablet to be taken four times a day after food max daily dose is 2.4g a day i.e. 800 mg three times a day |
| Ibu dosing for children | Tablets 200mg or in supsension 100ml/5ml |
| Diclofenac dosing for moderate inflammatroy or post op pain | Diclofenac sodium tablets 50mg 1 tablet to be taken three times a day pref. after food not for children |
| NSAID drug interactions | Inc. bleeding risk by aspirin antiplatelet anticoag. and increased risk of bleeding wiht SSRIs |
| NSAID in peptic ulcer case | Prescribe a PPI e.g. lansoprazole once daily during NSAID |
| Weak opoids in dentistry | No anti-inflamm and relatively inneffective and have adverse affects |
| Weak opoids in dentistry dosing (less appropriate) | Codeine phosphate 30mg tablets 1 to 2 tablets taken 4 times a day max 240 mg daily- can be given IM but not reccomended |
| Co-codamol | Codeine phosphate and paracetamol |
| Co-dyrmadol | Dihydrocodeine and paracetamol |
| Co-codaprin | Codeine phosphate plus aspirin |
| Tramacet | Tramadol plus paracetamol |
| Codafen continus | Codeine phosphate and ibuprofen |
| Amount of paracetamol per kg to refer to A&E | 75 mg/kg |
| What is the toxic intermediate of paracetamol shortened to | NAPQI |
| What is tramadol | Opoid analgesic and enhances 5HT indicated for moderate to severe pain see side effects dose is 50-100 mg every 4 hours max dose 400mg a day |
| (generally not in dental setting) Strong opiates e.g. morphine, fentanyl, oxycodone and pethidine | pethidine 50 mg orally 50-150mg every 4 hrs max dose daily 450 |
| What can be used to treat atypical facial pain | Tricyclic antidepressant |
| Trigeminal neuralgia treatment can be with | Antiepileptics e.g. gabapentin and carbamazepine |
| Adjunct medication in various facial pains | Anxiolytics e.g. diazeapam |
| Chronic and oral facial pain may be due to | Atypical/idiopathic, TMJ dysfunc. |
| Acute oral problems e.g. acute herpetic gingivostomatitis, apthous ulceration, erythema multiforme may be treated better | Topically e.g. benzydamine hydrochloride 0.15% oral rinse or spray15mls or 4-8 spraysused every 1.5 to 3 hrs |
| What is important to be aware of in some patients when prescribing | Addicts, liver and kidney disease patiets |
| prescribing to children | NSAIDs okay not aspirin prescribe by weight or age |
