References
How to manage pain in the dental patient
Abstract
Introduction
Pain in dental and oral surgery patients is of great concern to veterinary practitioners as there is an excellent nervous supply to the pulps of all teeth, as well as the supporting hard and soft tissues. Surgery involving these tissues, as with any other tissues in the body, will inevitably stimulate and activate the pain pathways, which can lead to sensitisation, hyperalgesia, secondary hyperalgesia and delayed wound healing to name but a few of the negative consequences of pain. It is the responsibility of all veterinary professionals to recognise when an animal is in pain, or when pain is likely to be caused, and formulate an appropriate pain management plan which is carefully implemented and evaluated. This article will recap the pathophysiology of pain and consider the concepts of pre-emptive and multimodal analgesia, before outlining some of the pharmacological and non-pharmacological interventions available for pain management in dental patients.
The International Association for the Study of Pain (IASP, 2016) defined pain as ‘an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. This should not be confused with nociception which refers purely to the sensory or physiological process involved in a painful experience, whereas pain relates to the overall experience and how the animal feels as a result. The perception of pain in animals is very difficult to quantify as it is a combination of the integration of nociceptor information with many other central nervous system (CNS) and body inputs into the cerebral cortex.
Nociception, the physiological component of pain, consists of three processes, which are transduction, transmission and modulation, and involves pain receptors, nociceptors, and nerve fibres in the periphery, spinal cord and brain:
The final step in the overall pain pathway is perception, which is the integration of the nociceptor information provided to the cerebral cortex with other information from learned experiences or memories resulting in the conscious, subjective and emotional experience of pain. Having a clear understanding of the pathophysiology of the pain pathway is vital if an informed approach to pain management and the use of analgesic drugs and hence pharmacological modulation is to be achieved.
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