Management Of Oral Pain Research Articles

Comparison of Pain Management Strategies to Reduce Opioid Use Postoperatively in Free Flap Breast Reconstruction: Pain Catheter versus Nerve Block in Addition to Refinements in the Oral Pain Management Regime.

Background Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group ( n = 63) had lower opioid consumption compared to the PP group ( n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay ( p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.

Patient satisfaction with oral pain management during extracorporeal shock wave lithotripsy

International Journal of Urological NursingVolume 17, Issue 2 p. 143-144 ABSTRACT Patient satisfaction with oral pain management during extracorporeal shock wave lithotripsy Lisbeth Leinum RN, MSc, Corresponding Author Lisbeth Leinum RN, MSc [email protected] orcid.org/0000-0003-2426-8346 Department of Urology, Zealand University Hospital, Roskilde, Denmark Correspondence Lisbeth Leinum, Department of Urology, Zealand University Hospital, Sygehusvej 6 4000 Roskilde, Denmark. Email: [email protected]Search for more papers by this authorSusan H. Soerensen MD, Susan H. Soerensen MD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this authorSveinar Menne MD, Sveinar Menne MD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this authorNessn Azawi MD, PhD, Nessn Azawi MD, PhD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this author Lisbeth Leinum RN, MSc, Corresponding Author Lisbeth Leinum RN, MSc [email protected] orcid.org/0000-0003-2426-8346 Department of Urology, Zealand University Hospital, Roskilde, Denmark Correspondence Lisbeth Leinum, Department of Urology, Zealand University Hospital, Sygehusvej 6 4000 Roskilde, Denmark. Email: [email protected]Search for more papers by this authorSusan H. Soerensen MD, Susan H. Soerensen MD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this authorSveinar Menne MD, Sveinar Menne MD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this authorNessn Azawi MD, PhD, Nessn Azawi MD, PhD Department of Urology, Zealand University Hospital, Roskilde, DenmarkSearch for more papers by this author First published: 08 June 2023 https://doi.org/10.1111/ijun.12353 Abstract accepted for European Association of Urology Nurses Congress, July 2022. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume17, Issue2July 2023Pages 143-144 RelatedInformation

The feasibility of academic detailing for acute oral pain management in outpatient dentistry: A pilot study

BackgroundOpioids are overprescribed in the outpatient dental setting. Therefore, opportunities exist for opioid stewardship. ObjectivesThe purpose of this pilot study was to test the feasibility of an academic detailing (AD) intervention to promote appropriate prescribing of opioids in outpatient dentistry. MethodsWe implemented an AD intervention targeting management of acute oral pain in a Midwestern Veterans Affairs outpatient dental facility. The intervention targeted dentists who actively prescribed opioids at the time of the study. The pilot study tested feasibility, adoption, and acceptance of the AD campaign. Visit-based prescribing rates were obtained from the Veterans Health Administration’s Corporate Data Warehouse for baseline and postintervention using difference-in-differences analyses to detect potential changes in health service outcomes. ResultsResults indicate moderate levels of feasibility through participation rates (n = 5, 55.5%) and high levels of organizational readiness for change (average of 88.6% agree to strongly agree). Furthermore, fidelity of the AD intervention was high. Adoption measures show moderate indication of motivation to change, and trends suggest that participating dentists decreased their visit-based opioid prescribing rates (P > 0.05). ConclusionThe intervention demonstrated feasibility with some indications of adoption of intervention techniques and decrease in opioid prescribing. We further recommend working closely with frontline providers to gather feedback and buy-in before scaling and implementing the AD campaign.

Oral pain in the cancer patient.

Oral pain is a common complaint in patients with cancer. This review aims to summarize the knowledge on the causes and approach to management of oral pain garnered over the past 2 years. A systematic review and meta-analysis included in the review, assessed cannabinoid versus placebo and showed only a small effect on pain, physical function, and sleep quality. Another review showed that chemical neurolysis as an adjunctive therapy, is effective in patients with pain of shorter chronicity and refractory head and neck cancer-related pain. Patients with cancer frequently experience oral pain because of a variety of factors. Factors inherent in the type and location of the malignancy, the modality of cancer treatment, and a holistic approach to management together contribute to their overall pain experience. Basic oral care should be implemented wherever possible, before, during, and after cancer treatment.

Dental Anesthesia for Medical Providers: A Novel Interprofessional Course.

To limit the use of opioids for nontraumatic dental conditions in emergency settings, the physician assistant (PA) and dental faculty at A.T. Still University designed a course that teaches PA students to administer dental anesthesia. Dental faculty and teacher assistants taught PA students proper dental anesthesia. The course consisted of a recorded, prelaboratory lecture and in-person lab. During the laboratory, students rotated through 3 stations where they reviewed dental anatomy, practiced injections on dental anesthesia manikins, and simulated injections on student volunteers using the Safe-D-Needle. Students completed verbal and hands-on assessments. Ninety-seven percent of students passed the assessments on their first attempt. Course evaluations suggested the course had a positive effect on students' attitudes toward oral pain management. This educational model allowed PAs to expand their emergency medicine toolbox. In the future, this model should be adapted to incorporate other healthcare professionals as well.

Dental care pathways for adult inpatients in an acute hospital: a five-year service evaluation.

Introduction The oral health of adult inpatients has been found to deteriorate during hospital admissions, which can impact on eating and drinking, risk of hospital-acquired infections and overall recovery, thus extending the length of admission.Aim The aim of this paper was to evaluate the reasons for inpatient referrals to the dental and maxillofacial department and the treatment outcomes through analysis of referrals over a five-year period collected prospectively.Method Data were collected from inpatient referrals to the dental and maxillofacial department at East Surrey Hospital over five years from January 2014 to December 2018. Information about reason for referral and treatment outcomes was reflected on.Results In total, 851 referrals were received from hospital staff over five years. The most common reason for referral was related to acute dental pain and potential analgesic overdose (16%), followed by suspected dental abscess or facial swelling (12%) and dental assessment for cardiac inpatients (11%). The most common treatment outcomes included consultation and advice only (16%) or dental extraction (16%). A large proportion of outcomes related to management of oral pain due to dry mouth (9%), oral ulceration (6%), broken dentures (8%) or fillings (5%).Conclusion The data collected show there is a clear need and benefit for hospitals to commission dental services for inpatients.

Abstracts from the 7th Congress of the World Federation for Laser in Dentistry European Division June 20–22, 2019 Parma, Italy

Abstracts from the 7th Congress of the World Federation for Laser in Dentistry European Division June 20–22, 2019 Parma, Italy

Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial.

To evaluate the effect of oral gabapentin in conjunction with usual oral pain management regimens of lorazepam, ibuprofen, oxycodone, and acetaminophen for surgical abortion on pain 5 minutes postprocedure. This was a randomized, double-blind, placebo-controlled trial of patients from 6 0/7-14 6/7 weeks of gestation scheduled to undergo surgical abortion at the Duke Family Planning Clinic. Participants were administered 600 mg of oral gabapentin compared with placebo with usual oral pain management. Pain score was assessed using a 100-mm visual analog scale, with the primary outcome being pain score 5 minutes after the procedure. The effect of gabapentin was assessed using a linear regression model controlling for baseline pain. We also measured pain perception 24 hours after the procedure. Secondary outcome measures included anxiety, side effects, and usage of opiate pain medication in the 24-hour postoperative period. Out of 113 women screened for this study; 96 women were recruited, enrolled, and randomized to study treatment arm from August 2016 to June 2018. Pain at 5 minutes after the procedure was similar between the gabapentin and placebo groups ((Equation is included in full-text article.)=3.40; 95% CI -8.20 to 15.0; P=.56). Gabapentin and placebo were well tolerated, with no statistically significant difference in side effects or anxiety levels. Although prescription of opioids after the procedure was not standardized among patients, 73% of women received a short-term prescription for oxycodone. A lower percentage of women in the gabapentin group self-reported taking opioids in the 24 hours postprocedure (18% vs 47%; odds ratio 0.26; 95% CI 0.09-0.75). The addition of gabapentin to usual oral pain management regimens with paracervical block did not reduce postoperative pain for patients undergoing outpatient surgical abortion. Although the addition of gabapentin was well tolerated and reduced oral opiate use 24 hours postprocedure, it did not affect the experience of pain during and immediately after the procedure. ClinicalTrials.gov, NCT02725710.

Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial

BackgroundIrreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars.Methods/designThis study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h.DiscussionThis randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions.Trial registrationClinicalTrials.gov, identifier: NCT02629042. Registered on 7 December 2015.(Version n°1.1 28 July 2015)

Strategies for Oral Health Management in Patients with Acute Confusional State

&lt;p class="AbstractContent"&gt;&lt;strong&gt;Background&lt;/strong&gt;: The presence of serious illnesses, medical complication, or drug intoxication may be the pathophysiological causes of acute confusional states (ACS). The oral diseases are highly prevalent in patients with this condition, which may cause life-threatening complications. Objectives: To describe the strategies for oral health management in patients with ACS who were treated in the inpatient ward of the Cipto Mangunkusumo Hospital.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Case Report and Management:&lt;/strong&gt; This report presented two patients with the diagnosis of ACS with differential diagnosis of dementia. The first patient was 67-year-old female with a history of nausea and vomiting before admission, eating difficulty, systemic disease and drugs use were unremarkable. The second patient was a 60-year-old female with history of nausea and vomiting every food or drinking intake, diabetes mellitus and hypertension. Clinical intraoral examination of both patients revealed poor oral health and progressive oral functional loss; However, in-office and invasive dental treatment was not indicated. The treatment focus was to improve oral comfort, oral pain management, and infection control.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: An appropriate oral healthcare plan should be considered depending on the patient’s dying stage or general condition with the collaboration between related healthcare providers.&lt;/p&gt;

Oral Pain Management for Pregnant Patients: A Survey of Endodontists

Oral Pain Management for Pregnant Patients: A Survey of Endodontists

Revealing Trends in Oral Pain Management in Pregnancy Between Obstetricians and Endodontists [6C

Revealing Trends in Oral Pain Management in Pregnancy Between Obstetricians and Endodontists [6C

Evaluation of the Percutaneous Absorption of Ketamine HCl, Gabapentin, Clonidine HCl, and Baclofen, in Compounded Transdermal Pain Formulations, Using the Franz Finite Dose Model.

This study evaluates the ability of four commonly used analgesics (ketamine HCl, gabapentin, clonidine HCl, and baclofen), when incorporated into two transdermal compounding bases, Lipoderm and Lipoderm ActiveMax, to penetrate human cadaver trunk skin in vitro, using the Franz finite dose model. In vitro experimental study. Methods. Ketamine HCl 5% w/w, gabapentin 10% w/w, clonidine HCl 0.2% w/w, and baclofen 2% w/w were compounded into two transdermal bases, Lipoderm and Lipoderm ActiveMax. Each compounded drug formulation was tested on skin from three different donors and three replicate skin sections per donor. The Franz finite dose model was used in this study to evaluate the percutaneous absorption and distribution of drugs within each formulation. Rapid penetration to peak flux was detected for gabapentin and baclofen at approximately 1 hour after application. Clonidine HCl also had a rapid penetration to peak flux occurring approximately 1 hour after application and had a secondary peak at approximately 40 hours. Ketamine HCl exhibited higher overall absorption rates than the other drugs, and peaked at 6–10 hours. Similar patterns of drug distribution within the skin were also observed using both transdermal bases. This study suggests that the combination of these 4 analgesic drugs can be successfully delivered transdermally, using either Lipoderm or Lipoderm ActiveMax. Compounded transdermal drug preparations may then provide physicians with an alternative to traditional oral pain management regimens that can be personalized to the specific patient with the potential for enhanced pain control.

Review article: Maxillofacial emergencies: oral pain and odontogenic infections.

Oral pain and odontogenic infections are common reasons for patients to present to EDs and general medical practice in Australia. Although most odontogenic infections can be managed on an outpatient basis, because of their proximity to the airway, infections in this region can be life threatening, requiring urgent surgical intervention and ICU management. This article focuses on the emergency assessment, triage and non-specialist management of oral pain and odontogenic infections.

Prospective Comparison of Nonnarcotic versus Narcotic Outpatient Oral Analgesic Use after Laparoscopic Appendectomy and Early Discharge.

Purpose. To compare narcotic versus nonnarcotic outpatient oral pain management after pediatric laparoscopic appendectomy. Methods. In a prospective study from July 1, 2010, to March 30, 2011, children undergoing laparoscopic appendectomy on a rapid discharge protocol were treated with either nonnarcotic or narcotic postoperative oral analgesia. Two surgeons in a four-person faculty group employed the nonnarcotic regimen, while the other two used narcotics. Days of medication use, time needed for return to normal activity, and satisfaction rate with the pain control method were collected. Student's t-test was used for statistical analysis. Results. A total of 207 consecutive children underwent appendectomy for acute, nonperforated appendicitis or planned interval appendectomy. The age and time to discharge were equivalent between the nonnarcotic (n = 104) and narcotic (n = 103) groups. Both had an equivalent number of medication days and similar times of return to normal activity. Ninety-seven percent of the parents of children in the nonnarcotic group stated that the pain was controlled by the prescribed medication, compared to 90 percent in the narcotic group (P = 0.049). Conclusion. This study indicates that after non-complicated pediatric laparoscopic appendectomy, nonnarcotic is equivalent to narcoticbased therapy for outpatient oral analgesia, with higher parental satisfaction.

Protecting All Children's Teeth (PACT): Oral Pathology

Abstract This resource reviews the differential diagnoses and management of oral pain, which is a common presenting complaint in the primary care office. It is imperative that pediatric healthcare ...

Empowering Patients: Partnering in Pain Management Using Patient‐Controlled Oral Medication

Childbearing Poster Presentation Purpose for the Program To increase our hospital's low patient satisfaction scores in the area of “How well was your pain controlled?” from the Press Ganey survey. Proposed Change The proposed change to patient controlled oral medication (PCOM) for analgesia was developed by a task force of nurses and pharmacists in collaboration with physicians, information technology staff, regulatory nurses from the Quality Department, Risk Management, Forms Committee, Education Council, Practice Council, and Leadership Council. Implementation, Outcomes, and Evaluation The implementation of this initiative began with a pilot program that lasted 1 month. When a patient who is about to deliver arrives in the labor and delivery unit, an obstetric assessment is completed by a registered nurse (RN), including patient screening. The patient is asked if she is able and wants to participate in PCOM. Postpartum, the physician orders ibuprofen PCOM. Upon arrival to the postpartum wing, the RN explains PCOM, the flow sheet, and documents. The outcome of this pilot program was a survey of RNs and patients using the PCOM. The PCOM program was re‐examined taking into consideration concerns from both surveys. We began the initiative again in 2010 with a few changes suggested by the nurses and patients. We used the Press Gainey survey to evaluate the program. In October 2010, our score for “How well was your pain controlled?” was 82.0. Seventeen months after implementation of the PCOM program in March 2012, our score was 90.9, 99% in ranking with like hospitals. Implications for Nursing Practice The implementation of a patient controlled oral pain management program allows the patient and the nurse to partner in pain management following delivery. The patient has ready access to pain medication and is able to manage medications based on her specific situation and needs.

Management of Oral Pain

ABSTRACT Pain is the leading reason for individuals to seek dental care and understanding factors in pain response assists in pain management. Some dental services, including those involving tooth preparation, can result in postprocedure discomfort leading to a recommendation for analgesic therapy following treatment. Analgesia is defined as pain relief by inhibiting specific pain pathways and drugs to relieve pain are analgesics. Over the counter agents are efficacious agents for most dental pain with ibuprofen and acetaminophen commonly recommended. Considerations for analgesic recommendations, based on the medical history, scientific evidence of efficacy, and patient preferences are discussed. How to cite this article Pickett FA. Management of Oral Pain. World J Dent 2012;3(2):207-212.

Opioid Management and Dependency Among Adult Patients with Sickle Cell Disease

While pain is one of the most debilitating symptoms of sickle cell disease, narcotics remain an effective although controversial widely practiced intervention. Vaso-occlusive crises are the most common cause for seeking pharmacological treatment. The influence of stigmatization and pseudo addiction in emergency departments and outpatient clinics was reviewed. We analyzed patterns of narcotic utilization in a sample of 63 adult patients with sickle cell disease to determine if their psychological functioning and reports of pain differed as a function of the primary narcotics they were taking for oral pain management. Fifty-one percent of patients reported treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine.Patients who were treated with Oxycodone reported greater sensory reactions to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged weekly pain intensity ratings than patients who did not use this medication. There were no differences in pain or affective response in patients treated with OxyContin, methadone or morphine. We suggest there are clear differences between the reports of pain in patients with sickle cell disease taking short-acting narcotics for pain management as compared to those who are not, a pattern that does not distinguish patients who are managed with long-acting preparations. We discuss the relevance of addressing narcotic management in the context of the perception of health care providers and patients with sickle cell disease.

Early management of dental pain in children and adolescents

Objectives: There is little information regarding the initial management of dental pain in children and adolescents. The present study investigated the early management of 155 children and adolescents with dental pain prior to definitive treatment in the Eastman Dental Institute and Hospital for Oral Health Care Sciences, London, UK. Method: Prior to the child being examined by a qualified dentist in the casualty department, the accompanying parents or guardians were requested to complete a self-administered questionnaire regarding the duration and severity of pain, presence of swelling, professional advice sought and medication taken. Results: Of the attending children, 83% were in pain, 20% having been in pain for over 1 month. Most parents sought professional health care advice, particularly from a dentist; however, 15% initially obtained advice from a medical practitioner and 5% from a pharmacist. Simple analgesics were taken by 74% of patients; however, these rarely produced complete pain relief. Of concern, 10 children were inappropriately given aspirin, three of whom had taken the aspirin on the advice of a pharmacist. Sixty-seven children received systemic antibiotic therapy; however, 31% of these patients did not have any local swelling. Conclusion: It is evident that children and adolescents often receive inappropriate initial treatment for dental pain and may thus suffer unnecessary symptoms for several weeks. There is thus a need to educate healthcare workers more appropriately on aspects of the management of oral pain and to promote oral health care and hence reduce the incidence of caries in children.