Examination of pain

Examination Of Pain

Introduction
Pain in definition is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage” pain is more than a sensation, or the physical awareness of pain; it also includes perception, the subjective interpretation of the discomfort.

Introduction

The pain is conveyed to the brain by sensory neurons, these pain-sensing neurons are called nociceptors, The central part of these cells is located in the spine, and they send threadlike projections to every part of the body. Nociceptors are classified according to the stimulus that prompts them to transmit a pain signal.

Classification of Nociceptors

Thermoreceptive nociceptors: are stimulated by temperatures that are potentially tissue damaging. Mechanoreceptive nociceptors: respond to a pressure stimulus that may cause injury. Polymodal nociceptors: are the most sensitive and can respond to temperature and pressure. Polymodal nociceptors also respond to chemicals released by the cells in the area from which the pain originates.

Classification of pain by origin

Somatic pain: pain result from noxious stimulation of normal neural structures that innervate body tissue. Neurogenous pain: is discomfort generated within nervous system and caused by an abnormality of neural structures that innervate body tissue. Psychogenic pain: pain result from psychic causes and not from noxious stimulation or neural abnormality.

Pain is the most common symptom for which patient seek dental clinic and since pain is a subjective experience, it may be very difficult to communicate its exact quality and intensity to other people.

There are no diagnostic tests that can determine the quality or intensity of an individual's pain. Therefore, a medical examination will include a lot of questions about the pain.

Examination of pain

Examination of pain include questions about the following : Type Nature Location (site of the pain) Onset(timing of pain) Duration Severity Exacerbating factors Relieving factors associated symptom Radiation of pain relevant past medical history


Type: dull, sharp, lacerating ,throbbing, stabbing, electrical shock, tenderness to percussion etc… .Nature: Continuous, episodic, and if not continuous is it present between the attacks?

Location (site of the pain): The patient should be asked to point the place where the pain is felt. Onset(timing of pain): Is it worse at particular time?(pulpal pain often waken patient at night).

Duration: Time since onset, the time at which pain persist after onset. Relieving factors (Activities or experiences that decrease pain): The nature and duration of relief afforded by mild analgesic, Previous treatments and their effects aid in the assessment of severity of pain.

Exacerbating factors (Activities or experiences that increase pain): The effects of eating, opening the mouth wide, rest, exercise, heat and cold on pain should be explored, as in: pulpal pain is often precipitated by thermal and osmatic stimuli. Antral pain by bending. Periodontal pain by biting and chewing although in the earliest stages of acute periodentities many patient obtain relieve by biting upon the affected tooth.

Severity: As (mild, moderate and sever). It related to patient pain threshold (high/ low) and it determined by the analgesic, interfere with sleep .

Mild → managed with mild analgesic, include:Paracetamol 500mg/3 times. Daily.Aspirin 300mg/ every 6 hr. or 900mg/ every 6 hr. Ibuprofen 200mg or 400mg/3 times. Daily. Mefenamic acid (Ponstan) 250 or 500mg/ (1Ч3) or (1Ч2).Indomethacine 25mg/ 3 times. Daily.Diclofenac (voltarin) 25- 50mg/ 2-3 times. Daily.Meloxicam (mobic) 7.5-15 mg/ twice daily.piroxicam (feldin) 10 mg/ twice daily. Analgesic (type and dose) include

Analgesic (type and dose) include Moderate → unresponsive to mild analgesic.Algesic → Paracetamol 350mg. → codeine phosphate 10 mg. → caffine 50 mg.Pentafen → pentazosine 50mg/3 times. Daily.Paracodol → Paracetamol 500mg. → codeine phosphate 8 mg.Dolo-stop → Paracetamol 350mg. → dextropropoxyphene 50mg.

Sever :Morphine derivatives:Morphine sulfate 10-20mg/ every 4 hr.Pethidine HCL 50-100mg / every 4 hr. interference with sleep in sever cases Analgesic (type and dose) include

Associated symptom: Intermitted swelling may characterize obstruction to the flow of saliva especially during meals. Discharge of pus intraorally may cause the patient to complain from either a sweet or unpleasant taste. Clicking and inability to open the mouth may occur in case of TMJ problems.

Radiation of pain: Pain felt at a site different from the location of the causative lesion or diseased part of the body. It is due to the fact that nerve signals from several areas of the body may "feed" the same nerve pathway leading to the spinal cord and brain.