INTRODUCTION
Learning objectives After completing this course, the learner will be able to: Identify the basic elements of pain and pain perception. Discuss the prevalence of pain and its impact on individuals and society. Describe standard assessment techniques for measuring pain, including self-report instruments. Course overview Pain is a basic human response and a major trigger to seeking health care. Although all dentists are trained in managing acute pain, far fewer dentists are trained in, or have an interest in treating, chronic pain conditions. Yet chronic orofacial pain is common and may occur after routine dental procedures. Thus, dentists will likely encounter patients who need help in managing, coping with, or adapting to their chronic pain. Generally speaking, modern medicine has become effective in treating acute pain – the kind of pain that results immediately from injury, dental decay, dental treatment, or surgical procedures and remits when tissues have been treated and have healed. Unfortunately, however, in some instances and for reasons that are not completely understood, pain may not remit after injury. Certainly, in some cases the pain is caused by a chronic degenerative process, as is the case with osteoarthritis, and ongoing pain reflects ongoing injury and inflammation. In other instances, an original injury creates conditions (such as scarring) in which tissue impinges on and rubs against nerves, irritates receptors, and leads to perpetual signals to the brain that damage is being done. But for many individuals with chronic orofacial pain, no clear physical pathology can be identified and no simple or expedient remedy is in sight. Chronic pain by definition is long lasting. By the time an individual with chronic pain presents for assessment and intervention, it is likely that the pain has affected various areas of his or her life. For example, chronic pain is often associated with disability, depression, and anxiety. Individuals suffering from pain may begin to limit their activities. In the case of chronic and severe pain, these limitations can be extreme. Individuals with chronic pain usually sleep poorly and may, as a result, suffer from chronic fatigue. Their pain may have brought about changes in their relationships, with the possible result of driving away loved ones. Chronic pain can cause the patient to withdraw socially, or in some cases can deplete the energy of friends and family who have fallen into a solicitous, overly helpful pattern out of
Identify proper techniques for the clinical assessment of pain. Describe treatments for chronic pain, including pharmacological treatment, complementary and alternative medicine approaches, and psychosocial treatments. Identify barriers to effective pain care.
love and concern. Unfortunately, dental schools provide only limited training in the diagnosis and management of chronic pain and even less instruction on its basic pathophysiology and biopsychobehavioral consequences. This intermediate-level course is intended to address this training deficit by providing dental healthcare professionals with an overview of the nature and scope of chronic pain, as well as basic skills for effective assessment and adjunctive treatments of chronic orofacial pain conditions and related problems. To accomplish these goals, the course first examines the basic physiological principles that underlie pain, describes the distinction between acute and chronic pain, and explains the factors that contribute to acute pain becoming chronic. The prevalence and impact of chronic pain on physical functioning, health, and quality of life are examined. An introduction to the practical assessment of chronic pain provides readers with a description of selected assessment tools and interview procedures. Dental practitioners may be familiar with the diagnosis and treatment of pain in a specific context, for example, temporomandibular disorders. However, the emphasis of this course lies in assessing other causes of chronic orofacial pain and in discussing their corresponding pharmacological and biobehavioral treatment modalities. The course provides an overview of common medications used to treat chronic orofacial pain and discusses issues surrounding addiction and adherence to a prescribed medication regimen. The course also provides basic information on empirically supported psychosocial treatment strategies that can be useful when working with patients who are experiencing chronic pain. This course is designed for dental health professionals who wish to further their knowledge in orofacial pain conditions. After taking the course, the participant will be able to assess the patient with chronic orofacial pain, identify comorbid disorders, and recommend appropriate treatment or referral options.
WHAT IS PAIN?
At one level, pain is simply a physical sensation (i.e., information carried along nerve bundles for processing) signaling tissue damage. At another level, it is an emotion, in the same way that happiness is an emotion. Like happiness, pain involves physiological changes, a subconscious recognition of those changes, and an inner subjective experience. Like many emotions, pain also involves a system of universally recognized social communications (such as grimacing or wincing) and a motivational aspect – in this case, to get away from whatever is causing the pain. Finally, pain involves advanced social behaviors unique to our species, such as requests for help, and elicits particular behaviors in other people, ranging from sympathetic sounds (e.g., inhaling sharply through the teeth when witnessing another person being injured) to the provision of help.
Pain is a surprisingly difficult experience to define – mostly because pain is not a single sensation, but rather a string of interrelated physiological and psychological responses. Text Box 1 describes the importance of pain as a condition of survival. The word pain is derived from the Latin poena, which means penalty or punishment. In the 1600s, René Descartes argued that pain was simply a reflexive response to physical damage and could not exist unless there was an injury. Known as the specificity theory , this model dominated Western medicine for the next 300 years (Trachsel and Cascella, 2020). More recently, the International Association for the Study of Pain (IASP) defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP, 2017). Even this definition, however, fails to tell the whole story.
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