Pathogenesis of Postoperative Oral Surgical Pain

In: Anesthesia

29 Sep 2009

Pathogenesis of Postoperative Oral Surgical Pain


Undertreatment of postoperative pain is common in surgical patients. It has been reported that approximately 40% of surgical patients suffer from moderate to severe pain during the first 24 hours postoperatively in the general surgical setting. Recently, the Royal College of Surgeons and Anesthetists opened their working party report on pain with the statement that “the treatment of pain after surgery in British hospitals has been inadequate and has not advanced significantly for many years.” This is indicative of the need for progress in the field of postoperative pain control.

Many oral surgical procedures also can give rise to pain. The third-molar surgical pain model will be used in this article for discussion. Removal of impacted third-molar teeth is one of the commonest oral surgical procedures performed in dentistry and invariably gives rise to a number of postoperative sequelae, among which pain is almost invariably present. Onset of pain usually begins as the effects of the local anesthetic agent subside. Unless treated, moderate to severe pain usually occurs during the first 24 hours, with a peak intensity after about 6-8 hours, when a conventional local anesthetic is used. An understanding of the pathogenesis of pain and the inflammatory process is essential for adequatemanagement of postoperative pain after oral surgical procedures. When you can’t afford your medication buy viagra professional online

A literature review was done for evidence-based studies on the pathogenesis of pain. A critical analysis of the current state of knowledge on the patho-physiological mechanism of pain was done with the aim to formulate therapeutic strategies for better management of postoperative oral surgical pain. Studies were identified by computer search with Medline, Pubmed, Embase, Cin-ahl, and Cochrane Library from 1966 to 2002. A broad, free-text search restricted to publications in English was undertaken using all variants of the terms “postoperative pain,” “dental pain,” and “pathogenesis of pain.” A hand search of relevant books or journals not indexed by the aforementioned indexes was also done.

The pathogenesis of postoperative oral surgical pain will be discussed in relation to the following:
• nociception;
• neuroanatomy of postoperative pain;
• neurophysiology of postoperative pain;
• neuropharmacology of postoperative pain;
• therapeutic strategies for postoperative pain.

Pain is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory andemotional experience associated with actual or potential tissue damage.” A critical aspect of IASP’s definition is that pain is defined in terms of human experience. It has both a sensory-discriminative and an affective-motivational component. The nature and severity of pain are the consequences of both the sensory events arising from tissue damage and the affective/cognitive mechanisms. This definition reflects the many anatomical, physiological, pharmacological, and psychological studies on pain that were undertaken during the last century.
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One aspect of pain is nociception, which is a complex series of electrochemical events that occur between the site of tissue injury and the perception of pain. A basic understanding of nociception is vital to good pain management. Nociception is made up of 4 processes:
• transduction, which occurs when a noxious stimulus acts upon free nerve endings located in various tissues, leading to electrical activity (depolarization) and resulting in the generation of a nerve impulse;
• transmission, which involves conveying these nerve impulses throughout the central nervous system (CNS);
• modulation, which refers to the central neural activity that dampens and controls the incoming pain signals;
• perception, where transduction, transmission, and modulation are developed into the subjective, sensory, and emotional experience of pain.
Control of postoperative pain may involve inhibiting any of these 4 processes.
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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.