Pain Management Flashcards

What is the pharmacological basis of topical benzydamine hydrochloride (Difflam) for oral mucosal pain?

Answer: An NSAID with local anaesthetic properties applied topically to oral mucosa — inhibits prostaglandin synthesis and has analgesic effect on inflamed mucosal surfaces

Benzydamine (Difflam) is a topical NSAID/local analgesic mouthwash effective for painful oral mucositis (from radiotherapy, chemotherapy, or surgery) and aphthous ulcers. It inhibits prostaglandin synthesis and provides surface anaesthesia.

What is 'allodynia' and when does it occur in dental/orofacial pain?

Answer: Pain from a stimulus that does not normally cause pain (e.g., light touch, air, cold water causing pain in irreversible pulpitis) — indicates sensitisation of the pain pathway

Allodynia is pain elicited by normally non-painful stimuli (e.g., touch, temperature, air). It indicates sensitisation of the pain pathway (peripheral or central). In irreversible pulpitis, allodynia explains pain from non-noxious stimuli like cool water.

What is the mechanism of paracetamol's analgesic action?

Answer: Not fully understood — proposed mechanisms include inhibition of COX-3 in the CNS, enhancement of endocannabinoid pathways, and serotonergic modulation — predominantly central analgesic action

Paracetamol's precise mechanism remains incompletely understood. Unlike NSAIDs, it has minimal anti-inflammatory effect peripherally. It acts centrally, possibly via COX-3 inhibition, endocannabinoid/serotonergic modulation, and reducing descending pain facilitation.

What is 'dry socket' (alveolar osteitis) and how is it managed?

Answer: Painful loss of blood clot from extraction socket exposing bare bone — managed by gentle irrigation, zinc oxide eugenol/Alvogyl dressing, and analgesia (NSAIDs + paracetamol)

Dry socket is painful exposure of the extraction socket bone after premature clot loss or failure, typically occurring 3–4 days post-extraction in lower molar sites. Management is palliative: socket irrigation, zinc oxide eugenol or Alvogyl dressing, and adequate analgesia.

What is the rationale for combining paracetamol and ibuprofen for post-operative dental pain?

Answer: They act via different mechanisms (central COX inhibition vs. peripheral prostaglandin reduction), providing additive/synergistic analgesia superior to either drug alone — multimodal approach

Paracetamol (central mechanism) and ibuprofen (peripheral/anti-inflammatory) target different components of the pain pathway, providing better combined analgesia than either alone, allowing lower doses of each while reducing side effects.

What is 'acute pulpitis' pain and how does it differ from 'irreversible pulpitis'?

Answer: Reversible pulpitis: short, sharp pain triggered by stimuli (cold) that resolves quickly; Irreversible: spontaneous, lingering, severe pain not fully resolving after stimulus removal — indicates pulp cannot recover

Reversible pulpitis: brief, stimulus-induced pain resolving within seconds — pulp can recover. Irreversible pulpitis: spontaneous pain and/or lingering pain after stimulus removal (>30 seconds) — irreversible inflammation requiring pulp extirpation or extraction.