An analgesic drug, also called simply an analgesic, pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain. It is typically used to induce cooperation with a medical procedure.

3. PAIN
‘An unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage or
described in terms of such
damage.’
Bonica JJ. The need of a taxonomy. Pain. 1979; 6(3):247–8

4. NOCICEPTION
Nociception is a term
used to describe the
ability of organisms to
detect noxious or painful
stimuli.
Wall and Melzack’s Textbook of Pain, 2000

7. FIRST
ORDER
NEURON
DESCENDING
MODULATING
SYSTEM

9. Descending Pain Modulating System
Neural network permits
pain experience based on
• Cognitive
• Emotional
• Attentive aspects

10. Modulation

13. Gate Control
Theory of Pain

16. PERCEPTION OF
PAIN
The subjective response of suffering and pain
behavior that results when pain information is
received in the higher centers of the brain.

17. Sensory and Motor Homunculus

19. ANALGESIA
A neurologic or pharmacologic state in
which painful stimuli are moderated
such that, although still perceived, they
are no longer painful.

23. I
N
F
L
A
M
M
A
T
I
O
N
MECHANISM

29. COX 2
Inhibitors

30. NSAID Selectivity

31. OPIOIDS

37. Dentists’ Considerations for Post-Op Pain
Management
1. The pain is
– usually not severe
– can be managed in most patients with mild OTC
analgesics
2. The peak pain experience occurs
– about 12 hours after the extraction
– diminishes rapidly after that
3. significant pain from extraction
– rarely persists longer than 2 days after surgery.

39. • Only when prescribed appropriately.
• Best managed by removing the Cause
• Appropriate and inappropriate use of antibiotics and
opioid analgesics can lead to serious adverse drug
events.
• Opioids prescribed for dental pain have the potential
for misuse, abuse, or addiction.
• Opioid misuse and abuse are strong predictors for
adverse events, including overdose.
Ralph D et al. Role of Dentists in Prescribing Opioid Analgesics and Antibiotics: An
Overview. Dental Clinics of North America, Vol. 62, No. 2 (April 2018): 279-294
Role of Dentists in Prescribing Opioid
Analgesics and Antibiotics: An Overview

40. Checklist for Prescribing Opioids for
Acute Dental Pain
• PATIENT EVALUATION
– History of previous opioid use and experience
– Potential Drug Abuse
• MULTIMODAL PAIN-MANAGEMENT STRATEGIES
– Preventive NSAIDs (ie, naproxen sodium 550 mg, ibuprofen 600 mg)
– Long-acting local anesthesia/analgesia (0.5% Bupivacaine with epi)
– Corticosteroids (dexamethasone 8 mg i.m. or i.v.) - Surgery
• PATIENT EDUCATION AND COUNSELING
• PATIENT COUNSELING
– Follow the labeled instructions
– Avoid alcohol and sedative drugs
– Dispose unused tablets properly
R.A. Dionne, S.M. Gordon, P.A. Moore Prescribing opioid analgesics for acute dental pain: time to change
clinical practices in response to evidence and misperceptions Compendium, 37 (2016), pp. 372- 378

41. Mild Pain
• As needed
• OTC NSAIDs
• e.g.
Ibuprofen,
Naproxen,
Ketoprofen
Mild to
Moderate
• Regular
Ibuprofen
400-600 mg
4-6 hourly
• Until pain
subsides
Moderately
Severe
• NSAID e.g.
Ibuprofen 400-
600 mg pre-op
or immediate
Post Op
• Long Acting LA
Bupivacaine
0.5% (Procedural
and/or Post Op)
• NSAID
concurrently or
alternating with
Acetaminophen
Severe
• Acetaminophen
combination with
Opioid
• Up to 2 tablets
Acetaminophen 325 /
Tramadol 37.5 mg
(Tonoflex P)
D/C Regular
Acetaminophen
• 3 Days only
• Additional NSAID SOS
R.A. Dionne, S.M. Gordon, P.A. Moore Prescribing opioid analgesics for acute dental pain: time to change
clinical practices in response to evidence and misperceptions Compendium, 37 (2016), pp. 372- 378
Prescribing Analgesics
for Dental Pain

43. Adjunctive and other medications
• Antidepressant
• Anticonvulsants
• Local Analgesics
• Antihistamines
• Antipsychotics
• Benzodiazepines
• Cannabinoids
• Placebos

44. NSAIDS
• Great caution should be exercised when using
NSAIDs during pregnancy. In dealing with
pregnant patients, acetaminophen usually is
the first choice.

45. Common Medical Conditions and
Associated Analgesics
Medical Conditions Analgesics to be used Analgesics to be avoided
Hypertension Acetaminophen
(Paracetamol) , OTC Opioids
in low doses (Tramadol)
NSAIDS ( e.g. Naproxen
Sodium)
Asthma Acetaminophen NSAIDS (e.g. Inflammatix,
Synflex, Celebrex)
Liver Disease NSAIDS (Inflammatix,
Synflex, Celebrex)
High doses of
Acetaminophen, High doses
of Opioids
Kidney Disease Acetaminophen
(Paracetamol, Tylenol)
Opioids, NSAIDS

46. Research Based
Findings
regarding
Analgesia

49. Patients with kidney failure are at increased risk
for adverse effects of opioids due to reduced
elimination and increased accumulation of the
parent analgesic and/or active metabolites.
Analgesics may also be removed by dialysis,
leading to uncertain analgesic effects during
treatment.

50. The demonstrated efficacy of postoperative pain relief
using the combination of ibuprofen and APAP provides a
potentially valuable strategy for postoperative pain
management in dentistry and an alternative to
prescription opioid formulations following dental surgery.

51. Acute liver failure (ALF) is defined
as the presence of hepatic
encephalopathy and coagulopathy
in patients with no history of liver
disease. Acetaminophen-induced
hepatotoxicity is an important
cause of ALF. Acetaminophen is
one of the most widely used
analgesics with few side effects
when taken in therapeutic doses
and hepatotoxicity is a common
consequence of acetaminophen
overdose.