I am doctor Theresa Gonzales from the James B. Edwards
College of Dental Medicine in Charleston, South Carolina.
I'll be presenting on a topic that is common to all of us
in health care practice and that is pain management and specifically,
chronic pain management and finally,
chronic orofacial pain management.
In the management of acute pain, dentistry,
as well as primary health care medicine has
a very well validated algorithm for the management of that pain.
It is codified in the World Health Organization's hierarchy
of pain management or stepped pain management.
And this is a skill set which has been deployed for more than 50 years
and has been effective in the management of post-surgical pain and acute pain.
Now, for the most part,
pain that occurs in the orofacial complex is acute.
And more commonly than not,
it involves the dentition.
And for that reason,
a patient experiencing any pain in
the orofacial region with the possible exception of headache will
default to primary care medicine or to
primary care dentistry to have that pain attenuated or alleviated.
This works very well with common pains,
with common pathologies like odontalgias,
inflammatory conditions of the pulp and periodontium for which there is abundant,
relevant history and pertinent history that informs that discussion,
as well as having the appropriate clinical factors that are evaluated.
Diagnosis is rendered, the treatment for that diagnosis is delivered and post-operative
pain or inter-operative pain are managed effectively with
the use of local anesthetic agents to keep all of that pain in the periphery.
That's the acute model,
and that is probably in the context of orofacial pain, the 90% solution.
Where we struggle, as does all of health care,
is in chronic pain management.
When that pain occurring in
the orofacial complex is not related to the dentition and there is
no organic source that can be reliably
identified, but there is the subjective symptom of pain.
Thus, it turns out pain is the primary motivator for
all unplanned or unscheduled health care encounters
across the ambulatory outpatients background.
Pain is the reason they come. And in the United States,
between about 9:00 pm and 3:00 am in the morning,
those individuals who have unreconciled pain tend to appear
at those touch points of care that are available for the management of pain after hours.
And for us, that tends to be emergency facilities,
and quite frankly, that's true around the world.
So it's brought about a rather significant discussion in the context of pain management.
In chronic pain, is it just an extension of acute?
Which is what we were classically taught.
Or is chronic pain a disease and not a symptom of disease?
So what we do know is that chronic pain ultimately manifests as
distinct brain disease, which impacts all aspects of the individual's life.
And if left untreated,
as a function of time, may become irreversible.