Skip to main content
SpringerLink
Log in

Perioperative Surgical Pain Management

  • Chapter
  • First Online:
Optimal Pain Management for the Dental Team

Part of the book series: BDJ Clinician’s Guides ((BDJCG))

  • 562 Accesses

Abstract

Acute dental pain continues to be under-managed, despite the availability of several effective over-the-counter analgesics. This article discusses the mechanisms underlying the pain experience, the impact of postoperative pain and how to overcome barriers to optimal pain management. Prescribing using principles of multi-modal analgesia will be covered as well as a discussion of associated side effects.

This article may contain repetition when read in conjunction with other articles in this issue as they are designed to be read independently.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet (London, England). 2011;377(9784):2215–25.

    Article  PubMed  Google Scholar 

  2. IASP. Global year against pain after surgery 2017. Available from: http://www.iasp-pain.org/GlobalYear/AfterSurgery.

  3. Dawes J AD, Bennett D, Bevin S, McMahon S. Inflammatory mediators and modulators of pain. In: McMahon S, Koltzenburg M, Tracey I, Turk D, editor. Wall and Melzack’s textbook of pain. Elsevier, Philadelphia, PA 2013.

    Google Scholar 

  4. Hudspith MJ, Sidall PJ, Munglani R. Physiology of pain. In: Hemmings HCH, Hopkins P, editors. Foundations of anesthesia: basic sciences for clinical practice. 2nd ed. London: Mosby Elsevier; 2005.

    Google Scholar 

  5. Vandermeulen EP, Brennan TJ. Alterations in ascending dorsal horn neurons by a surgical incision in the rat foot. Anesthesiology. 2000;93(5):1294–302; discussion 6A.

    Article  PubMed  Google Scholar 

  6. Juhl GI, Jensen TS, Norholt SE, Svensson P. Central sensitization phenomena after third molar surgery: a quantitative sensory testing study. Eur J Pain. 2008;12(1):116–27.

    Article  PubMed  Google Scholar 

  7. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.

    Article  PubMed  Google Scholar 

  8. Khawaja N, Renton T. Pain Part 3: Acute orofacial pain. Dental Update. 2015;42(5):442–4, 7–50, 53–7 passim.

    Article  PubMed  Google Scholar 

  9. Buvanendran A-N. Fact Sheet No. 2. Pain after surgery: what health-care professionals should know. International Association for the Study of Pain (IASP); 2017.

    Google Scholar 

  10. Szmyd L, Shannon IL, Mohnac AM. Control of postoperative sequelae in impacted third molar surgery. J Oral Ther Pharmacol. 1965;1:491–6.

    PubMed  Google Scholar 

  11. Howard MA, Krause K, Khawaja N, Massat N, Zelaya F, Schumann G, et al. Beyond patient reported pain: perfusion magnetic resonance imaging demonstrates reproducible cerebral representation of ongoing post-surgical pain. PLoS One. 2011;6(2):e17096.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arias A, de la Macorra JC, Hidalgo JJ, Azabal M. Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J. 2013;46(8):784–93.

    Article  PubMed  Google Scholar 

  13. Vena DA, Collie D, Wu H, Gibbs JL, Broder HL, Curro FA, et al. Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings. J Endod. 2014;40(12):1917–21.

    Article  PubMed  Google Scholar 

  14. Nixdorf DR, Law AS, Lindquist K, Reams GJ, Cole E, Kanter K, et al. Frequency, impact, and predictors of persistent pain after root canal treatment: a national dental PBRN study. Pain. 2016;157(1):159–65.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ince B, Ercan E, Dalli M, Dulgergil CT, Zorba YO, Colak H. Incidence of postoperative pain after single-and multi-visit endodontic treatment in teeth with vital and non-vital pulp. Eur J Dent. 2009;3(4):273–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J. 2005;38(3):169–78.

    Article  PubMed  Google Scholar 

  17. Estrela C, Guedes OA, Silva JA, Leles CR, Estrela CR, Pecora JD. Diagnostic and clinical factors associated with pulpal and periapical pain. Braz Dent J. 2011;22(4):306–11.

    Article  PubMed  Google Scholar 

  18. Cachovan G, Phark JH, Schon G, Pohlenz P, Platzer U. Odontogenic infections: an 8-year epidemiologic analysis in a dental emergency outpatient care unit. Acta Odontol Scand. 2013;71(3–4):518–24.

    Article  PubMed  Google Scholar 

  19. Martin WJ, Ashton-James CE, Skorpil NE, Heymans MW, Forouzanfar T. What constitutes a clinically important pain reduction in patients after third molar surgery? Pain Res Manag. 2013;18(6):319–22.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bandolier. Bandolier Oxford league table of analgesic efficacy. 2007a.

    Google Scholar 

  21. Bandolier. Acute Pain. Bandolier Extra, Evidence based healthcare [Online]. 2003. Available: http://www.bandolier.org.uk/Extraforbando/APain.pdf.

  22. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–7, e202–5

    Google Scholar 

  23. Toms L, Derry S, Moore RA, McQua HJ. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev. 2009;(1):Cd001547.

    Google Scholar 

  24. Derry S, Wiffen PJ, Moore RA. Single dose oral ibuprofen plus caffeine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2015;(7):Cd011509.

    Google Scholar 

  25. Bandolier. Oxford League Table of Analgesia, 2007. http://www.bandolier.org.uk/booth/painpag/Acutrev/Analgesics/lftab.html.

  26. Hersh EV, Levin LM, Cooper SA, Doyle G, Waksman J, Wedell D, et al. Ibuprofen liquigel for oral surgery pain. Clin Ther. 2000;22(11):1306–18.

    Article  PubMed  Google Scholar 

  27. Elzaki WM, Abubakr NH, Ziada HM, Ibrahim YE. Double-blind randomized placebo-controlled clinical trial of efficiency of nonsteroidal anti-inflammatory drugs in the control of post-endodontic pain. J Endod. 2016;42(6):835–42.

    Article  PubMed  Google Scholar 

  28. Smith EA, Marshall JG, Selph SS, Barker DR, Sedgley CM. Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: a systematic review and metaanalysis. J Endod. 2017;43(1):7–15.

    Article  PubMed  Google Scholar 

  29. Day RO, Graham GG. Nonsteroidal anti-inflammatory drugs (NSAIDs). BMJ (Clinical research ed). 2013;346:f3195.

    PubMed  Google Scholar 

  30. Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2013;(12):Cd004624.

    Google Scholar 

  31. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dental Assoc. 2013;144(8):898–908.

    Article  Google Scholar 

  32. IASP. Fact Sheet No. 2. Pain after surgery: what health-care professionals should know. 2017.

    Google Scholar 

  33. Anderson BJ. Paracetamol (acetaminophen): mechanisms of action. Paediatr Anaesth. 2008;18(10):915–21.

    Article  PubMed  Google Scholar 

  34. Poveda Roda R, Bagan JV, Jimenez Soriano Y, Gallud Romero L. Use of nonsteroidal antiinflammatory drugs in dental practice. A review. Medicina Oral, Patologia Oral y Cirugia Bucal. 2007;12(1):E10–8.

    PubMed  Google Scholar 

  35. Seymour RA, Ward-Booth P, Kelly PJ. Evaluation of different doses of soluble ibuprofen and ibuprofen tablets in postoperative dental pain. Br J Oral Maxillofac Surg. 1996;34(1):110–4.

    Article  PubMed  Google Scholar 

  36. Laska EM, Sunshine A, Marrero I, Olson N, Siegel C, McCormick N. The correlation between blood levels of ibuprofen and clinical analgesic response. Clin Pharmacol Ther. 1986;40(1):1–7.

    Article  PubMed  Google Scholar 

  37. Moore RA, Derry S, Straube S, Ireson-Paine J, Wiffen PJ. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain. 2014;155(1):14–21.

    Article  PubMed  Google Scholar 

  38. Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al. Vascular and upper gastrointestinc effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet (London, England). 2013;382(9894):769–79.

    Article  PubMed  Google Scholar 

  39. Sondergaard KB, Weeke P, Wissenberg M, Schjerning Olsen AM, Fosbol EL, Lippert FK, et al. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case-time-control study. European heart journal Cardiovascular pharmacotherapy. 2017;3(2):100–7.

    Google Scholar 

  40. Schmidt M, Sorensen HT, Pedersen L. Diclofenac use and cardiovascular risks: series of nationwide cohort studies. BMJ. 2018;362:k3426.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ. 2004;328(7437):434.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Szczeklik A, Nizankowska E, Mastalerz L, Szabo Z. Analgesics and asthma. Am J Ther. 2002;9(3):233–43.

    Article  PubMed  Google Scholar 

  43. Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011;(9):Cd008659.

    Google Scholar 

  44. Goldstein JL, Kivitz AJ, Verburg KM, Recker DP, Palmer RC, Kent JD. A comparison of the upper gastrointestinal mucosal effects of valdecoxib, naproxen and placebo in healthy elderly subjects. Aliment Pharmacol Ther. 2003;18(1):125–32.

    Article  PubMed  Google Scholar 

  45. Hegi TR, Bombeli T, Seifert B, Baumann PC, Haller U, Zalunardo MP, et al. Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac. Br J Anaesth. 2004;92(4):523–31.

    Article  PubMed  Google Scholar 

  46. Morales DR, Lipworth BJ, Guthrie B, Jackson C, Donnan PT, Santiago VH. Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: meta-analysis of controlled clinical trials. J Allergy Clin Immunol. 2014;134(1):40–5.

    Article  PubMed  Google Scholar 

  47. Sun SX, Lee KY, Bertram CT, Goldstein JL. Withdrawal of COX-2 selective inhibitors rofecoxib and valdecoxib: impact on NSAID and gastroprotective drug prescribing and utilization. Curr Med Res Opin. 2007;23(8):1859–66.

    Article  PubMed  Google Scholar 

  48. Aoki T, Ota Y, Mori Y, Otsuru M, Ota M, Kaneko A. Analgesic efficacy of celecoxib in patients after oral surgery: special reference to time to onset of analgesia and duration of analgesic effect. Oral Maxillofac Surg. 2016;20(3):265–71.

    Article  PubMed  Google Scholar 

  49. Hanzawa A, Handa T, Kohkita Y, Ichinohe T, Fukuda KI. A comparative study of oral analgesics for postoperative pain after minor oral surgery. Anesth Prog. 2018;65(1):24–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. FDA FaDA, editor. Briefing Document: Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee. April 24 and 25, 2018.

    Google Scholar 

  51. Khawaja N. Cerebral blood flow imaging of acute post-operative pain and analgesic response following third molar surgery. London: King’s College London; 2016.

    Google Scholar 

  52. Pickering G, Kastler A, Macian N, Pereira B, Valabregue R, Lehericy S, et al. The brain signature of paracetamol in healthy volunteers: a double-blind randomized trial. Drug Des Dev Ther. 2015;9:3853–62.

    Article  Google Scholar 

  53. Weiser T, Richter E, Hegewisch A, Muse DD, Lange R. Efficacy and safety of a fixed-dose combination of ibuprofen and caffeine in the management of moderate to severe dental pain after third molar extraction. Eur J Pain. 2018;22(1):28–38.

    Article  PubMed  Google Scholar 

  54. Nack B, Haas SE, Portnof J. Opioid use disorder in dental patients: the latest on how to identify, treat, refer and apply laws and regulations in your practice. Anesth Prog. 2017;64(3):178–87.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Best AD, De Silva RK, Thomson WM, Tong DC, Cameron CM, De Silva HL. Efficacy of codeine 5 when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: a double-blinded randomized control trial. J Oral Maxillofac Surg. 2017;75(10):2063–9.

    Article  PubMed  Google Scholar 

  56. Penprase B, Brunetto E, Dahmani E, Forthoffer JJ, Kapoor S. The efficacy of preemptive analgesia 5 for postoperative pain control: a systematic review of the literature. AORN J. 2015;101(1):94–105.e8.

    Article  PubMed  Google Scholar 

  57. Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol. 2011;24(3):331–8.

    Article  PubMed  Google Scholar 

  58. Bidar M, Mortazavi S, Forghani M, Akhlaghi S. Comparison of Effect of Oral Premedication with Ibuprofen or Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study. The Bulletin of Tokyo Dental College. 2017;58(4):231–6.

    Google Scholar 

  59. Nagendrababu V, Pulikkotil SJ, Veettil SK, Teerawattanapong N, Setzer FC. Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis. J Endod. 2018;44(6):914–22.e2.

    Google Scholar 

  60. Viswanath A, Oreadi D, Finkelman M, Klein G, Papageorge M. Does pre-emptive administration of intravenous ibuprofen (caldolor) or intravenous acetaminophen (ofirmev) reduce postoperative pain and subsequent narcotic consumption after third molar surgery? J Oral Maxillofac Surg. 2019;77(2):262–70.

    Article  PubMed  Google Scholar 

  61. Weil K, Hooper L, Afzal Z, Esposito M, Worthington HV, van Wijk AJ, et al. Paracetamol for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2007;(3):Cd004487.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK

    Nadine Khawaja

Authors
  1. Nadine Khawaja
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadine Khawaja .

Editor information

Editors and Affiliations

  1. Department of Oral Surgery, King’s College London, London, UK

    Tara Renton

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Khawaja, N. (2022). Perioperative Surgical Pain Management. In: Renton, T. (eds) Optimal Pain Management for the Dental Team. BDJ Clinician’s Guides. Springer, Cham. https://doi.org/10.1007/978-3-030-86634-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-86634-1_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-86633-4

  • Online ISBN: 978-3-030-86634-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation