MATE Act Course 4 - Pain Management and Substance Misuse-MATE Act Course 4

Video Transcription

Video Summary

The presentation focuses on effective pain management in dental practice, especially regarding patients with or at risk for substance use disorder (SUD). Beginning with historical perspectives on pain perception and the placebo/nocebo effects, it highlights the importance of setting patient expectations pre-procedure to improve pain outcomes. Dental pain is primarily acute and inflammatory, lasting typically up to 72 hours; managing this phase effectively is crucial.<br /><br />Different types of pain are discussed—nociceptive (acute toothache), neuropathic, central sensitization, and opioid withdrawal pain—with the latter being especially significant for patients misusing opioids or in recovery. Opioids, while commonly prescribed in dentistry historically, are less effective for dental pain than non-opioid alternatives like ibuprofen and acetaminophen, which studies show provide better pain relief with fewer risks. Opioids mainly mask pain by altering brain perception and may be used more for emotional pain relief than physical pain, raising concerns about their overprescription.<br /><br />The presentation details identifying drug-seeking behaviors, common patient strategies to obtain opioids, and emphasizes compassionate communication and screening methods like SBIRT to assess and refer patients as needed. The importance of opioid stewardship is underscored, noting that a single opioid prescription can increase the risk of future misuse or heroin use, especially in adolescents.<br /><br />Pain management protocols highlight NSAIDs and acetaminophen as first-line treatments for most dental procedures in adults and children, with opioids reserved for severe cases or contraindications and used cautiously, particularly in patients under 12 or those in recovery. New developments include long-acting local anesthetics (e.g., liposomal bupivacaine) that extend postoperative pain relief and reduce opioid needs.<br /><br />Lastly, the talk stresses the necessity of comprehensive patient education, follow-up, and individualized care plans, particularly for those with SUD history. It advocates for minimizing opioid prescriptions, utilizing multimodal pain control, and incorporating emerging tools like pharmacogenomics for precision medicine to improve outcomes and combat the opioid crisis in dental care.

Keywords

pain management

dental practice

substance use disorder

SUD

pain perception

placebo effect

nocebo effect

acute dental pain

nociceptive pain

neuropathic pain

opioid withdrawal pain

opioid stewardship

NSAIDs

acetaminophen

pharmacogenomics