Pain relief

How does pain relief (analgesics) work?

Toothache results from pain transmitted from damaged (inflammed) tissues along nerve fibres to the brain. Analgesics work to interfere with this pathway. Analgesics can:

–Affect the central component and the emotional aspects of pain, the brain’s perception of pain (e.g. opioids and antidepressants)

–Work at the site of injury to decrease the pain associated with an inflammatory reaction (e.g. non-steroidal anti-inflammatory drugs)

–Alter nerve conduction (e.g. local anaesthetics)

–Modify transmission (e.g. opioids and some antidepressants)

What pain medications can be used for toothache?

Opioids

– Work at various points of the pain pathway and diminishes the brain’s perception of pain.

– Side effects: Respiratory depression, nausea and vomiting, constipation, fatigue, dependence.

– These medications require a prescription:

• Codeine phosphate tablet (15-60mg) four times a day, maximum 300mg daily
• Tramadol capsule (50mg) or slow release tablet (100mg), 50-100mg every four times a day, maximum 400mg daily

Non steroidal anti-inflammatories (NSAIDs)

– NSAIDs work at the site of tissue damage to decrease inflammation.

– Avoid this medication if known hypersensitivity to NSAIDs, some asthmatics (9-20%), taking warfarin, have a bleeding disorder, prone to gastrointestinal ulceration and bleeding, have a serious acute infection.

– These medications can be purchased over the counter without a prescription:

• Naproxen Sodium (Synflex) tablet (275mg), take 275mg three to four times daily for maximum 1375mg daily
• Diclofenac (Voltaren) tablet (25 – 50mg) two to three times a day for maximum 450mg daily.
• Ibuprofen (Neurofen) tablet (400mg, 200mg), take 400 to 600 mg three to four times daily for maximum 2400mg daily.
• Ibuprofen suspension 100mg/5ml, the dosage is calculated per weight (kg) of the patient. Best to contact your dentist or GP for the most accurate dosage calculation. Ibuprofen for children is not recommended below the age of 6 months, and Paracetamol should be used in the first instance for children. Seek medical advise before giving Ibuprofen to children under the age of 12 months.

Paracetamol

– Paracetamol is an analgesic as well as an antipyretic (reduces fever). Paracetamol acts to block the pain signal centrally to the brain.

– Adverse reactions are rare if taken in recommended dosage. Not following the recommended dosage can result in liver damage.

– Paracetamol does not require a prescription and can be purchased over the counter.

• Paracetamol tablet (500mg), adult dose 500-1000mg four times daily maximum 4000mg daily.
• Paracetamol suspension 120mg/5ml and 250mg/5ml, the dosage is calculated per weight (kg) of the patient. Best to contact your dentist or GP for the most accurate dosage calculation.

Can I use a combination of pain relief medications?

Yes, this is called multimodal analgesics (a combination) in which more than one method or modality for controlling pain is used. Using a combination of medications which operate through different mechanisms or at different sites along the pain pathway can be very effective in controlling pain.

Maxigesic is an over the counter medication which contains Paracetamol (500mg) and Ibuprofen (150mg). 1-2 Maxigesic tablets can be taken every 4-6 hours with maximum 8 tablets daily. Paracetamol blocks the pain signal centrally to the brain’s cortex while Ibuprofen blocks the pain transmission at the site of the tissue damage.

Panadeine is an over the counter medication containing Paracetamol (500mg) and Codeine (8mg or 15mg) depending whether it is the plus version of the product. 1-2 Panadeine tablets are taken every 4-6 hours with maximum 8 tablets daily. Paracetamol blocks the pain signal to the brain while codeine works centrally to diminish the brains perception of pain.

Another effective way to combine medications is take a different medication at different times. Each medication takes time to reach its most effective level before tapering away as it is metabolised. The idea is to have the second medication peak as the first mediaction is tapering away thereby creating a “blanket” effective. For example:

• Ibuprofen 4oomg, after 3 hours take 1000mg paracetamol, after a further 3 hours take 400mg Ibuprofen and so on.
• Ibuprofen 400mg, after 3 hours take Panadiene, after 3 hours take 400mg Ibuprofen and so on.

Why did my dentist recommend I take two Ibuprofen before my tooth removal?

Your dentist was considering pre-emptive analgesia which is the administration of one or more analgesics prior to a noxious event. Pre-emptive analgesia attempts to prevent peripheral and central sensitisation of nerves, minimizing post-injury pain.

To find a dentist for more definitive pain relief visit www.fillinggaps.co.nz.

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