Pain Management

Toothache, jaw and facial pain. Postoperative pain.

Patients in pain are always seen promptly. Analgesics such as paracetamol (eg Panadol) and ibuprofen (eg Nurofen) in their various forms and combinations are very effective in most situations, with minimal side effects if used following the manufacturers’ instructions. When prescribed in combination with codeine (eg Panadeine/Nurofen Plus) they may help control more severe pain, but side effects from the codeine (eg nausea and vomiting) are common.

Side effects such as abdominal pain and heartburn from ibuprofen (as can occur with all non-steroidal anti inflammatory medications) can be minimized by taking them with food, and it is always important to drink plenty of fluids.

Antibiotics do not relieve pain per se, but by treating infection, reduce pain intensity over time as they start taking effect. Effective pain management depends on an accurate diagnosis. A dental/medical history and a comprehensive examination (often including X-rays and scans) is required. Information provided by the referring doctor or dentist is always especially helpful.

More about Pain Medication

As a general rule two paracetamol taken 4-6 hourly provides baseline pain control, with a maximum of eight (500mg tablets) in a 24 hour period for adults. In addition to this, most other pain medication can be taken together with (or in between doses) provided they do not contain paracetamol as well.

A precautionary word about Codeine (which also applies to all other opioids): Codeine on it’s own or in combination with other analgesics can provide additional benefit in cases of severe pain, but it becomes a balance between achieving pain control and mitigating side effects – nausea and vomiting being the commonest and most distressing complication; and this can continue for much longer than the pain relief. Individuals who are ‘used to’ these drugs are less likely to have these problems, but constipation, stomach cramps, and lightheadedness can also occur, increasingly so with duration of use.

Furthermore, a certain number of people don’t have the enzyme that converts codeine into it’s active metabolite and it may therefore provide no benefit. So all-in-all codeine may not be a viable option except In selected cases…Hence Panadeine/Prodeine/Panadeine Forte/Nurofen Plus (contain codeine 8,15,30,12.8 mg respectively) may be prescribed by your surgeon, but only if considered appropriate.

There are other opioid/narcotics and also non-steroidal anti-inflammatory analgesics that can be prescribed especially after a potentially painful surgical procedure. Toradol (ketorolac) is very effective eg after wisdom tooth extraction and instructions regarding it’s use are fully covered in the SURGICAL EXTRACTION section. Other modalities for managing pain are utilised for specific problems and are dealt with in their relevant sections.