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Chronic pain management and treatment
All people once in life have consumed some anti -inflammatory. The purpose of these is the decrease in the inflammation process in the body. Anti -inflammatories produce an inhibition or a reduction in the production of agents acting in the immune response nonspecific medicines before an infection of an external pathogenic agent.
As a type of medication, anti -inflammatories are not exempt from producing side effects in the consumer body, although generally any are well tolerated with a high percentage of patients who do not have important side effects, but it should be noted that in a non -negligible amount Adverse reactions are presented, mainly mild gastrointestinal, such as dyspepsia, hyperacidity, nausea, vomiting and epigastric pain or severe reactions such as gastroduodenal ulcer, bleeding and perforation, apparently more related to high doses and prolonged treatments. Among other side effects, we can find the increase in these vascular accidents, renal toxicity due to the drug platelet effect of drugs.
Medications with anti -inflammatory function are divided into two types: steroidal anti -inflammatories, such as corticosteroids for example, and non -steroidal anti -inflammatories, such as aspirin or ibuprofen (known as NSAIDs). These are among the most used pharmacological elements in the world for mild to moderate pain control, however, on many occasions they are misused to abuse them, being sometimes unnecessary their prescription.
On the WHO analgesic ladder, they are among the first steps.
The function of non -steroidal anti -inflammatories (NSAIDs) consists in the inhibition of cycloxygenase 1 constitutive (COX 1) and cyclooxygenase 2 pro -inflammatory (COX 2) caused in the site of inflammation, and subsequently the synthesis of prostaglandins and thromboxan. The ability of a NSAIDs to inhibit COX2 would explain its therapeutic action, and the ability to inhibit COX1, side effects. Prostaglandins have protection functions, for example, controlling the well -being of the gastrointestinal mucosa, on the other hand they sensitize the nociceptors. They also stimulate local vasodilation producing edema. They do not act on opioid receptors, play a role primarily on the periphery and have very little effect on the CNS.
It is estimated that the Aine day consumption is around 216 million doses, speaking of the average of acetylsalicylic acid (or aspirin) per year. NSAIDs have a maximum effect, this means that the increase in doses does not entail a therapeutic improvement and a greater incidence of adverse effects, so it is recommended not to increase the maximum doses. This is a big problem in today’s society, since people make unreasonable and impulsive use of these medications. It has been shown that more than half of the drugs are prescribed and incorrectly sold and that half of the patients do not take properly. The choice of an NSAIDs must be rigorous, based on its quality, safety and efficacy.
self-medication can be very helpful, especially when we feel that it affects us positively, and aims to improve pain in certain clinical situations through patient education, for which they should be involved to health professionals (doctors, dentists , Pharmacists, etc.). The analgesic treatment must be methodical to have adequate control of the efficiency and guarantee of the drugs and improve adhesion by the patient.
These types of medications, in addition to its anti -inflammatory and analgesic effect, has a considerable negative effect on coagulation, being an anti -addor of platelets. This quality gives them an effect against thrombosis. When a person has some kind of blood coagulation problem, it is recommended to avoid other consumption of acetylsalicylic acid, as well as non -steroidal anti -inflammatories. Being able to use in its absence and in case of needing some type of analgesic, paracetamol, which does not have anti -inflammatory properties and does not alter the platelet function, despite being considered an NSAID.
In dentistry, they are a good alternative for pulp and periodontal pain (the most used paracetamol and ibuprofen being moderate) of mild to moderate, temporomandibular disorders, dental post-treatment, mild to moderate postoperative pain and in combination with oral or parenteral opioid analgesics, This being an advantage, since minor opioid doses can relieve pain with less adverse effects.
Providing adequate treatment after dental surgery requires a careful medical history and proper anticipation of the level of pain that the patient can find. There are new options for available analgesics and should be considered, in particular combined analgesics, which can provide a faster start and prolonged duration of the action and can combat pain in multiple sites. A bad experience, as a consequence of unpleasant control of dental treatment can lead patients to avoid or postpone treatment. The development of new pain management strategies equip dental doctors with additional treatment options that can provide more effective pain relief.
Dentists have been using anti -inflammatories on the basis of commercial criteria or for the persistence of laboratories for imposing their products for a long time. The most used are paracetamol, diclofenaco, ketorolac, ibuprofen naproxen, each having their advantages and disadvantages.
We must keep in mind, and never forget that if we abuse the prescription of NSAIDs, it can modify the availability of the antibiotic. Today there has been an increase in the number of strains resistant to usual antibiotics of oral cavity. Approximately 10% of the prescriptions carried out by dentists have to do with odontogenic infections, such as prophylaxis of focal infection or local infection and extension to fabrics and neighboring organs. The use of NSAIDs in dentistry is based on clinical and bacterial epidemiology, they use antibiotics that act against a wide range of pathogenic bacteria, both against gram -positive and gram -negative, during short periods of time and a very small battery of antibiotics.
Duration of NSAID THERAPY IN Dentistry
By norm the therapy should not be extended by more than 48h to 72h, since at a longer time of use of NSAIDs, the higher the patient’s organic lesion risk. It is also recommended that if we have performed any intervention in our patients using local anesthesia and we know that later pain and inflammation will occur, attach the anesthetic effect with the analgesic-anti-inflammatory effect, thus reducing postoperative pain.
Periodontitis is a disease that continues immunologically with the release of many factors that induce the immune response causing the destruction of periodontal tissues, secreted by countless bacteria involved in the progression of periodontal disease.
Once the tissue colonization is initiated by bacteria, the immune response triggers the release of certain factors that function as an authentic network, and initiate the tissue destruction at the bone and connective level, leading to the loss of the tooth. Today the roads and factors are known, so these processes are triggered, and therefore different investigations have focused on proposing drugs that repress these waterfalls with the purpose of maximizing periodontal inflammation and tissue destruction.
Knowing the mechanisms of tissue destruction and the mediators that promote it, we can propose the search for drugs that inhibit their synthesis. Today, new possibilities are discovered to reduce tissue destruction based on the inhibition of processes other than those explained, and very different drugs are applied to the previous ones, such as phosphonates and tetracyclines. Initial studies focused on drugs like NSAIDs, but Cox 2 later was known, which is the most related to tissue inflammation.
As a consequence of the above, we can say that as we already know, NSAIDs anti -inflammator large therapeutic treatments. However, we must take into account its other negative effects on our body, not only of blood coagulation but of stomach damage. It should be noted that the use of these medications as we have seen is very widespread and in many occasions consumers are supplied by themselves disregarding a doctor’s advice, and ignoring other effects that could occur in the agency. In the field of dentistry they are also quite used, to reduce pains especially postoperative.