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Dentistry tackles issues of pain management (8/20/97)

Pain is the main reason patients seek emergency dental treatment and fear of pain is a major barrier preventing patients from seeking routine dental care, according to Kenneth M. Hargreaves, DDS, PhD, professor and new chairman of the department of endodontics at The University of Texas Health Science Center at San Antonio.

"Pain management has been revised during the last several years," Dr. Hargreaves said. "This is an ongoing area of research and very effective strategies have been developed for managing many forms of acute pain."

Pain caused by inflammation produces a distinctly different sensation =66rom pain induced by transient noxious stimuli, such as touching the tooth with a dental instrument during an examination. Inflammatory pain is usually characterized by its spontaneous occurrence; innocuous stimulus often produces a prolonged painful reaction. To control either type of pain the dentist must customize the patient's treatment plan, balancing the general principles of endodontics and the mechanisms of hyperalgesia - a condition which magnifies pain perception - with the medical history, nature of the pain and any current medications being taken by the patient.

"A common example of hyperalgesia is sunburn. Drugs used to block pain in hyperalgesia may offer new advances in the control of endodontic pain," Dr. Hargreaves said.

Numerous non-sterodial anti-inflammatory drugs (NSAIDs), such as ibuprofen, are available for the management of pain and inflammation. Opioids are also used, in combination with tylenol or aspirin, but opioids induce numerous side effects and chronic usage is associated with tolerance and dependence.

"A combination formula is preferred by both the endodontist and the patient," Dr. Hargreaves explained, "since this permits a lower dose of the opioid and reduces side effects."

The two major classes of analgesic drugs used in dentistry and medicine are both derived from plants. Aspirin is derived from the willow - the bark of the willow has salicylic acid in it - and opiates come from the poppy.

Dr. Hargreaves has accomplished three levels of research in pain management. In clinical studies of patients he has evaluated both novel and standard drugs, administering these drugs at different times and in different doses to maximize their benefits to patients. He has and is researching inflammatory mediators in the body, sampling chemicals released after surgical procedures to determine which mediators are most important in causing pain. And basic research is being conducted in his laboratory, using tissue in cell culture studies to evaluate biochemical methods of pain control.

"Research in pain mechanisms and teaching methods of pain management are important since it will lead to better techniques for diagnosis and treatment," Dr. Hargreaves said. "In my practice I am often challenged by patients who are in pain and as a scientist, I can think of nothing more important in my research than in helping those patients.

"UTHSCSA has one of the largest departments of endodontics in the country and a strong reputation for clinical studies," Dr. Hargreaves said. "Since many patients still think of root canals and pain as synonymous, one of the things I would like to do here is to complement the clinical side of the Health Science Center by adding to the research side, specifically in pain management."

Before coming to the Health Science Center, Dr. Hargreaves was associated with the National Institute of Dental Research for well over a decade, and later the University of Minnesota.

Contact: Jan Elkins (210) 567-2570