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Related Concept Videos

Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Local Anesthetics: Adverse Effects01:12

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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Disparities in Emergency Department Pain Treatment for Toothache.

H H Lee1, C W Lewis2, C M McKinney3

  • 1Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA.

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|September 8, 2017
PubMed
Summary

Black patients and those with non-private insurance receive fewer opioids for emergency department toothache pain compared to white patients and those with private insurance, indicating racial and insurance-based disparities in pain management.

Keywords:
analgesiahealth equityhealth services accessibilityminority healthoral healthphysician practice patterns

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Area of Science:

  • Emergency medicine
  • Health services research
  • Pain management

Background:

  • Emergency departments (EDs) are increasingly relied upon for dental care.
  • Racial disparities in ED toothache pain treatment are not well-documented.

Purpose of the Study:

  • To investigate associations between race/ethnicity, insurance type, and ED toothache pain treatment.
  • To identify potential disparities in pain management for toothache patients.

Main Methods:

  • Nationally representative cross-sectional study of adult ED toothache visits (2008-2010).
  • Utilized the National Hospital Ambulatory Medical Care Survey data.
  • Employed multinomial regression models to analyze treatment outcomes (none, nonopioid, or opioid pain medicine).

Main Results:

  • Black patients had higher odds of receiving nonopioid-only pain medicine compared to white patients.
  • Patients with Medicare, Medicaid, or other non-private insurance had significantly higher odds of receiving nonopioid-only rather than opioid pain medicine compared to privately insured patients.
  • Racial and insurance status disparities were observed in opioid prescription rates for toothache pain.

Conclusions:

  • Significant racial and insurance-based disparities exist in emergency department pain management for toothache.
  • Black patients and non-privately insured individuals are less likely to receive opioids for toothache pain.
  • Further research is needed to understand the causes of these disparities and develop targeted interventions.