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Pain part 1: introduction to pain Tara Renton Dental Update 2024 42:2, 707-709.
Authors
TaraRenton
BDS, MDSc, PhD
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
This series of papers aims to provide the dental and medical teams with an update in pain, both acute and chronic orofacial conditions, relevant to dentistry and medicine. Pain is the most common symptom for patients presenting to their dentist, and is increasingly commonly presenting to doctors as well, in general practice and A & E departments. Most of the dental team take for granted their knowledge and ability to manage acute dental pain. However, the education and preparation in managing patients with chronic pain conditions remains poor in many medical and dental schools. Conversely, medics are better educated and exposed to chronic pain during their undergraduate education, however, with regards to orofacial pain education, exposure is diminishing due to decreased exposure to dentistry, ENT, otolaryngology, OMFS and oral surgery. Thus many clinical teams remain disadvantaged when diagnosing and managing orofacial pain.
Clinical Relevance: Significant advances that have been made in understanding the pain mechanisms are not to be overlooked and have a huge impact on how we manage patients in pain.
Article
The Greek goddess of revenge, ‘Poine’, was sent to punish the mortal fools who had angered the gods. This gave us our word pain. Many ancient cultures believed pain and disease were punishment for human folly, resulting in many ‘pain-inducing rituals in ancient cultures’. Most people dealt with pain using some derivative of opium (first reported c5000 BCE). Opium is a Middle English word (c1100–c1500 AD) of Greek origin that passed through Latin into English. Opium is a diminutive of the ancient Greek opos, or milky juice of plants. Few reports of attempts were made to understand the mechanisms of pain. Galen (129–216) was the first to describe a network of nerves leading to the brain. Later, Mairnonides (1138–1204), a Spanish philosopher residing in Egypt, reported that ‘Galen's art heals only the body but Abou Amran's (Mairnonides) heals the body and soul’. Later, Descartes (1596–1650) was the first to state that pain was experienced in the brain, rather than in the heart, as the accepted Aristotelian doctrine. Patrick Wall and Ron Melzack's 1965 gate theory of pain1 was a breakthrough, based on our better understanding of pain pathways in man.
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