 Hello everyone welcome back to another session in dentistry and more today. We have pain management in palliative care This palliative care is a very vast topic So this session is about a very superficial Overseeing of the pain management in palliative care even the pain management is very Wast we are just going very superficially. So first of all we need to understand the components of pain In a palliative care patients that is it just it's not a physical pain. It has all other dimensions we can Make a acronym PAIN Pain that is a physical pain It is like the symptoms or conditions what the patient is suffering from like arthritis The bladder spasm headache thresh and as well as a cancer pain It stands for the anxiety anchor depression hopelessness and The eyes stands for interpersonal issues such as family tensions financial issues and Stands for non-acceptance Of approaching the death that is more of like a spiritual pain So, how do we plan? Pain management so before that we need to assess the pain we can use Many scales commonly used very descriptive scales or was scale that is visual analog scale Visual Analog scale so very commonly used scale Then The faces scale So once the pain is assessed we can use the World Health Organization ladder of pain management Okay, so in this pain management ladder commonly used up opioids and other adjuvants and also non opioids It depends upon the severity of pain. Okay So it starts from very milder pain. So in milder pain we can go for non opioids and adjuvants So opioids are commonly the centrally acting drugs morphine hydromorphine fentanyl and methadone and Adjuvants the lots of adjuvants. It can be an algesic. It can be a radiation therapy It can be a calciton and bisphosphonate or anti convulsions or anti depressants anything we add To the opioids or non opioid regimen Is considered as a adjuvant So for milder pain we can go for non opioids and adjuvants For mild to moderate pain. We should start opioids with or without adjuvant and for moderate to severe pain also we need to try different opioid with or without adjuvant so each level we Give different opioids The potency will be increasing as we go higher. So that is a scale and this will be the pain free so ultimate aim of this ladder is to Make the patient pain free. So at the bottom we have very milder pain where we use non opioids with adjuvants Then for mild to moderate pain we have opioids With or without adjuvant that is this plus or minus sign then for moderate and severe pain similarly opioids With or without adjuvants, but the potency and the drug will be different at the third level And finally the patient will be pain free. So most commonly when we give opioids We need to give laxatives because of the main disadvantage of this morphine and all is a constipation So in order to relieve the patient out of constipation, we need to give laxatives That was all about pain management and palliative care from Last two years since the palliative care has been included in the dental curriculum questions were regularly asked for all University exams so the question might be different, but whatever question under palliative care comes Palliative dental care or palliative care if it is a palliative dental care You can write a little bit about the dental care along with this But you need to include all these points like the components of pain How do we assess the pain and this WHO ladder and all the four components then regarding the Various checks we use that is non opioids opioids laxatives and adjuvants So these points will give you around 60 to 70 percentage of the mark So I'll come up with a new topic in the industry and more. Thank you