The current definition of pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage”. In laymen’s terms pain is subjective. It is whatever the person experiencing pain says it is. Pain can range widely in intensity, quality, and duration and has diverse pathophysiologic mechanisms and meanings. Pain is distressing, unpleasant and perceived as a negative experience.
Today we will discuss five pain management options we offer here at SkinSavvy Aesthetics. Which each route we will cover the time it takes to reach maximum effect, the amount of time it lasts, any contraindications and any possible side effects.
In medical spas, any oral pain medication recommended is usually over the counter. It is unlikely that you will be prescribed any opioids or prescription strength NSAIDS for the type of treatments you will be undergoing at SkinSavvy.
Acetaminophen, also known as Tylenol, works on the central nervous system. This accounts for its pain relief properties. The benefit to Tylenol is that unlike NSAIDs, there is no bleeding complication. One recent literature review determined that a single dose of Tylenol after a surgical procedure achieves a 50% reduction in pain over 4-6 hours. Tylenol reaches its peak effect in a little as half an hour. The maximum dose of Tylenol in a healthy adult is 4,000mg in a 24 hour period or 3,000mg in someone who’s taking the medication for a period of greater than 7 days. Contraindications include those with liver disease, malnutrition, low body weight, geriatric age or febrile illness. These circumstances would require a decrease in dosing.
NSAIDs are similar to Tylenol in the sense that they can be purchased over the counter to be used for moderate pain relief. However drugs in this category, such as Ibuprofen and Aleve, increase your risk for bleeding and bruising after undergoing minimally invasive aesthetic procedures. Onset for their pain relief effects can be as quickly as 30 minutes and can last up to 7 hours after administration. Headache, dizziness, rash, edema, alterations in blood pressure, abdominal pain, cardio vascular risks, peptic ulcer, GI bleeding are all concerns with use of NSAIDs.
The most common use of pain management at SkinSavvy is the use of topical numbing cream. We prefer a compounded mixture of Lidocaine and Tetracaine. This combination allows a quick onset and a duration that is adequate for our most uncomfortable treatments. With Lidocaine you can expect an onset of as quickly as 5-10 minutes and a duration of roughly 3 hours or more. In a recent double blinded study evaluating the effectiveness of Lidocaine/Tetracaine cream, it was found that pain scores were significantly lower in treatment sites compared to placebo. It was noted that 95% of subjects using the cream had adequate anesthesia. Any history of allergic reaction to numbing medications would be a definite contraindication and amount we use is also closely monitored to ensure we do not reach toxic levels.
Aside from using Lidocaine on the skin, we can also inject lidocaine into the skin and fatty tissue to achieve adequate pain relief for procedures. The effect of this administration is rapid and can last even longer than the topical route, depending on the dose used. An absolute contraindication, apart from an allergy, would be any tissue inflammation in the treatment area. Tumescent anesthesia is a common technique and involves the use of diluted lidocaine in large volumes and allows for higher maximum safe dosage of lidocaine. This is a method your provider may discuss with you for the use with Morpheus8.
Pro-Nox™ is a 100% self-administered N2O and O2 gas delivery system, producing effects which most practitioners and patients describe as “similar to laughing gas.” Unlike anesthesia (which halts the brain and body’s nerve signals), analgesia temporarily blocks the body’s pain signals from reaching the brain, and disassociates the brain’s ability to even process pain signals. Pro-Nox is FDA approved and can minimize the need for oral pain medications and numbing cream. Effects wear off in 5-10 minutes. The short-lasting effects of Pro-Nox allow the patient to reap the benefits of an pain medication, while still being able to drive before and after an procedure. Some possible short term side effects of nitrous oxide are dizziness, nausea, light-headedness, and unsteadiness. Anemia and/or a vitamin B12 deficiency is a major contraindication of Pro-Nox. Someone who suffers from extreme chronic fatigue, a typical symptom of anemia and B12 deficiency, should not use Pro-Nox. Pro-Nox is contraindicated for patients, providers and assistants in the first trimester of pregnancy. Other relative contraindications include nasal obstruction, chronic obstructive pulmonary disease, active cystic ?brosis, recent tympanic membrane surgery, claustrophobia, intoxication, and others.
Recently a number of studies have demonstrated a benefit from using a vibration device for injection associated pain. Using these tools has been shown to induce what is called stimulation-induced pain control. This concept originated from the Gate Control Theory of Pain reported in 1965. The thought is that while sending small stimulating signals to the brain, the brain is forced to focus elsewhere instead of on the painful stimuli alone.