Narcotic analgesics as adjuncts to dental practice.

Pain is both a symptom and a sensation. As a symptom, pain signals danger and thus provokes appropriate reflexes. Sher­ rington,2 accordingly, described pain as “the psychical adjunct of an imperative protective reflex.” From a therapeutic viewpoint, pain is a valuable clinical symptom to the practitioner. It also follows that the management of pain— a symptom— must be subject to the same limitations as any other pallia­ tive or symptomatic treatment. Because pain is also a sensation, it is a highly personal and individual experience. Variations in the sensation experienced by different individuals in response to the same noxious stimulus are to be expected, but there are also wide differences in the response of the same individual. For ex­ ample, one would expect that the reac­ tion of a phlegmatic, stoic patient to the dental bur would be quite different from that of a nervous, “high-strung” woman. Yet the same stoic might behave in an­ other fashion if he came to the dentist’s office after a distressing experience with the Bureau of Internal Revenue. Or the same nervous woman might be more complacent if she arrived at the office after a triumphant session at the bridge table. Thus, the reaction to pain often differs in the same individual as well as between individuals. As a physiologic entity, pain can be considered as being composed of at least the following: