CASE STUDY A
Acute Pain
L.Y. is a healthy 13-year-old who had all her wisdom teeth removed 6 hours ago and is experiencing significant pain. She has been prescribed acetaminophen and codeine for pain relief and is at home recovering. Her mother wants her to rest and stop text- messaging her friends about her dental surgery.

1. How do acetaminophen and codeine act to reduce pain? What is a side effect of high levels of each drug? Why has the dentist prescribed only a limited supply of the medication?
2. How does L.Y.'s text-messaging behavior affect her perception of pain?
3. Does L.Y. need to rest in bed quietly to reduce pain?
4. L.Y. becomes increasingly irritated with her mother and tells her to "get off my case." How does L.Y.'s stress affect pain perception?

1. Acetaminophen and codeine act to reduce pain through different mechanisms. Acetaminophen is an analgesic and antipyretic that works by inhibiting the synthesis of prostaglandins, which are responsible for pain and inflammation. Codeine is an opioid analgesic that acts by binding to opioid receptors in the brain, reducing the perception of pain. Side effects of high levels of acetaminophen include liver damage, while high levels of codeine can lead to respiratory depression, constipation, and addiction. The dentist prescribed a limited supply of the medication to minimize the risk of side effects and potential dependence.

2. L.Y.'s text-messaging behavior may have both positive and negative effects on her perception of pain. On one hand, communicating with friends can provide a distraction, which may help to reduce the perceived intensity of the pain. On the other hand, continually discussing her dental surgery may keep her focused on the pain, potentially exacerbating it.

3. Resting in bed quietly may help L.Y. to reduce pain by allowing her body to recover and heal. However, engaging in gentle activities that distract her from the pain, such as reading or watching a movie, can also be beneficial. It's essential to find a balance between rest and distraction that works best for L.Y.

4. L.Y.'s stress can negatively affect her pain perception. Stress can increase the release of stress hormones, such as cortisol, which can intensify the sensation of pain. Additionally, stress can exacerbate emotional responses, leading to increased discomfort and a heightened perception of pain. It's crucial for L.Y. to manage her stress levels during recovery to ensure optimal pain control.