Learning Objective #1: The learner will be able to identify three reasons objective measures of acute pain are useful for clinical practice.

Learning Objective #2: The learner will be able to identify groups of patients who are undertreated for acute pain due to inability to report their pain experience.

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Purpose: To test four biological markers contained in saliva as easily obtained physiological measures of pain. The assessment of pain is now regarded by many health care institutions as the fifth vital sign, similar to the other vital signs like blood pressure, pulse, temperature and respiratory rate. Pain is a frequent cause of patients seeking health care, yet healthcare providers often under treat pain. The personal and subjective nature of the pain experience for patients creates a unique challenge for healthcare providers to treat it adequately. Objective measures of pain would assist healthcare providers in assessing patients' pain and would help to assure more adequate pain control measures.

Methods: In this study we will use the well-established elective third molar extraction model of pain to assess the correlation between salivary biomarkers and visual analog scale (VAS) measures of pain in 60 subjects before and after dental extraction. Saliva and VAS scores will be obtained before extraction and again once the local anesthetic has begun to wear off and pain is experienced. The saliva samples will be analyzed for substance P, alpha amylase, lysozyme and total salivary proteins that several studies have found to vary with pain.

Findings: Data collection for this study is scheduled to begin in January 2008.

Conclusions: Salivary measures offer advantages over blood measures including: ease of obtaining multiple samples, and less risk to healthcare personnel. An objective non-verbal measure of pain would help healthcare providers adequately treat groups of non-verbal patients such as children, stroke victims, intubated patients and those who are comatose, among others. Furthermore, objective pain assessment could reduce treatment disparities by practitioners who are reluctant to rely solely on patient reported pain symptoms in prescribing analgesics for groups of patients such as racial and ethnic minorities who are sometimes labeled as drug seekers.