Pain management/the rx craze... Please read and consider if you are a dentist!

Discussion in 'General Dentistry Discussion' started by Synaptrix777, May 11, 2011.

  1. Synaptrix777

    Synaptrix777

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    I found this site and read through posts on a patient who was refused a rx after an extraction, and went through the whole process of registering just to respond/add my experience to this - I think it's important to have a patient's experience/feedback on here!

    I had a lower rear molar extracted 2 days ago, and have had 2 other extractions over the years. My first automatically included a prescription for I believe vicodan. From leaving the dentist's to going to the pharmacy, some of the novicaine began to wear off. Painful. By the time I was in the sitting area of the pharmacy, waiting for it to be filled, I was experiencing the most debilitating, agonizing pain - more pain than i have ever felt. When the pills started to kick in, it was an immediate relief, and a manageable pain from there on out. The second extraction was done at a different place, at a dentistry school. I was told that pain treatment consisted of taking the staggered ibproufen/advil mix, and that this offered the same level of pain relief, and "was the same thing." I dutifully followed these directions, and within an hour or so started to experience the same horrible pain as before. I hesitate to even use the word pain, because I don't think this really conveys the level of extreme, debilitating agony that I am talking about. I tried to tough it out, wait for the regime I was given to set in.. and could not stand it. I drove (!) in a desperate move to the previous dentist I had seen. He helped me, and I don't know if there was anything wrong with doing so or any risk involved but I cannot appropriately convey my gratitude to him for that. Having for any amount of time, this kind of pain, even in going to and waiting for the prescription (going through this in public, no less!), is a horrific thing to experience.
    This time, I approached it proactively, and explained to my dentist the experiences I've had, and made absolute clear that I could not and would not go through this again. The result was (very nicely) another explanation that the staggered ibproufen offered the same pain relief, that it was actually "the same thing", that opiates just take your mind off of the pain, and so on. The receptionist chipped in later that in her opinion, people are prescribed these things too much, and again the oral surgeon repeated the whole mantra. All this, and I had a prescription written and the extraction done. Again, as I waited in line at the pharmacy, the numbness was wearing off, and in the 45 minutes it took to get that bottle in my hands, the same agonizing pain had started to come one and only got worse. I have been taking one every 5 hours or so, not getting much sleep, and have had to go to work and manage a store since. It is not in any way nice to have to work while spaced out and sleep deprived, but I would not be able to stand or afford the alternative. I would go to the ER if placed in that position. I would find someone to buy "street drugs" from to not experience that. Isn't it a little crazy I would not hesitate to engage in illegal activities to alleviate this? How could I even be brought to think of that as an option, when the care I need is so easily possible to be provided to me? (I work hard! Pay a huge portion of my income, with that hard earned money, jump through the hoops I need to, deal with the on and off pain in my teeth, and live with a constant fear that I will never be able to catch up with the dental issues I face. I deal with more than enough, on my own end of my dental woes!)

    So, I understand the epidemic rise of prescription drug abuse going on right now. I understand doctors having a responsiblity to be careful, to avoid being a supplier, to avoiding possible charges, etc. However, this seems to be leading to an unacceptable imbalance. I have for the first time ever experienced what I would label presumed guilt instead of presumed innocence (guilty of seeking drugs vs. genuine need for care), experienced mistrust, suspicion, and implication. It is natural that I feel demeaned by this, it is in fact the right feeling in my situation. My stance now MUST be proactive to ensure I receive the care I need, and ironically, this stance also labels me as having potentially "drug-seeking" behaviors. In researching this, it is apparent that something must be done. I have no idea how, as a practice, network of practices, or even nation of practices, this can be addressed and resolved, but it must.

    I do know people experience pain differently. There aren't absolutes, only probabilities that what was effective for one is effective for another in a lot of these issues. There is science, studies and data (opiate vs. ibproufen in this case) that we can make decisions based on, but one's experience of pain is fact for them, and cannot be swept aside. The one point that came to my mind when talking to my current dentist, is that I suppose the prescription simply "taking my mind off of the pain" must in fact be a crucial part of pain management, for me. I can't understand that and it does not seem logical or believable that the prescription I got doesn't have a clearly identified, scientifically proven, higher, stronger dosage of pain alleviating properties. If this is absolutely true (I can't fathom it, at all), then there is an entire conversation that is being missed in the whole pain management debate, theory, what have you - isn't there?

    Thank you to anyone who actually read all of this (sorry it's so long!), and for any responses/suggestions/knowledge that might glean some light on this whole topic... I would really appreciate any information to help me understand or resolve this. :)
     
    Synaptrix777, May 11, 2011
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  2. Synaptrix777

    Mona Lisa

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    I read the whole thing.

    I too, am having the same issues with my cervical spine and they have prescribed me only muscle relaxers 3xs a day which does not kill the pain and knocks me out.

    I have oral surgery in 2 days. In my whole life I have had close to your first experience. Extraction, and then given approx. 10 Tylenol 3 with codeine and done! Now, I am very concerned about my upcoming surgery. I totally see your point and think ppl are freaking out over this opiate addiction. I have never been an addict, but my bf was....all prescriptive! Dentists coming to my home delivering his drugs in a small brown paper bag or calling past 7 PM. He threatened to sue my dentist and told him, "You cannot tell me how much pain I am in by law. I will pick up another prescription or you'll be talking to my lawyer. He was already on Methadone, Valium and Neurontin. The dentist gave him a second script for opiates. No lie. I heard his pain management doctor was under federal investigation. Now, everyone is suffering because of these addicts.

    An extraction cannot be handled with naproxen. Ask for Torodal next time, imho better than anti inflammatory. Stick with your first dentist!

    Better luck next time!
     
    Last edited: Apr 25, 2018
    Mona Lisa, Apr 25, 2018
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  3. Synaptrix777

    MattKW Verified Dentist

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    Synaptrix, yes this is a difficult area of medicine/dentistry. The low dose codeine/acetaminophen drugs here in Australia have recently been taken to "behind the counter" because of the dependence and toxicity problems. I can still prescribe heavier doses, but the patient needs a prescription. The accepted wisdom for mild to moderate pain is not the staggered acetaminophen/ibuprofen regimen you mention, but a combination acetaminophen/ibuprofen (e.g. "Nuramol" taken for 1st 24 hrs. An additional option to consider if you have so much pain after an extraction is to ask for a longer lasting local anaesthetic, e.g. bupivacaine or ropivacaine. I routinely give that to all my surgical extraction patients, plus the Nuromal. Good luck. And Toradol can have some serious side-effects.
     
    MattKW, Apr 25, 2018
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  4. Synaptrix777

    Mona Lisa

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    Excellent information. My surgery is scheduled for tomorrow and I do not want to go. I have to go. Yes, I suppose too much of the tooth is decayed and broken. I will mention the anesthetic and Nuramol. The last IM of Toradol left my muscles burning so bad I cried for hours.

    I will update tomorrow!
     
    Mona Lisa, Apr 25, 2018
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  5. Synaptrix777

    MattKW Verified Dentist

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    Good luck. Just be aware that not too many general dentists carry long-lasting LA; it's mostly used by oral surgeons.
     
    MattKW, Apr 26, 2018
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  6. Synaptrix777

    Mona Lisa

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    Hello!

    My update is that the oral surgeon and staff proved to be excellent. No pain med, only IB Profen 900 mg and 2 bottles of chlrohexidine. They did not have Nuramol. They did give me a longer lasting LA. Tonight very sore but tolerable. FYI: Pharmacist said he had a wisdom tooth pulled and only prescribed IB Profen.
     
    Mona Lisa, Apr 28, 2018
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  7. Synaptrix777

    MattKW Verified Dentist

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    Glad to hear. :)
     
    MattKW, Apr 28, 2018
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  8. Synaptrix777

    sekagirl

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    I was buchered out by dentist denied any pain med I was informed to take motirn which I AM ALLERGIC TO!! (was informed to take Benadryl along with motrin) well ended up in er so after that nightmare I am too reluctant to accept any sort of health care sad how health care has evolved !!!!
     
    sekagirl, Sep 30, 2018
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