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dental procedures and acute pain management in the chronic pain patient
I'm having intensive dental surgery tomorrow. I am a chronic pain patient on methadone 5mg tid.
I am wondering if any here have faced a similiar situation and what their pain management for the dental procedure was like. I know my dentist was going to talk to my pain doctor but I haven't heard anything from either one yet. I do see my pain doctor tomorrow before the surgery. I would feel better if I had a general idea of what is in store for me. There is going to be some bone scraping done....anybody had that done?!? Thanks for your help.
I am wondering if any here have faced a similiar situation and what their pain management for the dental procedure was like. I know my dentist was going to talk to my pain doctor but I haven't heard anything from either one yet. I do see my pain doctor tomorrow before the surgery. I would feel better if I had a general idea of what is in store for me. There is going to be some bone scraping done....anybody had that done?!? Thanks for your help.
Thank you so much for your kind words of support. I am worried sick I'll get a dry socket from messing with the sore places with my tongue. I can't help myself!
Other than that and looking like Grandma Gums, things are getting better by the minute. I can't wait until thursday and I plan on being a very good girl between now and then! One thing, I have a wad of gelfoam imbedded in one the sockets and I'm wondering what's up with that. Any ideas? I will call the office monday and ask a nurse. I don't think it is supposed to be there. Thanks again Sherry for your time and interest. It really helps to get feedback from someone who has an idea of what things are like when you feel like you are under assault with all this pain coming at you.
Other than that and looking like Grandma Gums, things are getting better by the minute. I can't wait until thursday and I plan on being a very good girl between now and then! One thing, I have a wad of gelfoam imbedded in one the sockets and I'm wondering what's up with that. Any ideas? I will call the office monday and ask a nurse. I don't think it is supposed to be there. Thanks again Sherry for your time and interest. It really helps to get feedback from someone who has an idea of what things are like when you feel like you are under assault with all this pain coming at you.
Beano, how devastating to you that they weren't able to finish the "job"!! I canonly imagine how disappointed you must be. :(
It just goes to show, once again, that you are NEVER to old to learn something. As you proved about the instructions with the antibiotics!! You really are fortunate as sometimes if you don't take the antibiotics and get rid of the infection as they instructed you to they will refuse to even begin the procedure until the infection is gone. At least the largest part of the removal is behind you now. :)
PLEASE be careful getting up and down!! All you need is to fall and break something on top fo all that you are going through right now!!!
We are all thinking of you and hope that somehow this pain will get better for you. I'm VERY thankful that you included your PM Doctor in on this as you are correct in that it WILL go a L_O_ N_N_G_G in building that trust between you and your PM Doctor that is CRUCIAL for you to have in your Pain Management!! Congratulations on doing that!!
I hope that you have less pain with each day and that your five days will go by FAST!!!
Please keep us updated and feel free to VENT here during this at any time you need to!!!.........Sherry
It just goes to show, once again, that you are NEVER to old to learn something. As you proved about the instructions with the antibiotics!! You really are fortunate as sometimes if you don't take the antibiotics and get rid of the infection as they instructed you to they will refuse to even begin the procedure until the infection is gone. At least the largest part of the removal is behind you now. :)
PLEASE be careful getting up and down!! All you need is to fall and break something on top fo all that you are going through right now!!!
We are all thinking of you and hope that somehow this pain will get better for you. I'm VERY thankful that you included your PM Doctor in on this as you are correct in that it WILL go a L_O_ N_N_G_G in building that trust between you and your PM Doctor that is CRUCIAL for you to have in your Pain Management!! Congratulations on doing that!!
I hope that you have less pain with each day and that your five days will go by FAST!!!
Please keep us updated and feel free to VENT here during this at any time you need to!!!.........Sherry
Golly gee, you guys! Thank you so much for the kind send off, I appreciate the kindwords SO much. It's not over, he maxed out on the lidocaine dosage (infection made it very difficult to manage the pain and numb me completely.) I have 5 teeth left and have to come back in a week. Five!!! In a WEEK?!! I cried when he said he couldn't finish because I so wanted to get it overwith. My doc is so kind, he took his time explaining everything and I accept what has to be (resigned is a better word!).
Anyway, for those of you want to know what the plan of care was when the surgeon and pain med specialist work together (as should be, don't misunderstand) here goes. No Narcs during the procedure. Best explanation: they don't work because you have been on a narc for so long, hard to establish what would be a good dose,etc. (you were right on the money, Sandee 1818!) I had a prior heart attack from my chemo and that also complicated things, however, my heart was fine during procedure, altho bp went thru the roof at choice moments !) So, bye bye to the planned midazolam/fentanyl mini-sleep planned and hello to very small dose of propofol and mucho lidocaine. At this point I must tell you what I did to make everything so much worse and DON"T BE LIKE BEANO!! SHE STUPID-BAD!! If you are given antibiotics a week before the procedure, start them right away! Don't wait until the night before as I did. I had so much unresolved infection it made it very difficult to numb my mouth. If I had started my med like I should have it wouldn't have taken so much lidocaine and he could have pulled all the teeth. Bottom line, the mess I'm in is mostly my fault. Also because Beano too smart for own good, Gobs and Gobs of painI
The shots were many and hurt like an ATM eating your paycheck, Today those places where I got the shots hurt terribly and everytime I clean up the drool on my chin and chest it reminds me of how dopey I can be even without the medication! I will take antibiotics now, no problem. Post surg I was given perkies 5/325mg #40 1-2 Q3-4hprn. I continued my methadone 5mg tid. By late evening I'd had 3 doses (2 each time) of perkies (woeful misnaming of medicine on my part) and my usual methadone. I felt clear headed but I forgot to ask my legs. Under normal circumstances I have trouble getting up and walking after sitting for awhile and I have to hold onto things for a few steps until my knees unlock and my muscles relax and I can walk easier. I thought I did that but I ended up falling anyway. Like many drunks in car wrecks, I was unhurt even tho I whacked my head good and my knees were still "locked" when I fell. Lesson is you are probably high as a kite as far as your body is concerned, even tho your brain isn't going all psychedelic on you. Be careful getting up, sitting down, walking around, etc.
I saw my pain doc after the surgery in the afternoon and managed to look so pathetic that I was in and out of there in 15 minutes. She gave me props for the way I handled keeping her in the loop and that will probably go a long way in building further trust in my relationship with her. If I had kept my mouth shut about that part of my medical history, I would have had a much more pleasant experience with stronger anesthesia. But it would have come at a cost...it wouldn't have been as safe and just as importantly, it would have been based on dishonesty-with my dentist by omission and with my pain doc by denial. Having an honest relationship built on trust is so important, most eapecially with my pain management doctor. When I look at it that way, the pain seems a small price to pay. Plus I have to remember what part my stupidity played. Sorry to ramble so, but I'm sure it's all the perkies fault!
Anyway, for those of you want to know what the plan of care was when the surgeon and pain med specialist work together (as should be, don't misunderstand) here goes. No Narcs during the procedure. Best explanation: they don't work because you have been on a narc for so long, hard to establish what would be a good dose,etc. (you were right on the money, Sandee 1818!) I had a prior heart attack from my chemo and that also complicated things, however, my heart was fine during procedure, altho bp went thru the roof at choice moments !) So, bye bye to the planned midazolam/fentanyl mini-sleep planned and hello to very small dose of propofol and mucho lidocaine. At this point I must tell you what I did to make everything so much worse and DON"T BE LIKE BEANO!! SHE STUPID-BAD!! If you are given antibiotics a week before the procedure, start them right away! Don't wait until the night before as I did. I had so much unresolved infection it made it very difficult to numb my mouth. If I had started my med like I should have it wouldn't have taken so much lidocaine and he could have pulled all the teeth. Bottom line, the mess I'm in is mostly my fault. Also because Beano too smart for own good, Gobs and Gobs of painI
The shots were many and hurt like an ATM eating your paycheck, Today those places where I got the shots hurt terribly and everytime I clean up the drool on my chin and chest it reminds me of how dopey I can be even without the medication! I will take antibiotics now, no problem. Post surg I was given perkies 5/325mg #40 1-2 Q3-4hprn. I continued my methadone 5mg tid. By late evening I'd had 3 doses (2 each time) of perkies (woeful misnaming of medicine on my part) and my usual methadone. I felt clear headed but I forgot to ask my legs. Under normal circumstances I have trouble getting up and walking after sitting for awhile and I have to hold onto things for a few steps until my knees unlock and my muscles relax and I can walk easier. I thought I did that but I ended up falling anyway. Like many drunks in car wrecks, I was unhurt even tho I whacked my head good and my knees were still "locked" when I fell. Lesson is you are probably high as a kite as far as your body is concerned, even tho your brain isn't going all psychedelic on you. Be careful getting up, sitting down, walking around, etc.
I saw my pain doc after the surgery in the afternoon and managed to look so pathetic that I was in and out of there in 15 minutes. She gave me props for the way I handled keeping her in the loop and that will probably go a long way in building further trust in my relationship with her. If I had kept my mouth shut about that part of my medical history, I would have had a much more pleasant experience with stronger anesthesia. But it would have come at a cost...it wouldn't have been as safe and just as importantly, it would have been based on dishonesty-with my dentist by omission and with my pain doc by denial. Having an honest relationship built on trust is so important, most eapecially with my pain management doctor. When I look at it that way, the pain seems a small price to pay. Plus I have to remember what part my stupidity played. Sorry to ramble so, but I'm sure it's all the perkies fault!
Im glad everyone already answered you well before you left for your appt today. Boy can i relate. I also need all my teeth removed and dentures. Unfortunately I still have no insurance of any kind and cannot afford it. Im getting freaked out about infectin spreading, Im betting I have bone involvement too by now as my teeth have been bad for years.. Every morning I wake up and a nother piece of tooth has broken off somewhere (I grind in my sleep and have TMJ). I wish you the best of luck and I will be looking forward to your update with great interest.
I just want to clarify what I said earlier. I think it's fine for you to use whatever pain relief your dentists uses while working on you. I didn't mean you could get a prescription for pain killers from him. Sorry if I didn't put that well.
Sara
Sara
I'm so sorry to meet you this way!! But I want to add my best wishes to you for your ordeal tomorrow!!
Believe me you have EVERYONE at MH behind you here keeping you in our thoughts and prayers!!! I'm so glad that your PM Dr. and Surgeon/Dentist have already talked and you will be set for tomorrow. Try to think about how much better you will feel once all of this is over!! You won't have to worry about this pain anymore!!
Do your best to get some rest so that you will be ready for tomorrow. :)
Best wishes and we are ALL with you, My Dear..........Sherry
Believe me you have EVERYONE at MH behind you here keeping you in our thoughts and prayers!!! I'm so glad that your PM Dr. and Surgeon/Dentist have already talked and you will be set for tomorrow. Try to think about how much better you will feel once all of this is over!! You won't have to worry about this pain anymore!!
Do your best to get some rest so that you will be ready for tomorrow. :)
Best wishes and we are ALL with you, My Dear..........Sherry
A 33 year old relative of mine lost her teeth for the same reason. She is very pretty and was terrified. She felt the same way you do...or at least she expressed the same things.
I won't tell you she had a easy time but it was very short lived. Her dentures are beautiful and no one can tell. It took her awhile but her smile is beautiful and she eats with confidence. She say it's a blessing not to have tooth or mouth pain anymore!
I hope you will have the same results.
I won't tell you she had a easy time but it was very short lived. Her dentures are beautiful and no one can tell. It took her awhile but her smile is beautiful and she eats with confidence. She say it's a blessing not to have tooth or mouth pain anymore!
I hope you will have the same results.
Some of the chemo drugs I was treated with for breast cancer destroyed the enamel on my teeth. I have an infection in my jawline also as a result. They cannot save my teeth so I'm having them taken out tomorrow. The bone scraping is also because of the infection and also in preperation for posts that will be inserted into my jaw in order to anchor the new teeth I will be getting. Frankly, I'd rather be shot. This is so traumatic to me, losing my teeth. I'm not a vain person but this hits pretty hard, I never wanted to lose my teeth and tried to be conscientous in taking care of them. Oh well, such is life.
I do know I'll be given iv analgesia consisting of fentanyl and midazolam, Post surgery I'm not sure what I'll be given. My pain doc had told me before in general conversation that acute episodes like this will come up from time to time and the important thing was to fully inform my doctor or dentist that I was a chronic pain patient and what I was taking.
Thank you guys for your help and feedback. I'll let you know how it goes.
xx/Gummy(mama)Bear
I do know I'll be given iv analgesia consisting of fentanyl and midazolam, Post surgery I'm not sure what I'll be given. My pain doc had told me before in general conversation that acute episodes like this will come up from time to time and the important thing was to fully inform my doctor or dentist that I was a chronic pain patient and what I was taking.
Thank you guys for your help and feedback. I'll let you know how it goes.
xx/Gummy(mama)Bear
My PMP once told me that the drawback of taking narcotic pain medicines if when we have to have any type of surgery the anesthesia will not work well for us because of the medications we take on a daily basis.
Anytime we have surgery we have to have our PMP to discuss our medications with the anaesthesiologist because otherwise we would not get the proper amount.
I know that Nitrous oxide is a gas and therefore it should not be a problem but I would double check to be sure with your PMP and dentist.
Good luck and I hope you come thru this with as little pain as possible:)
Anytime we have surgery we have to have our PMP to discuss our medications with the anaesthesiologist because otherwise we would not get the proper amount.
I know that Nitrous oxide is a gas and therefore it should not be a problem but I would double check to be sure with your PMP and dentist.
Good luck and I hope you come thru this with as little pain as possible:)
Hello Beanoville,
Ouch! I absolutely despise going to the dentist. I can empathise.
First let me say that in the past CP patients have reported on this forum that they were dismissed by their PMP because they received a opiate from their dentist. So you are doing the right thing by obtaining permission from your PMP before you are prescribed any thing from your dentist.
Everyone has a different pain tolerance to dental procedures. While I have a very high tolerance for pain generally I have a zero pain tolerance for dental procedures. I had significant pain following bone scraping. You may not.
Nitrous oxide is a must for me but as you know it only last while the are doing the procedure and does nothing for post procedural pain. Hopefully your dentist has contacted your PMP and everything has been resolved. If not I would be weary of accepting an offered narcotic.
I wish you the very best. Please let us know how your procedure turns out. I will be thinking of you...and my mouth will be hurting! :)
Peace,
~Tuck
Ouch! I absolutely despise going to the dentist. I can empathise.
First let me say that in the past CP patients have reported on this forum that they were dismissed by their PMP because they received a opiate from their dentist. So you are doing the right thing by obtaining permission from your PMP before you are prescribed any thing from your dentist.
Everyone has a different pain tolerance to dental procedures. While I have a very high tolerance for pain generally I have a zero pain tolerance for dental procedures. I had significant pain following bone scraping. You may not.
Nitrous oxide is a must for me but as you know it only last while the are doing the procedure and does nothing for post procedural pain. Hopefully your dentist has contacted your PMP and everything has been resolved. If not I would be weary of accepting an offered narcotic.
I wish you the very best. Please let us know how your procedure turns out. I will be thinking of you...and my mouth will be hurting! :)
Peace,
~Tuck
what kind of "dental procedures " are you scheduled to have?
My Dad, brother & sister are all dentist and Ive been CDA for 16 years
My Dad, brother & sister are all dentist and Ive been CDA for 16 years
I get Nitrus Oxide. I have an extreme anxiety towards any dental work.
Yes, I've had the scraping. They should numb you with an injection in your mouth, like for a filling. And as I said, I get nitrus oxide. I don't remember being overly sore afterward if that's what you're asking.
Most of our pain medications make our mouths dry. Horrible for teeth. There are dental rinses for dry mouth. Also OTC rinses you can use. Some fluoride treatments will dry out your mouth. It helps if you use with in your Waterpik water.
Because of pain med related dental problems, I've become almost OCD about blushing, flossing and rinsing. I eat very little sugar. Still, I was at the dentist this morning. I have 3 cavities. They're in my front teeth-YUCK!! And then the stupid doctor used latex even though I'd told him I'm allergic to it Fortunately I was able to remind him before he's done too much. Just needed 10 Benadryl. And that's not bad for me!
Sorry for the boring diversion. It's nothing to worry about. I doubt your PMP would have a problem with anything administered at the dentist office. Good luck. I hope someone else can give you a better answer.
Sara
Yes, I've had the scraping. They should numb you with an injection in your mouth, like for a filling. And as I said, I get nitrus oxide. I don't remember being overly sore afterward if that's what you're asking.
Most of our pain medications make our mouths dry. Horrible for teeth. There are dental rinses for dry mouth. Also OTC rinses you can use. Some fluoride treatments will dry out your mouth. It helps if you use with in your Waterpik water.
Because of pain med related dental problems, I've become almost OCD about blushing, flossing and rinsing. I eat very little sugar. Still, I was at the dentist this morning. I have 3 cavities. They're in my front teeth-YUCK!! And then the stupid doctor used latex even though I'd told him I'm allergic to it Fortunately I was able to remind him before he's done too much. Just needed 10 Benadryl. And that's not bad for me!
Sorry for the boring diversion. It's nothing to worry about. I doubt your PMP would have a problem with anything administered at the dentist office. Good luck. I hope someone else can give you a better answer.
Sara
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