tolerance to pain meds and tooth extractions

[townhermit]

I have long delayed getting proper dental treatment and one of the major problems I face is proper treatment of pain after tooth (teeth) extraction. *I have had to take strong pain meds for almost 11 years now for an inoperable back injury as well as multiple musculoskeletal injuries and disorders. *As a result I have a high tolerance to opiate painkillers. *About a year and a half ago I actually had to be transported to my local hospital by ambulance for uncontrolled dental and back pain. *I had a broken off tooth with exposed root and major infection in my jaw. *I had just had injections a day before near my spine to hopefully alleviate my back pain which instead caused a major pain flareup. *The combination of the pain due to the broken tooth, exposed nerve, gum/jaw infection and reaction to the spinal injections caused my already high blood pressure to go dangerously higher (200/120 stroke level). *My pain level was off the chart. *The ER "doctor" intentionally delayed treatment for the severe pain and ridiculed, mocked and insulted me for daring to come to "his emergency room" via ambulance to "waste his time seeking drugs." He in fact walked away from me as I was lying on the geurney in agony! *Very little indeed can ever make me cry like a baby but at this point I was beyond the point of any control. *Only when the nurse checked on me and found me in the early stages of shock was any treatment for pain started. *I required nearly a dozen blankets over me since I felt intensely cold, *unable to control my arms and legs from violently shaking, had severe difficulty breathing, had heart palpitations and the previously mentioned extremely high blood pressure. *I was starting to go into convulsions when finally the persistent nurse (God Bless her!) got the idiot "doctor" to get off his butt and start a strong pain killer (liquid Demerol I think) into an IV in my arm. I also had to take a large pill of some kind. I began to experience pain reduction within a few minutes and in a couple hours the pain was more or less under control. *This traumatic experience has stayed in my mind ever since and even more so due to the fact that I desperately require the extraction of all of my upper teeth. *The combination of medications I have taken the past 10 years and lack of affordable dental treatment in my rural area has taken it's toll on my teeth. *I am now very concerned regarding getting the proper dosage of pain meds after having these teeth extracted. *If I have all the upper teeth pulled at once (surgery) I could very likely end up in an emergency hospital room again. *Emergency rooms are the poorest places to go regarding severe dental pain as I've discovered. *Most ER doctors refuse to treat pain with opiate pain killers due to unreasonable fears regarding the Drug Enforcement Agency and U.S. drug laws. *Also they believe that all persons who ask for stronger pain meds for severe pain are some kind of drug addict! As a result persons in severe pain (including those with severe dental pain) receive only Tylenol or some other type of NSAID. *NSAIDS may be effective for low level pain but are absolutely worthless when it comes to severe pain and especially for chronic pain. *Apparently ER doctors do not believe that dental pain can cause or be a factor in pain induced shock. I know far too well it can and does! *So how exactly does one go about getting dentists (dental surgeons) to recognize that a patient who has been taking *opiate pain meds for several years will have a high tolerance to these meds and that they will require either a higher than normal dosage for pain after the surgery or an adjunctal pain medication? *I will be having the surgery at a well known dental college about 2 hours from where I live. *Its the only way I can afford dental treatment of any kind. *Afterwards I will pay out of pocket for an upper plate from a local clinic which will accept payments. My only other alternative is to have only one tooth pulled at a time (I have only 9 upper teeth left) at the dental college which would require the 4 hour commute via a county transit van each time. *I am not able to withstand the severe back pain that comes from performing this long commute so I'd definitely prefer getting the surgery done all at once. *I have a morbid fear that I will go into pain induced shock again either after dental surgery or before. *Currently it would take only one abcessed tooth or another broken off tooth to set off the entire sequence of being in the ER again. *I am now on three different blood pressure medicines and take one opiate based pain med several times per day and one non-opiate muscle relaxer type of pain med at night. *Even all this medication is not really effectively controlling either the pain or the hypertension. *What I really would like to find is documentation on-line that does indeed prove that severe dental pain can and does cause pain induced shock and also information that clearly points out that a dental surgeon should consider a patients current pain level and tolerance to medication and be able to safely adjust upward that medication (to titrate it) to control the pain or to prescribe an accompanying pain med that will accomplish the same. *I'd be glad to hear from those with a similar situation and/or information. *Thanks! *

[Parsnip]

Oh Lordy - thats not a very festive story. You should discuss this with your dentist and seek referral to an oral surgeon really. They should be able to take account of your current medication and history in order to make things as comfortable for you as possible. Most hospitals (In the UK anyway - and I'm sorry I have no experience of facilities in the US) have an oral surgery department, and if you were my patient, thats where i would send you.

Hope you get this matter sorted, sorry I can't be of any more help *

Pars

[freakout]

Hi...just to help out with a bit of US knowledge :-/ *US hospitals usually have an oral surgery departments as well, especially in the larger hospitals. *