Pain Management not Just a Global Issue

 It is well documented that patients with terminal illness in general do not receive what experts would consider appropriate and continuous pain relief. This is an issue even more acute globally. And the reasons are equally well documented: no access to morphine, HCP attitude, family concerns, lack of knowledge on how to treat.

On a very small scale and in many regards unrelated I witnessed this. Thursday I had to go to have a dental implant removed. It went from a scheduled procedure to an emergency one. I was able to contact my previous DDS who referred to a very good oral surgeon. Prior to him beginning I played 21 questions just to make sure I knew what was what. I asked about postoperative pain. “Do you have any ibuprofen at home?’ was his answer. After my WTF look and saying “you’ve got to be kidding me” he relented and said he would write a script.

The procedure was quick. I left the office with a ton of lidocaine on board. Not so bad. I got home laid down and within 30 minutes my face felt like I was hit with a brick. Acute, sharp, and relentless is how I would characterize the pain. Ibuprofen? In a pig’s eye? It would not even begin to touch this. Filled the Rx and found some relief behind the pain, not in front of it.

I will confess that within 24 hours the pain was resolved. Still, to feel like I needed to beg to get a strong analgesic that was in fact needed was a bit of an issue. This does not compare to chronic pain associated with terminal illness. I witnessed this with my wife in hospice and how well and professionally the pain management team kept ahead of her pain and was able, even when Donna could not communicate, to read her body language to know when they needed to change or increase medication. This was not the same. I do not expect an HCP who is board certified as a dental anesthesiologist and oral surgeon to understand pain and terminal illness. But he should know about pain and its effective management. Really now he should.

His first reaction was to not offer an analgesic unless asked. I was put into the role of a drug seeker. If I did not have that Rx I would’ve been on the phone demanding he call it in. Wasting his time and mine. At the very least he should describe the level of pain for how long and ask me what I thought I wanted. Not think he knew me better then he did at our first meeting. In some small small way this is the state of pain management. 

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