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Which pain killers do you prescribe?
A Townie discussion from www.dentaltown.com
azmjmdds
Phoenix, AZ
Posts: 46
Reg.: 3/24/2003
DJR
Thousand Oaks, CA
Posts: 248
Reg.: 6/9/2001
hudley
Saginaw, MI
Posts: 1,041
Reg.: 9/18/2002
MikeGee
Citronelle, AL
Posts: 611
Reg.: 1/2/2002
hudley
Saginaw, MI
Posts: 1,041
Reg.: 9/18/2002
MikeGee
Citronelle, AL
Posts: 611
Reg.: 1/2/2002
Posted: 4/14/2003 8:27:25 PM
Post 1 of 29
I have a question about choice of pain relief for patients with a history of drug abuse or
codeine intolerance and/or allergy. What does everybody recommend? I usually go with 600800mg ibuprofen QID but any success with other regimens? I recently had a patient in this
category who also had GI problems, so no NSAIDS.
Posted: 4/14/2003 9:01:32 PM
Post 2 of 29
Cox-2 inhibitors like Vioxx and Celebrex are great alternatives to common NSAIDS, have
very little GI problems and don’t have the bleeding time problems associated with NSAIDS.
Posted: 4/15/2003 4:40:24 AM
Post 8 of 29
If I’m not mistaken, narcotic analgesics are actually well tolerated by most. A true allergy is
rare, but intolerance to narcotics is pretty common in my experience. The same goes for
NSAIDS. Just beware of the drug seeker claiming allergy to naproxen, ibuprofen and Cox-2
inhibitors. They often claim that they can only take narcotic pain relievers and Tylenol (e.g.
pretty much every codeine and hydrocodone combination out there)!
Posted: 4/15/2003 5:34:31 AM
Post 10 of 29
Ultram and Ultracet cause fewer gastric upsets than most other NSAID-type meds. We have
had great success with both in our country practice, and give to most patients, unless they
have had gastric bypass or active peptic disorders. Vioxx gives a lot of our patients pretty
hard indigestion, and so I do not use it much. One Tylenol with one Advil works great for
simple extractions.
Posted: 4/15/2003 6:15:04 AM
Post 11 of 29
Hey Mike! It’s interesting that you mention this. Ultram has abuse potential, as it is a mild
narcotic. According to the addiction medicine specialists that I’m familiar with, Ultram is not
a safe drug for recovering addicts, thus has abuse potential with drug seeking patients. I’ve
not noticed a lot of trouble with Vioxx as far as GI upset.
Posted: 4/15/2003 7:16:26 AM
Post 12 of 29
Hudley, it does have an abuse potential. I am the director of our state’s wellness program, and
some of the guys we monitor have had problems with Ultram. I would not use it for a pt. I
knew who was recovering.
My personal experience with drug seekers is that they want narcotics like Lortab. For almost
all simple extractions in my practice in non-substance abusers, I tell them to take a Tylenol
and an Advil, or I Rx Ultram.
As far as addicts, if I suspect them of drug seeking before or after treatment, I am in favor of
being very up front with them and let them know I feel that they are asking for Rx that I as
their dentist do not feel they need. This ALWAYS opens the door–either to some further
conversation, or the front door. You can believe that every drug seeker who has the balls to
come into your office and try to get narcotics has heard absolutely every story you can make
up. You cannot hurt their feelings.
78 DentalTown Magazine
June 2003
yentadent
San Diego, CAPosts: 146
Reg.: 8/9/2001
Posted: 4/15/2003 6:48:29 PM
Post 23 of 29
Has anyone tried Bextra? Also a Cox-2 inhibitor
with none of the GI problems. Very pricey right now but you
guys just wait, according to Kit Weathers it will be the next
Motrin. Excellent for mild to moderate pain @ 40mg one
time daily.
mattdmd
Posts: 367
Reg.: 4/19/2002
Posted: 4/15/2003 9:52:02 PM
Post 25 of 29
Bextra is a good med if you don’t mind forking
out some big bucks for it. I still personally prefer Motrin.
ucme4dk
Wylie, TX
Posts: 288
Reg.: 1/5/2002
Posted: 4/18/2003 6:11:13 PM
Post 27 of 29
I have had excellent results with Synalgos DC for
post-op pain. Very low stomach upset and great tolerance. It’s
a large bright yellow and blue capsule. Makes it look strong
and effective. Gives the patiets a psychological advantage
instead of a white chalky pill.
sperkins
Houston, TX Posts: 581
Reg.: 9/18/2001
Posted: 4/18/2003 7:35:12 PM
Post 28 of 29
Combination meds work well. There are some
studies that show synergistic effects when acetaminophen and
ibuprofen are used together. This combo has been shown to
be more effective than some narcotics. Using a narcotic, with
the A/I combo when necessary is an excellent way to knock
out severe pain. Of course the new NSAIDS that don’t lock
onto the Cox receptors in the stomach are good for those who
have GI problems.
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June 2003
DentalTown Magazine 79