28
|
Volume3 Issue3
I
ssues and
P
eople
➲
Riskof opioiddependence
BC:
The riskof developinganopioidaddiction is very lowwhen thesedrugs areused for acutepain. For an
individualwhoendsupbeing treated for a longer periodof time for acuteorofacial painafter aprocedure, be
aware that after about 1week you’ll need to taper themoff theopioid so theydon’t getwithdrawal effects.
Theother concern is that it’snot unusualwithinaperiodof 1–2weeks todevelopa tolerance to thedose. Of
course, if theyare inconsiderablepainafter 1week,muchmoreconsultation isneeded tofindoutwhat is causing
thepain.
➲
Howmanyopioids toprescribe
BC:
In someprovinces, part fills and refills canbeallowed for certainopioids. Unfortunatelywedon’t have
verygood tools to screen for addictive tendencies. If you suspect an issue, youcan involveapharmacist and
communitynurse inmonitoring thepatient’suseandalsominimize theamount youwriteon theprescription.
InB.C.,whereyoucandoapart-fill prescription, for anacute situation likepost-operativepainyoucouldwrite
aprescription for 24hoursof narcoticandallow1or 2 refills. The total amountwouldbe for 3or 4days, but
youwouldwrite it as a24-hour supply. Theadvantageyour patientswill have is far lessunusedopiates in their
cupboards.
CL:
Youwant togiveenoughmedication that thepatient ismanaged,without giving toomuch. I tend to say
1-2daysof anopioid is reasonableand then follow-upwith thepatient if needed.
BC:
I’daddas acaveat, that if this is anadd-on treatment andyour primary treatment is still anNSAIDor
acetaminophen, then Iwouldmaybewrite themonly24hoursofmedication. I think theassumption is that
they’regoing touse it for theworst part of thepainand then theywon’t need it, andwedon’twant any left in the
cupboard. If anopioid is your primary treatment, Iwouldbeokwitha2–3dayprescription.
➲
Long-acting local anesthetic
CL:
Iwouldbe remiss if I didn’tmention long-acting local anestheticmedication. For example, if you’re takingout
mandibular teeth, Iwouldblockwith lidocaineand infiltratewithbupivacaine. The long-acting local anesthetic
can reallyhelpwithmanagingpost-operativepainbeforeyouget breakthroughpain.
➲
Communication
CL:
I thinkoneof themost important thingswecandoas clinicians is evaluateapatient’spainandnot
discount their pain.We’veall hadpatientswhocome inand they just don’t feel like their pain isbeing
managedappropriately; oneofmyfirst duties is tomanage thepainofmypatients. Patient
communication is key—make sureyou take time tomanage thepatient’s expectations and
let them knowwhat toexpect in termsof paincontrol.
a
This interviewhasbeeneditedandcondensed.
Theviewsexpressedarethoseoftheauthorsanddonotnecessarily
reflecttheopinionsorofficialpoliciesoftheCanadianDentalAssociation.
