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Letters: Opioid discussion

November 05, 2018

The Oct. 15 issue of the ADA News contained a cover story regarding recent opioid legislation ("Congress Overwhelmingly Passes Bipartisan Opioid Legislation") and a letter to the editor from Dr. Edwin S. Mehlman regarding the use of a combination of Ibuprofen and Extra Strength Tylenol as an alternative to opioids for dental pain.

I want to point out that there are many people who suffer from severe, chronic nerve pain who have no alternative to opioids. These people cannot take NSAIDs due to gastrointestinal sensitivities that cause them to double up in even more pain if they take them.

They often have gone through the gamut of pain management options up to, and including, placement of spinal cord stimulators. Yet, their nerve pain is not fully attenuated.

Daily use of opioids is the only alternative for these folks to get through a day without looking like the dental patient with severe endodontic pain who we have all seen in our careers — the ones who look pale as a ghost.

The prescribing limits portion of the new legislation is a major concern to these folks. Physicians are being shamed into being reluctant to prescribe the amounts of opioid medication needed by these patients.

The non-narcotics portion of the recent legislation is welcomed by these patients, but it has to be a non-NSAID alternative as well.

I never knew the plight of chronic pain sufferers until four years ago, when a family member suffered a severely broken ankle and developed complex regional pain syndrome immediately.

When we can't "see" a problem, prescribers — both dental and medical — tend to dismiss it or not think it is so serious. It's rather like mental health issues.

It is an area of the opioid issue that needs to be addressed, not buried.

Michael J. Reese, D.D.S.
Fitchburg, Wisconsin

Editor's note: An overview of systematic reviews published in the April edition of the Journal of the American Dental Association found that combinations of ibuprofen and acetaminophen were more effective at relieving acute dental pain with fewer acute adverse events.