DENTAL CARE AND CHRONIC PAIN

Dental Care and Chronic Pain
By Louis Siegelman, DDS

Many aspects of daily life are a significant challenge for patients dealing with chronic pain conditions like complex regional pain syndrome (CRPS) or fibromyalgia. 

Dentistry can often be an extremely difficult environment with its inherent discomforts. Most dentists provide their care with local anesthesia as the sole means of pain control. Some dentists will also use nitrous oxide, which delivers excellent analgesia, and/or a benzodiazepine, such as diazepam (Valium) or triazolam, for relaxation. A limited number of dentists can provide more advanced multimodal therapy that is within the limits of a dental license. Such dentists may be oral surgeons, dentist anesthesiologists, or others with extensive postdoctoral training in anesthesia and pain control. These dentists with more comprehensive training can provide intravenous sedation for oral surgical, pediatric, or general dental procedures.

A comprehensive evaluation and consultation should be the first step in developing a treatment plan that suits the patient’s needs. A detailed past dental and medical history needs to be reviewed. Co-existing mental health conditions relating to panic and anxiety, depression or posttraumatic stress disorder are considerations. Coordination with other involved healthcare providers, such as pain management doctors, internists, neurologists, and surgeons, may be required. All of this information forms the basis for appropriate dental and anesthetic treatment planning.

Multimodal treatment includes a pain management estrategy for pre-emptive analgesia, intra-operative comfort, physical therapy, and postoperative pain relief. The goal is to cover as many pathways of discomfort for patints during the peri-operative period as is reasonable and indicated for specific patients and procedures. Possibilities include alpha agonists, NMDA receptor antagonists, antihistamines, opiates, acetaminophen, NSAIDs, benzodiazepines, steroids, anti-emetics, local anesthetics, and sedative hypnotics. Common routes of administration may be topical, oral, intravenous, or intramuscular. Skillful use of these medications can provide a patient experience that minimizes pain, swelling, nausea, and anxiety. Talk therapy with the dentist or mental healthcare professional can be instrumental in overcoming obstacles to care.

Many patients with chronic pain face constant suffering and may be unwilling to seek professional care for their dental conditions because of fear of additional pain. They may also expect the same level of anesthesia and pain control available for minor medical procedures in the dental environment. Trained dental providers are available, but it’s important for patients to ask questions like what was the type of training the doctor received, how many patients like your self the doctor sees, and how often he/she does these procedures? Many offices and programs offer information online about their services, and treatment philosophy. Calling the office and asking questions of the dental team members is a great way to see if a doctor will be best able to serve a your individual needs.

Louis Siegelman, DDS, is a dentist anesthesiologist practicing in New York City.

RSDSA Review. Summer 2009.

Ain't Nothin Big

 Oh, I must have done something verwy baaaaadQQ

It ain't nothing big,
just in and out of the hospital
in a couple days......
Sixteen months later,
I know my life to be nothing
other than to feel intense, wicked pain

You're up for days
like a "Cowboy...."

I am your mother/father

a treasured brother/sister,

a loved aunt/uncle,

your niece/nephew,

cousin, and anyone else you love and care about!!!

I can be a (or your) doctor, lawyer,

fireman, paramedic, paralegal,

secretary, receptionist, next door

neighbor.  Your family friend.  A member

or several members of your church.

I can be a minister, a psychologist,

a bus driver, a police officer,

the person who delivers your pizza...

IN SHORT--

I can be right here next to you!

and I suffer from RSD/CRPS;

pain knows no boundaries!!!

RSD/CRPS DOESN'T EITHER,

thus far, the most documented severe form

of continuous, unrelenting, undertreated,

least researched cause of "chronic pain."

It is not chronic pain:

It's chronic torture!!!

It is a burning HOT PAIN!!!

Burning, hot, fire,
skin feels scalded down to the wire,
open sores picked at and scrubbed
at with Brillo pads, wire scrub brushes

the slightest breeze,
the smallest bump,
sends the pain into an
unending frenzy of tears,
crying, messy snot and red eyes,
my leg is red and sweaty,
my muscle cramps are unbelieveable....

I feel like I'm shouting into
the wind sometimes
just because this or that symptom isn't
here or there right there right then

Never when they're "testing" for it

I wish like hell you'd leave me alone.....
 I am tired, at age 37,

of feeling like I've been to hell and back,

and back to hell and stayed

longer with each "flare."

I am tired of dreading each flare;

not knowing when it will strike;

only that it will!
would it be my hands resembling claws; 

virtually useless; or totally useless?

Or a leg, shriveled up,

useless, rendering me unable to walk?

Unable to walk, or would it be

unable to hold a fork and feed myself?

Fear the treatment or the disease?

Or my legs?  What happens then?  No, I am not

living in the future, fearing tomorrow;

I have to plan and make sure that I am ready;

ready to kick some ass!

I have already grown tired of the migraines 

the  helllish "syndromes" that grow with you;

I've done nothing to deserve this....

...nothing to put my face on a

"Wanted Poster" that bears either

of these likenessesses on them; and the pain,

The being called a liar,

Looked at I am nuts when I say

I keep the schedule of a cat;
and possess the hearing of a dog........
No longer is a cute baby to behold,

I find them frightening, especially if unprepared

with my trusty earplugs....

I fear they turn into a screaming baby.....
and the agony, horrible burning

pain that goes with it;

screeching, screaming, hollering;

I want to be rescued, I want to be cured;

I want to leave this torture behind...

The swelling, the color changes,

the changes in me-to someone

I don't even recognize, like, and I fight it,

try to smile, and make myself scarce.

But sometimes, it does require an amends.

But see, pain on this scale makes

you feel like you are GOING cray,

not that you are, you reason; you know

you cannot let them win, that in

these days, you have to advoate for yourself

since sure as hell, no one else will!!!

When is the next attack going to hit?

Navy Seal Team 6 gives the fix;

Come on out and kick some ass!

A team that actually

does the job--now can we please

get something done?

You got rid of Osama binLaden

when no one else could;

Can we put you on the job

to help the people suffering

from RSD, chronic, unrelenting pain,

be it from nervous system disorders,

or whatever else-you see gentlemen,

It's being fouled up big time now;

Let's work on it--YOU guys

have a better track record than

what the various governments are

in way of completely screwing it up!

So what--how do I give the order?

Ketamine in Liquid Form-CUT WITH GOD KNOWS WHAT-go legally

Basics

Ketamine, Special K or K, is a fast-acting 'dissociative anesthetic'. Rather than blocking pain like traditional painkillers, it shuts off the brain from the body. With the brain no longer processing information from nerve pathways, awareness expands resulting in a hallucinogenic state.
Since 1970, it has been popular in medicine in the UK and US and all over the world as a safe anesthetic for children and the elderly. Doctors in the Emergency Room may use K for certain procedures, including intubating youngsters.
Special K is also used as a sedative for patients in the Intensive Care ward of the hospital and to treat bronchial spasms. It is also used by vets on animals for short operations, hence it being dubbed a "horse tranquilizer." Find out more about Ketamine's use in medicine here.
Ketamine users tend to be teenagers and young adults. This drug may be bought at dance clubs and raves. According to a survey conducted by the University of Michigan's Monitoring the Future Survey, approximately three percent of high school students had tried K at some point.
Street prices vary, depending on the dealer involved, the quality of the product and the geographic area involved. In some cases, ketamine can be bought for as little as $10 per gram, although some dealers charge between $20-$50 per gram of the drug at parties and special events.

Special K Appearance

Ketamine comes in three main forms: powder, tablet and liquid. The most common form is white powder which is snorted. It looks like cocaine but is smoother and less likely to form hard rocks or a flowery texture if damp.
Most users start out by taking Ketamine in powdered form as it allows them to introduce themselves to the drug with small amounts. When ketamine is being ingested
in this way, the dosage ranges from 15-200 mg.

K in a Tablet Form

Ketamine also appears intermittently in tablet or capsule form, often masquerading as a brand of Ecstasy with the same meaningless "dove" or "Mitsubishi" logos.
Ketamine pills are usually very diluted and cut with a stimulant like ephedrine (a natural amphetamine-like chemical) to produce a mildly trippy speedy effect.
Ketamine sold as Ecstasy may be the origin of the "smacky pills" legend, which contends that pills sold as EX were cut with other substances, such as speed, LSD or other substances. Taking one of them made the user more likely to have an overdose or have an allergic reaction, since the true ingredients of the pill may not be known.

Ketamine in Liquid Form

Ketamine Hydrochloride, intended for use as a hospital anesthetic, is sold in liquid form in small 10 ml bottles, often with the brand names Ketaset, Ketavet and Ketalar.
Some recreational Ketamine users inject this liquid into a muscle. We strongly advise against injecting Ketamine intravenously. You could pass out immediately.
Some people mix Kit Kat with another liquid so that they can consume the mixture as a beverage. Avoid drinking it as well. Liquid ketamine is very hard on the stomach. Profuse vomiting is possible. If you pass out, you may choke on your vomit.
Do not mix Vitamin K with alcohol. Driving while under the influence of ketamine is not a good idea, either. People who choose to use this drug should also avoid activities like swimming or operating heavy equipment.

CK 1

CK 1 is a combination of cocaine or crack cocaine (smokeable cocaine mixed with sodium bicarbonate) and ketamine. The cocaine roots the user in the real world and counters the tendency for higher doses of K to send you into a conscious, paralyzed state.

Sucks to have it-what are people doing stupid crap?

I wonder-why in God's name would anyone or  how, someone could waste away, malnutrition--I'm sorry, but there's no way to fake RSD.  I get bored talking about nothing but getting the grail, ketamine.


Anyhow, I am hurting, in pain, and need to medicate-so here are some videos for your viewing pleasure.

Cheers!

Is there a difference in the 1st 2 vids, and the last 2?

Can Ketamine fix this?

What is RSD?

It is the sleeping hours of a cat,

and the hearing of a dog......only sometimes

A cute, albeit nightmarish hell of a screaming baby

in a store can unleash the torrents of hellish pain,

and in feeling like you've just heard fingernails dragged across a chalkboard.

But can set off your RSD pain...arm, leg, whole body, whatever...

That cute child???

The one everyone, including me,

would love to hold and love, if this thing called pain

is ever to be “brought under control”

as my neurologist, Dr. J says,

so that he can do the proper studies....

pain control exists, I wonder, I think to myself.

I should see that day.

What is RSD?

RSD is an “Odd duck,” even to neurologists,

the very doctors you'd think would treat this....

and some have been unknowingly been outright cruel to RSD patients,

subjecting them to the nerve conduction studies

before achieving enough control to examine them

without causing excruciating pain..

I had a neurologist examine me, causing a cresendo of pain,

I nearly threw up on her shoes,

and I've achieved enough control not to scream,

and she then told me it was a “psychological problem,”

having to do with my “psychological issues,

and refraining also from saying anything “impolite”

I merely took the slip that said I was to make a follow-up,

and threw it away on my way out.

I'm not a sadist. I just have RSD.

She even wrote that it was “neurogenic pain”

due to my “psychological disorder.”

Anyone would have psychological disorders after a screaming exam like that!

But what does RSD feel like??

The sleeping habits of a cat, the hearing of a dog.

I start the month with a large box of ear plugs.....

the only thing that helps the latter.

The skin sensitivity is a killer...the pain will take your breath away,

make you vomit, and when you finish, you want to scream and cry.

The burning pain, the burning, flaming, incinerating, kindling,

roasting, scalding, scorching, smoking, blazing, and finally withering away

of just one part of the body.....my leg was never the same after the surgery.

I feel like acid has been poured on my skin,

but no burn can be seen....

Dousing your leg with lighter fluid, and lighting a match,

leaving the fire to burn, 24/7....

Then, when someone touches me,

it feels like an open wound

being rubbed, scrubbed, and scraped, with sandpaper and wire brushes.

My soft warn blankets bring relief.

the electric on a low setting

No pain when they touch my skin,

and they serve to protect me from the elements

I have an apartment full of medical equipment.

I have not one, but two shower chairs: 

One is a bench, and see below:

age 19

2003

2008

 I want to be optimistic.  If I could say anything to the doctor, this would be it-

To the CEO of Virginia Mason, and gave my doctor a degree, diplom

Life can really suck

This "driver" called a couple times, and he DID NOT show up, and I am low on it-stuff that is any good, and it is a bunch  of shitt=could  not leave a message?  His last call was at 5:45 and he can't leave a fucking message-I called several times since his car supposedly broke down, and until 8, when they put up a closed sign.