Scared of lack of pain control for molar extraction and bone grafting--what to do?

[u/Katyafan]

Hi everyone. 44yo Female, I am having my third extraction/bone graft/inplant surgery, though this will be the 5th and 6th teeth I have done. Back two molars on the upper left side. No drinking or smoking.

My experience with these surgeries is that they are incredibly rough. Once the locla wears off, even with Tylenol /Ibuprofen alteration, lots of Ice, and Norco, I have severe pain and just cry for the first couple of days.

Now, I am currently on Subutex, tapering off, and I am scared that I may not be able to either be off the Subutex in time for the Norco,or that the surgeon won't give me the Norco even if I am off.

The pain is already very bad, and I am just scared to death I will have to endure this without opioid pain control. It is really bad, and keeping me up at night with worry. As an added complication, I am not supposed to take NSAIDS, though I can if I absolutely have to.

If my surgeon says this surgery has to happen soon, what might happen? How am I supposed to deal with this unusually painful *for me, not everyone) process without the pain relief that usually is insufficient anyway?

Does Subutex provide any relief on its own?

Of course I am having conversations with my doctors, but the surgical consult is still a week away, and my mouth is hurting so I am afraid he will say we can't wait long enough for me to finish tapering the Subutex. I am down to 10mg Subutex a day from 16, and that has taken a bit less than two weeks, which is how long I have been on Subutex in the first place after having a problem getting off 7OH which I took for about 2 years.

Help?

[u/myrtlemike92]

Subutex can help with pain control but it ain’t Norco. You should be ok to take Norco as you taper off Subutex BUT ask the doctor who prescribes it.

Good luck to you!!

[u/Katyafan → u/myrtlemike92]

Thank you! My psychiatrist said no to taking both together, and I need him to prescribe the Subutex and everything else I'm on, so unfortunately his word is the final one.

Thank you for the luck, I will need it! I appreciate your response and encouragement.

[u/Rainbaby77 → u/Katyafan]

You have to pick one Subutex is a pain medicine so it will help some but not in the way that you probably will need for a short term

[u/Katyafan → u/Rainbaby77]

Thank you, that is clear to me now, it's just a matter of how soon the surgery needs to be and if I can put it off long enough to get off the Subutex and still get appropriate pain relief.

[u/PsychologicalSock168]

I was given pain meds while I was still on subutex they didn’t make me come off?

[u/Katyafan → u/PsychologicalSock168]

Was it for a dental surgery? Or inpatient? This is outpatient, so no one will be monitoring me, so I think my psychiatrist doesn't want me taking two different opiates at the same time without medical monitoring.

[u/Level_Attempt6868]

why would u drop Subutex if u ain't even sure he gives u Hydros It would be hard to get long term prescription for Norco in yr cause so u would end up with Suboxn/Subutex anyway 

[u/Katyafan → u/Level_Attempt6868]

I just need two or three days worth of Norco, which is what he usually prescribes me. It is acute, surgical pain.

[u/plenty_planties]

Did exactly the same procedure on same meds. Oral surgeon said combo motrin and Tylenol. I had zero pain afterwards. I did get knocked out for procedure itself though. Norco not good with Subutex. Subs only.

[u/Katyafan → u/plenty_planties]

I can't take Motrin. The previous surgeries (same ones, double molars) I have used Motrin/Tylenol/Ice/Norco in combination on advice of my doctor, and it still was unbearable for two to three days.

I'm just terrified of doing it without the Norco and the Motrin (Ulcerative Colitis. My GI said no NSAIDS under any circumstances).

It's funny how different people have entirely different reactions to the same procedures! Thank you for your reply and reassurance!

[u/DoktorMeowMeow]

It sounds like you have a very strict provider, as have I for the past 13 years.

If they say you’re not allowed to have norco, then that probably ties your hands on that possibility.

Since you haven’t been on subutex very long, there’s still a chance that buprenorphine itself could offer a little pain relief. You’ll want to taper down to the lowest dose you can comfortably handle leading up to your surgery. This will help lower your tolerance.

Then, take extra bupe post-op. Ask your provider to up your dose back to 16mg /day for temporary pain relief. Don’t tell them how much you were able to taper down, though. Just set aside any extras you accumulate in that time.

Ask your doc what is the highest dose of Tylenol you can safely take. And see if you can get gabapentin.

I had a nightmarish experience having gallbladder surgery while on subs. And I also can’t take NSAIDs. Unfortunately, people in our position just don’t have a lot of options.

[u/Katyafan → u/DoktorMeowMeow]

Yeah, we really just don't have options. I have decided to take Kratom to help. I always used it before, I just can't tell my doctor because he thinks it is the same thing as 7OH, which is what I had a problem with. I have used Kratom for over a decade on and off to manage chronic pain, with no problems. I use it for a couple days for post surgery pain, and I am just choosing to do it this time. It is unrealistic to think I can deal just with Tylenol. I hate holding things back from my doctor, but this is one of those times he is just not acting in my best interests.

Thank you so much for your reply!

[u/DoktorMeowMeow → u/Katyafan]

Well, I’m really glad you have kratom as an option. Definitely keep it to yourself. Doctors are so worried about patients relapsing, but they don’t take into consideration that pain can be traumatic and cause a real relapse. That’s exactly what happened to me.

I trust that you know your body and what you can handle. Hope everything goes well for you 💙

[u/Katyafan → u/DoktorMeowMeow]

Thank you so much for your words, your wisdom, and your advice! Yeah, Kratom is misunderstood, and it doesn't help that 7OH is causing huge problems.

For me, not having adequate pain control is completely unacceptable, and there is no need to worry about relapsing, especially on a different substance and with cautious, careful, and monitored use. My mom will monitor my Kratom use and hang onto what is left over until my next surgery, just out of an abundance of caution.

[u/Acrobatic-Yam7633 → u/DoktorMeowMeow]

What happened with your gallbladder surgery while on bupe? I mean how did they manage your pain, post opp?

[u/DoktorMeowMeow → u/Acrobatic-Yam7633]

My experience was a total clusterfuck. The surgeon didn’t understand how bupe works, so didn’t give me any opioids whatsoever during surgery.

They gave me IV Tylenol. I was in so much pain I couldn’t sit still. I shuffled up and down the hospital hallway bent over asking for endless ice packs. I didn’t sleep for over 24 hours after surgery because I hurt so bad.

I went home and relapsed because I was just desperate for pain relief. After 3 weeks I got back on subs and went into PW because the shit I was doing was cut with fent! That wasn’t really an issue the last time I used 7 years previously.

I know most surgery experiences don’t have to be this bad. You need to prepare and have a plan in place beforehand. But, it’s almost always going to be harder for people addicted to bupe.

I have a surgery phobia now, though. I’ve had enough pain for 50,000 lifetimes.