Enhancing Pain Control.

What else can I, as a dentist, do to enhance the effectiveness of pain control medication?

What else works for better pain control besides using nonopioid (ibuprofen plus acetaminophen) medication?

Along with the nonopioids for pain control (see Breaking Dental Drug News - Nonopioid vs, Opiods), I provide my patients with a very large dose of positive outcome.

I describe to them exactly how to take the medication, 400 mg of ibuprofen plus 500 mg of acetaminophen immediately after the appointment (before the local anesthetic wears off), and continue to take it 4 times a day, breakfast, lunch, dinner, and before they go to bed, for the next 2 days. I also note emphatically that if they do that, they should have very little pain, or perhaps none at all. 

I know you’ve heard of a placebo, a suggestion that something good (no pain) will happen, and the statement above is a strong placebo suggestion. I tell them (And I believe it, because it is true) that what I am prescribing for them, what good will happen if they follow my “prescription”, and when it will happen.

Have you ever heard of a nocebo? It is a real thing. It is also known as medical hexing. It is a suggestion or comment that will make the patient worse instead of better. (It is usually, I hope, inadvertent, but it happens none-the-less.) 

A nocebo can happen when the dentist doesn’t believe nonopioids are  effective for pain control and says, for example, “If you want, you can take some ibuprofen and maybe a Tylenol. They say that works for the pain that you will almost certainly have, but who knows? If it works for you, I’ll be surprised, but it’s the best I can do.” 

Nonopioids and a strong supportive suggestion as to their benefit will provide the most effective dose of pain control you’ll be able to give to your patient and it will almost always be effective for the pain that occurs with dental procedures.

You might be curious to know why opioids got so famous for pain control. It is because they are effective for one dimension of pain. They alleviate the emotional distress associated with pain.

If you give a person ibuprofen and acetaminophen,, the patient will tell you the pain is gone. If you give a patient an opioid they’ll tell you the pain is still there, but they don’t care anymore.

Opioids work to separate the physiological pain from the psychological pain of worry and fear. I prefer, and I suspect almost all dental patients prefer, that the patient not have the pain in the first place; that way, they can avoid the negative emotions and anxiety of pain.