Case 3

Initial Presentation: A 47-year-old man has a history of facial trauma in a motor vehicle accident approximately 10 years ago. He reports seeking care at a pain clinic for back and facial pain and receives physical therapy, steroid and anesthesia injections, along with monitoring and urinalysis at this clinic. He presents for a routine extraction of a tooth with a vertical root fracture and would like to discuss post-operative pain control given the medications he is currently taking. Upon receiving his report from the PDMP, he has received 20 opioid prescriptions in the last year by two prescribers, both physicians at the pain clinic he discussed.

Action Plan: Given this patient’s history of chronic pain and medication and symptom monitoring by his pain-care physicians, consultation prior to surgical treatment in the dental office is recommended. Preprocedural use of NSAID and scheduled use of NSAID and acetaminophen along with his current medication barring any other contraindications in his medical history should be considered.

Conclusion: After consultation with his treating physicians, patient was managed periprocedurally with preprocedural NSAID pain control and post-operative use of regular time-interval NSAID and acetaminophen medication. Patient was also seen within 48 hours of extraction by his pain physician to monitor any additional symptoms and stated that he felt that his pain was managed well during this procedure.