a bit more than toothache

December 17, 2009 by

<not for the squemish…>

I consider myself to have a high tolerance (albeit a low threshold) for pain: I can usually accept it and work my way through it when it arrives. Having experienced kidney stones and dental abscesses before, I know roughly where some of my own limits are.

My experience over the last week has been a little different, with some different outcomes that I wanted (and needed) to document.

Firstly, the definition of pain is always subjective. However the small amount of research I did to try and find a common, non-jargon-based language didn’t really reveal what I was expecting: if anyone knows of a simple, official 1-10 scale with clear examples, please comment below with a link.

The most useful I found was here (from 2002) and its author also expresses frustration about the lack of a common language. It’s a good article, and I’ve copied the table here for completeness

Comparative Pain Scale
0
No pain. Feeling perfectly normal.

Minor

Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.

1
Very Mild
Very light barely noticeable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.
2
Discomforting
Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this self-test.
3
Tolerable
Very noticeable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don’t notice the pain. You have adapted to it.

Moderate

Interferes with many activities. Requires lifestyle changes but patient remains independent. Unable to adapt to pain.

4
Distressing
Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the similated pain is initially piercing but becomes dull after that.
5
Very
Distressing
Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong, or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed. Temporary personality disorders are frequent.
6
Intense
Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migraine headache combined with several bee stings, or a bad back pain.

Severe

Unable to engage in normal activities. Patient is disabled and unable to function independently.

7
Very
Intense
Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.
8
Utterly
Horrible
Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache.
9
Excruciating
Unbearable
Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn’t work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer.
10
Unimaginable
Unspeakable
Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.

And so, onto the story.

On Tuesday one of my teeth started to ache. I recognised it as likely to be a root canal issue as my dentist had it on their list of to-do’s. With impeccable timing – Tuesday was our last board meeting of the year, and am in the midst of negotiating our biggest ever deal – I had to just start on the Nurofen and pace out the day. That night it stepped up and after a very interrupted night I started to alternate Paracetemol and Ibuprofen to get through the next day, and arranged a dental appointment for Thurs 9am.

Weds night stepped up again, about a (6) on the above scale, so almost no sleep, but pain I can certainly “meditate through” for a few hours. On Thursday my dentist duly identified an abscess and I started 500mg Amoxicillin 3x a day. Unfortunately Thursday night went up a notch (7) and was continuous, so to try and seek some stronger pain killers, I trundled myself off to A&E at about 11pm. A&E is never a good place to go, but after 3 hours of concentrated pacing (one of my pain management techniques is to walk and count out loud, small wins of control) I was given a course of 60mg Codine (heavy duty pain killers) and 50mg Diclofenac Sodium (reduces inflammation). To help them get into my system, I walked the 30 min journey home, they kicked in, and I went to sleep. For an hour. Then I was back to a continuous (7)… fitful sleeps, and the next morning my partner picked up a course of 400mg Metronidazole from my dentist (heavy duty antibiotics). The thing is with antibiotics is that they often take 24-48 hours to kick in.

Friday saw the intensity grow from a (7) to an (8) in the evening and, with my energy levels falling, inability to eat and increased tiredness, tipped me into a “must do something” state. Consultation (via my partner) with NHS Direct (which is excellent by the way) at 8pm led to direct referral to an all night emergency dental clinic… albeit a 40 minute cab journey away. Unable to see any alternative, I bundled myself into a cab and concentrated my way to the dentist, somehow filled in a form (no idea what it said) and that’s when things got really interesting.

The dentist could clearly see I was in distress, understood why and wanted to help. So he injected an anaesthetic to numb the area, to relieve the pain, then work on the tooth.

It’s difficult to remember now what it felt like, and still sounds like a very unreasonable claim, but this is where things went to a (9). At the point of the injection I felt like I was going to pass out. However, the step change thereafter – from a (9) to a Zero (no pain) was so dramatic (I could actually feel the anaesthetic moving through my jaw) that within seconds I was in shock: shaking, weeping, numb hands and arms.

After “an amount of time” and a glucose drink, I calmed down. The relief of having no pain was ecstatic. I then smiled my way through a partial root canal treatment, drifting in and out of sleep.

After that, feeling vastly improved (still numbed), I got the tube home and started to rest.

If only.

Bang. The anaesthetic wore off. The pain was worse than before. I’d say a (9) although still feel uncomfortable about that number because I can’t compare this to throat cancer(!), but it was more than an (8).

I subsequently learned from my normal (excellent) dentist, that while the emergency guys were obviously dealing with the situation in hand, you *never* inject and/or operate on an infected tooth. Even just the additional liquid from the injection adds more pressure to the abscess, never mind the drilling/etc.

So, in my on-the-ground state, my partner called for an ambulance, checking carefully that it was both appropriate to have one and that there would be someone at the other end to deal with the issue. They said “yes, we’ll be there immediately, get out onto the street”.

Note to all: never call an ambulance for a dental problem. They have no way to deal with it and dental units at hospitals seem to close at 10pm.

After standing on a cold December street for 40 minutes the ambulance finally arrived. I don’t remember waiting, just pacing and counting. They then said that there was nothing they could do and the dental unit was shut, and I needed to go back to the all night dentist. In a cab (since it was on the other side of town).

The medics were very empathetic and did what they could: 10ml of oral morphine. But it didn’t touch the pain. And they flagged down a cab…

40 mins later I was back in the dental surgery. It’s now 1am Saturday, and a different dentist, who … anaesthetised me.

Same reaction as before. (9) + shock + calm.

Peace was now not the only outcome, but substantial delirium. The cocktail of pain, morphine, pain killers, lack of sleep/food/etc. meant my most concerted efforts to concentrate were futile. Sentences were slow/slurred, even if visualised well in my head.

“Did I want an extraction or to leave it?” was my choice.

I suppose I should feel happy that even under these conditions, a part of my sanity had already worked out that that would be terrible, not just because of the loss of a tooth (even though a part of me wanted that payback so very desperately!), but because I was working out why the last visit hadn’t worked.

“No” was my answer, so in my somewhat befuddled mess of a state, I got another cab, 40 mins, home.

Home, I slept, the second (double-dose) of anaesthetic wore off while I was asleep and I can only imagine that the antibiotics magically had kicked in to reduce the basic cause of infection.

Saturday 9am I woke up, totally exhausted, but not in excruciating pain. My normal dentist saw me at 11am and imparted the words of wisdom about having to wait it out until the antibiotics kick in, even if it seems impossible at the time. There really isn’t another option.

Home by noon, and starting to get the rebound effects of the last few days I went into extremely deep lethargy and narcolepsy. I couldn’t keep my eyes open for more than a few seconds before plunging into fitful/lucid dreaming/ sleep.  My entire body ached. I couldn’t really move.

Given the lack of nutrition I knew I had to at least drink, however it would take me over 2 hours to actually make it across the bed to the glass in-between sleep, waking, realisation and trying to move. And, unfortunately, my body had reacted so badly that I wasn’t able to retain even water…

18 hours later I knew I was also feeling the impacts of dehydration, and again NHS Direct were great, at 5am, over the phone diagnosing and sourcing a local doctor to prescribe additional medication.The only glitch being: I had to pick it up from the local hospital. At this point I couldn’t pick my head up from the bed, so back to sleep it was.

And of course, if you can’t keep down water, you can’t keep down antibiotics. I remember thinking … “oh crap” … as I drifted back to sleep again, but was comforted by the last words my dentist had said to me on Saturday: “it will not be as painful again, you are over the worst of it”. Fortunately, she was right.

Throughout Sunday and early Monday, my condition was steady-state: utter exhaustion and all-over aching. Gradually, with some moments of quite deep shock/emotional release, it started to pass.

Monday afternoon I was, finally, able to digest water, and that started a proper, but gradual recovery.

What did I learn/what would I do differently?

I’d get onto antibiotics (all of them) sooner.

I’d not call an ambulance for any dental-related emergency, regardless of how severe.

I’d somehow insist that any emergency dentist did not inject anaesthetic. Apparently this not only increases the long-term pain, but introduces the potential to spread the infection to other areas.

I don’t know how to reconcile that level of pain with no action/waiting. I know in retrospect that it’s “one of those things”, and quizzed my normal dentist about it a lot. However, “in that moment”, I could easily imagine asking for a full extraction.

I have no idea how I’d deal with something similar again. My pain management process is always to focus on accepting the pain, taking it on board, then thinking about how I’ll reflect on it later (as this blog post is doing). There always has to be a future point to anchor to.

Reading up on pain, and seeing the definitions above, I was quite shocked to see suicide mentioned so many times. It’s not something I think could ever conceive of, but I could easily imagine that prolonged exposure to this kind of intense, crushing, omnipotent pain could entirely take over your whole perspective of life.

My admiration of those who suffer this on an ongoing basis has certainly increased.

Take care.

Comments are closed.