RSD in the News-great article on RSD and receiving dental services

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 care only
with local anesthesia to
control pain. Some dentists
also will 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 strategy for pre-emptive
analgesia, intra-operative comfort,
physical therapy, and postoperative
pain relief. The goal is to cover as
many pathways of discomfort for
patients 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 about 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.