Next Up: Dentists!!!

https://www.upi.com/Health_News/2024/02/06/dentists-pain-control-guidelines/3551707239073/

New dental guidelines limit use of opioids for teens, adults
By Dennis Thompson, February 6, 2024

New guidelines from the American Dental Association (ADA) are cracking down on the use of opioids for tooth pain.

The guidelines say that non-steroidal anti-inflammatory drugs (NSAIDs) taken alone or alongside acetaminophen should be the first-line treatment for managing short-term dental pain in teenagers and adults.

The available medical evidence indicates that those medications can effectively manage pain from a toothache or after a tooth removal, an ADA guideline panel concluded.

The guidelines also say that opioid painkillers should be prescribed under limited circumstances, after considering any risk factors for opioid misuse.

Dentists should avoid providing "just in case" opioid prescriptions for patients, and use extreme caution in prescribing opioids to teens and young adults, the guidelines say.

Patients also should be educated on proper storage and disposal of opioid drugs, according to the guidelines.

The guidelines were developed under a $1.5 million grant handed down by the U.S. Food and Drug Administration in 2020 to develop guidelines for handling dental pain in patients.

"We hope this clinical practice guideline will reduce the risk of opioid addiction, overdose and diversion," Marta Sokolowska, deputy center director for substance use and behavioral health at the FDA's Center for Drug Evaluation and Research, said in an ADA news release.

A previous set of recommendations for pediatric patients was published in 2023.

Over-the-counter NSAIDs include aspirin, ibuprofen and naproxen sodium. There also are prescription-strength NSAIDs available for more severe pain.

"It's important to take special consideration when prescribing any type of pain reliever, and now dentists have a set of evidence-based recommendations to determine the best care for their patients," said senior author and panel chair Dr. Paul Moore, a professor emeritus at the University of Pittsburgh's School of Dental Medicine.

"Patients are encouraged to discuss pain management expectations and strategies with their dentist so they can feel confident that they are receiving the safest, most effective treatment for their symptoms," Moore said.

The new guidelines appear Monday in the Journal of the American Dental Association.

"Evidence-based" and "paid for by the government" for some reason fail to stoke my confidence that guidelines are based solely on patient well-being.

Some anecdotes:

https://pjmedia.com/david-manney/2025/06/24/the-door-was-locked-when-pain-clinics-disappear-and-lawmakers-dismiss-the-fallout-n4941140

The Door Was Locked: When Pain Clinics Disappear and Lawmakers Dismiss the Fallout

By David Manney | June 24, 2025

Three more Americans share how bureaucracy, policy failure, and indifference deepen the pain.
It’s a strange thing, that moment when you realize the world doesn’t see you anymore. You’re standing in front of a door that used to open. A place that once gave you some sliver of relief. But now it’s locked. No note on your phone. No warning. No follow-up. No care. Just a door that doesn’t open. Pain, as always, stays.

Behind that locked door isn’t just a shuttered clinic. It’s the final echo of trust in a system that no longer pretends to function. The war on opioids didn’t kill addiction. It just redirected the cruelty.

Steve in Tennessee: The Locked Door and the Flood

Steve’s story begins more than half a century ago. Chronic pain has been his companion since his twenties. Over the years, he found some stability through managed care: a daily regimen of 215mg of morphine sulfate extended-release and low-dose oxycodone for breakthrough pain. It wasn’t comfortable. It was a function.

Then came the bureaucracy. In Tennessee, patients with pain management needs are often limited to one clinic, one pharmacy, and one provider. Change any of those, and you risk losing everything. The process is rigid, overcrowded, and indifferent.

Steve describes it plainly. “You can’t move your prescription. You can’t change pain clinics. Appointments last 15 minutes or can be scheduled for the entire day. I’ve waited four hours. Once, I had to leave for five hours, then return before closing, just to be seen.”

But the worst blow came without warning.

“I arrived at my pain clinic and found a note on the door,” Steve wrote. “The clinic had permanently closed. Two weeks before. No calls. No newspaper notice. Just… gone.”

Gone, along with his supply of morphine.

He’d been saving leftovers, one or two pills at a time, preparing for a “rainy day.” That day had turned biblical.

Outraged, Steve contacted his state representative. The reply? Cold and condescending. The state, the rep said, had “worked very hard to make things easier for pain patients.” Steve was told he didn’t understand the system.

But he did. He understood it too well. And he knew how to survive without it.

“My anger was greater than my dependence,” Steve wrote. He weaned himself off morphine entirely. He still manages with lower doses. “It’s a struggle, but I’m managing. I was lucky.”

He ends with a wish that’s less a curse and more a reckoning: “I wish those who make it hard for us had to live with my pain for just one day. Then they would know.”

Jean: Allergic, Responsible, and Still Humiliated

Jean’s story is quieter on the surface but just as cruel. For over eight years, she’s lived with migraines. Not headaches, migraines. The kind that dismantles your life in slow, pounding waves.

Her treatment involved a medication containing codeine, one of the few opioids she can tolerate. Morphine? Off the table. All the codones? Same problem. Her body metabolizes them like poison.

Then came the state requirement: quarterly drug testing just to access the one medication that worked.

Jean refused. The intrusion was humiliating, the assumption clear: if you need relief, you’re probably lying.

So she turned to ibuprofen. Aspirin. Whatever would blunt the edge.

The result? A gastrointestinal bleed was so severe that she ended up in the ER.

Her doctor, sympathetic but powerless, urged her to write a letter to the state. “He asked why they were trying to kill me,” she recalls.

And still, the suspicion followed her. When Jean returned to the ER with shingles, she informed them about her allergies.

“They thought I was just there for the ‘good stuff,’” she said. They failed to diagnose shingles even after the rash broke out. And then came the kicker: “They asked if I wanted some ‘fentanyl to go.’”

Jean is a sixty-something professional woman. She’s used her voice. She’s warned others. The rules play her. And still, she’s been treated like a junkie at every turn.

“I resent being treated like an addict,” she said. “I have a legitimate need, and I use medication responsibly. But I worry about the future. My doctor is nearing retirement. When he’s gone, I don’t know what happens next.”

She asked for anonymity, not out of shame, but out of fear. Real, understandable fear. Because every time the rules change, she’s the one left exposed.

Beckie: The Bomb in Her Leg and the Wall of Indifference

Beckie lives in the heartland. She shattered her femur in February. The surgeon described it like a bomb had gone off inside her leg: bone fragments shredded muscle, tendons, ligaments. Repair required a full-length rod, screws, and plates from hip to knee.

She was sent home nine days later. No infection, no MRSA, but only because she escaped the hospital quickly enough.

Her discharge instructions? Ten days of oxycodone. After that, Tylenol. That’s it.

Beckie explained her medical history: 30 years of undetected Hepatitis C, cirrhosis, and a warning from a liver specialist to avoid NSAIDs or risk further liver damage.

She pleaded. She asked for Tramadol, a mild opioid. She was denied. The surgeon told her it was out of his hands. She’d need to go to pain management.

However, pain management requires monthly visits. Urine samples. Pill counts. And a primary physician that she didn’t have. No insurance for eight years. No way to pay out-of-pocket.

She’s now 66 years old, surviving on $2,200 a month from Social Security and a pension. Her life has shrunk. She lives alone. Basic care is now painful, and the fear of making the pain worse means she does even less. The dark thoughts have come. So has the spiritual fatigue.

“When it gets really tough, I recite Philippians 4:13,” she said. “It helps me through the pain, but it never resolves the pain.”

Her grandson, just 30 years old, already has three compressed discs. He has a partner. Three kids. No relief. No options. Just pain and swallowed frustration.

“I worry more for him than me,” she wrote. “I’ve had my life. But the way this system treats pain? It’s not built to help. It’s built to deny.”

She ended with a brutal truth: “Someone else’s tragedy shouldn’t mean I have to suffer. I didn’t cause the addiction crisis. Why should I be punished for it?”

Where Policy Becomes Punishment

In each of these stories, the same pattern reappears: guidelines become a punishment, and pain becomes suspicion, while those in power hide behind the phrase out of my hands.

Tennessee’s guidelines aren’t unique. Most states begin with federal recommendations and then add additional restrictions. Why do they do this? To avoid liability and appear tough on paper, the human cost is often buried in paperwork.

Steve’s locked door.

Jean’s fentanyl insult.

Beckie’s rod and no relief.

These aren’t edge cases. They are the new normal.

The CDC quietly walked back its 2016 guidelines because it knew it caused suffering. But the damage was done.

Final Thoughts

These stories aren't outliers. Their signal flares were fired up by people who were ignored and insulted but still kept fighting.

They don't want pity. They want dignity.

And they’re not alone.

To those reading this column, if you're in pain or know someone who is, tell your story. Loudly. Publicly. We need more noise because silence helps the system, not the sufferer.

Let the lawmakers see who they’re really writing off.

Let the media understand that the “opioid crisis” is more than a headline. It’s a policy of sanctioned neglect.

As Beckie reminded us, quoting Mark Twain: “Nothing so needs mending as other people's bad habits.” That includes the habits of lawmakers who punish the innocent to look like they’re helping the guilty.

We’ll keep telling these stories.

And we’ll keep writing.

Until someone listens.

Got a Story? I Want to Hear It.

If you live with chronic pain and have been pushed aside, doubted, or punished by the very system meant to help you, I’m listening.

You don’t need to write a novel. Just say what you need to say. You can share as much or as little as you like.

And if you’d prefer to stay anonymous, that’s absolutely fine. I’m not a government agency or research lab. I’m not running numbers.

I’m just trying to tell the truth, your truth.

Not to sensationalize suffering. But to hold the system accountable for what it’s done to real people: mothers, workers, veterans, neighbors.

People who didn’t ask for pain but live with it every day.

You can send your story by clicking the “TIPS” button and including your email address so I can follow up if needed. Please include my name at the beginning of your message so I can ensure I receive it.

Please let me know if you would like to remain anonymous again. If not, I’ll simply use your first name and where you’re from if you include it.

Normally, we [PJ Media] keep these columns behind our paywall, but this is a special glimpse into this important series.