Out of the Opioid Fog: A Personal Perspective

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When I was created I must have thought that God was asking if I wanted to be a good thief. Of course I said no. What God was really asking was if I wanted good teeth. Twenty years ago I had a root canal. That tooth started to throb in early April. I dutifully went to my dentist. Those of you who know, the symptoms of a bad tooth are sensitivity to heat and cold, pain when tapping on the tooth, and a sore gum. My only symptom was pain when pressing on the gum. I was referred to an endodontist and promptly told I needed an apicoectomy. Imaging is so much better than it was 20 years ago. I could see that some of the nerve was not cleaned out 20 years ago.

An apicoectomy is a gruesome procedure. After several injections of novocaine, the endodontist cuts the gum to expose the root of the tooth. The nerve is cut, the area is cleaned, and sealant is applied. Then after suturing, ice is applied. I was sent home on antibiotics and steroids. The pain completely subsided even after the novocaine wore off. I was elated. Two weeks later, the pain returned. I was put on another course of antibiotics and steroids. I was given hydrocodone for pain.

Because I had to wait to see whether the antibiotics would help and I was having a good deal of pain, I developed strategies to relieve the pain while not curtailing work or other activities. One strategy was to take nothing for the pain in the morning. After arriving at work I would take the hydrocodone. Then I would make certain it had worn off before driving home.

The wait seemed unbearable. The pain was getting worse. Two weeks later the endodontist saw me again. Palpating the gum sent me through the ceiling. She gave me a prescription that had more hydrocodone in it. I was told that I needed the apicoectomy repeated. There must be some tissue left. Surgery would be in 8 days.

Here is where the notion of opioid fog comes in. The hydrocodone would take about 35 minutes before I became almost obtunded. I tolerated being oblivious because I had excellent pain relief for about 2.5 hours. Here is where watching the clock comes in. When it was time, I would take another dose. This would go on for days. If I had to drive my children to work or school, I would time it so that the hydrocodone had worn off (and of course the pain became excruciating) so that it was safe to drive.

The surgery was scheduled for the day after Memorial Day. I lost a whole weekend. I took hydrocodone faithfully every 4 hours. I nearly became incapacitated. I would drift off as the drug peaked. After it was metabolized, I would watch the clock and wait for the next dose.

Finally Tuesday came. I was thrilled when the endodontist injected the Novocaine. Complete relief! After the surgery I took antibiotics and steroids. When the Novocaine wore off I had absolutely no pain. What I was left with was the opioid fog. I seemed to react more slowly. I was walking around in a daze that lasted 3 days.

The point of sharing my woes is that how do people with chronic pain function? Do they drive under the influence of opioids? Do they try to grin and bear it? Are they functioning in a fog? Or do they adapt to it?