Three weeks of toothache and tramadol: the wait nobody measures

A month of toothache, two tramadols and a waiting list

Three weeks of intense dental pain, four hours of interrupted sleep a day and a tooth that will end up in the bin. That is the starting point of a conversation about chronic pain that begins with a very specific case: the person telling it has had the pain for almost a month, cannot afford a private extraction, and is waiting for an appointment in Spain's public health system. Tramadol, their first opioid, is the only thing that has brought relief after Nolotil (a common Spanish painkiller brand) did « all».

The discussion soon shifts to an issue that goes beyond the tooth: what counts as chronic pain, when it stops being a one-off episode, and to what extent administrative waiting turns a trivial problem into a clinical one.

When does a toothache stop being temporary and become chronic?

The criterion used by the person who opens the case is simple: almost a month of daily pain, with «small peaks of painless peace», already falls within their definition of chronic pain. It is not an outlandish reading. Chronicity depends not only on intensity, but on duration and sleep disruption, which here amounts to four interrupted hours a day. Poor sleep makes pain chronic and pain prevents sleep: the loop is well known.

The question of the cause comes up in the exchange. Some point to the trigeminal nerve because of the pain radiating down the right side of the face; others argue that a cavity with radiating pain is a sign of infection or advanced inflammation of the dental nerve, and that the acute condition must be treated before extraction. The patient himself says there is no infection and that the X-ray and extraction are scheduled for the coming days.

Tramadol, Nolotil and naproxen: the combination that gets them through the wait

The medication story is that of half of Spain: intramuscular Nolotil that «did almost nothing», naproxen that does not cover the pain, and tramadol that finally allows sleep. The description of the effect —tingling, a feeling of floating— is that of an opioid working. Warnings trinc about this combination: tramadol causes tolerance and dependence if taken long term, naproxen without gastric protection punishes the stomach, and alcohol is strictly forbidden because it depresses breathing and lowers the seizure threshold.

The usual maximum dose in adults is 400 mg a day, although whatever the doctor has prescribed takes precedence. And one piece of advice is repeated: do not increase the dose on your own when the effect wears off, and stop taking the drug as soon as the tooth is out.

Waiting as a risk factor

The case exposes a management problem: the free extraction does come, but it comes too late. In the meantime, you have to put up with it. Ways to shorten the wait are suggested —requesting an urgent dental appointment at the health centre, going to dental schools where supervised treatment is available at low cost— as well as warning signs that miccionan going to A&E without waiting: swelling of the face or neck, fever, difficulty swallowing or opening the mouth.

The conversation also leaves a touch of dark humour: the suggestion of combining tramadol with a stiff drink, the magnet on the infected area, the spiritual healer who fixes dental sensitivity overnight. Remedies that circulate and are best read for what they are.

How many more teeth have to wait their turn before the waiting list stops being an administrative detail and becomes a public health statistic?