Summary

I have experienced chronic pain since November 20th. It affects the right side of my face, my jaw, my teeth and ear. I was hospitalized at Mayo Clinic for pain management for two days last week. ┬áBut no one really knows anything yet. I just know that I’m in chronic pain, barely managed by narcotics. Please read this first. I wrote this all for the future medical community I may yet have to meet. My next visit is to the oral surgeon on Monday, December 23. he has given me a referral to the Mayo Clinic Oral & Maxillofacial Surgeons, where they have indicated a bone scan may be needed. We will decide that on Monday.

Tuesday, December 17, 2013

Symptoms:
Jaw at the joint under ear extremely painful, can’t open it far. Same teeth hurt.

Pain: 3 on pain med; 5-6 when pain med expires

Actions: Two doctor visits today

Providers Seen: Dr Viswakarma, Dr Young

Results of Visit: Dr Vishwakarma, 9:45am:
He said that there was no way it could be necrosis of the jaw, since the CT scan did not show it. He was supportive that I was seeing the oral surgeon. He refilled a 4 day supply of Dilaudid, 1 every 6 hours. There were no ideas proffered for a “next step” other than follow up with my oral surgeon.

Results of Visit: Dr Young, Oral Surgeon, 3:10pm:
He took time to hear all my recent symptoms. He did a thorough exam of my mouth. He told me that he had contacted Mayo Clinic Oral & Maxillofacial team, and I now have an official referral to them. He said it was their idea for a bone scan, and that they would look for a number of potential problems with the bone scan, and he didn’t feel it right to get into all the weird things it could be. He is concerned that the numbness I had before tooth 31 was ever extracted, and the abnormality of the pain beneath so many teeth that has existed through all of this since November 20. He does not have an answer, neither does Mayo. But both are sure that there is a good chance something is wrong that they can’t see yet. We agreed on a plan: since my last dose of antibiotic is tomorrow, we will wait to see after the last dose if the infection increases, swelling increases, or if pain stays the same or gets worse. Also we will see if the numbness subsides. We will then meet next Monday morning the 23rd and look at where we are symptom-wise, and decide about a bone scan then. I am pleased with this plan. If symptoms get bad between now and then, I’m to contact the ER and they will know what to do. I’m now officially referred to Mayo by him, so they should all know what to do.

I am also hoping that this just all goes away over time and no more medical care is needed. That would be nice. And I would take that boring resolution any day over more and more tests and visits.

Medications:
Dilaudid 4mg and Tylenol 325 every 6 hours, Augmentin 875-125 every 12 hours

Monday, December 16, 2013

December 16, 2013 (Monday)

Symptoms:
12:01am-4am: on pain med can’t sleep, pain level at a 5
4:00am-8:45am: took pain med, pain med combined with exhaustion, I sleep
8:45-12:45: took pain med, it seems this time to really help, pain at a 4
12:45pm: I skip my scheduled pain dose
12:45pm-3:45: pain at a manageable but distractible level, increasing from 4-6

3:45pm: Without pain med on board, and pain at 5-6, I test teeth with gentle pressure:

Tooth 31: They removed this tooth and socket is just uncomfortable, level 1-2
Tooth 30: level 2-3
Tooth 29: level 6 (scream and shake)
Tooth 28: level 8-9 (scream loudly want to die)
Tooth 27: level 6 (scream and shake)
Tooth 26: level 3
Tooth 25: level 2

Now my whole jaw and gum are reverberating with pain that won’t go away.

4:00pm: Took my pain med. Skipping a cycle was an experiment. Afraid to skip again.

Jaw at the joint under ear extremely painful, can’t open it far. Diarrhea continues.

Pain: 3 on pain med; 5-6 when pain med expires

Actions: None

Provider Seen: None

Results of Visit: N/A

Medications:
Dilaudid 4mg and Tylenol 325 every 4 hours, Augmentin 875-125 every 12 hours
Two doses of Zofran to help stem the diarrhea caused by the antibiotic

Sunday, December 15, 2013

December 15, 2013 (Sunday)

Symptoms:
Pain and swelling have leveled out. Not much swelling on the outside. Pain is under control for about 3 hours each Dilaudid dosage. For about 3 hours each dosage cycle, pain is at a 4. Then as it wears off, it goes to a 5. A couple times due to sleeping I went 5 hours between doses, and the pain hit a 6. Sleep is normally in 3 hour sessions. Jaw seems a bit more painful than yesterday, especially at the joint just under the ear.

Pain: 4-5

Actions: None

Provider Seen: None

Results of Visit: N/A

Medications:
Dilaudid 4mg and Tylenol 325 every 4 hours, Augmentin 875-125 every 12 hours

History from November 20 to December 14

December 14, 2013 (Saturday)

Symptoms:
Pain and swelling decreasing. Thankfully, sleep is coming in 3 hour batches now. Bowel unhappiness and diarrhea, but that’s to be expected. Jaw mobility seems more limited than yesterday, so that’s a new symptom I hope is just related to all the banging around in my mouth that has been going on, and not a bad symptom.

Pain: 5

Actions:
Rested all day.

Provider Seen: None

Results of Visit: N/A

Medications:
Dilaudid 4mg every 4 hours
Tylenol 325 every 4 hours
Advil 600 mg every 4 hours
Zofran, 4mg, one every 8 hrs

———-
December 13, 2013 (Friday)

Symptoms:
Pain and swelling now reducing a bit. Jaw seems to be hurting more, especially at the joint of the jaw. I am experiencing less range of opening, and a new pain when I try to open wide.As soon as I got back from the periodontist at about 1:30, my bowls start moving… nonstop, for next few hours. This is exhausting and painful. Now I have diarrhea issues after almost two weeks of constipation.

Pain: 5-6

Actions:
I go see the Periodontist at noon, for a consultation.

Provider Seen: Tom Wolfe, DDS

Results of Visit:
He said that he had had a long discussion with my oral surgeon, Dr Young, that morning, about me and my case. They both reviewed all of the X-rays and CT scan and the history. After reviewing all my X-rays (full pans before and after the tooth extraction) and bite wings and the ones from the dentist on the 20th, he concurred that it is “highly unlikely” that there is a dental issue causing this. He also examined my gums closely, and said he could see no periodontal disease. And he said in his 25 years of practice, he had never had a periodontal disease patient have this kind of persistent and intense pain.

Moreover, he said that Dr Young wanted to see me as soon as possible because he is more convinced than ever that there must be a jaw issue, possibly a necrosis of the jaw bone. After meeting with me, Dr Young will probably order a bone scan for me at Mayo Clinic.

We made an appointment for Tuesday at 3:10. This works perfectly as I also have my first appointment with my primary care doctor, Dr Vishwakarma, at 10:45 am on Tuesday.

Medications:
Dilaudid 4mg every 4 hours
Tylenol 325 every 4 hours
Advil 600 mg every 4 hours
Zofran, 4mg, one every 8 hrs

———-
December 12 , 2013 (Thursday)

Symptoms:
Swelling and pain a bit increased. Sleeping was difficult. Finally used an enema at night, and a plug was removed but I still felt blocked up. Severe stomach distress. I haven’t had a movement since November 30.

Pain: 6-7

Actions:
Mary spent the day trying to find a Periodontist that would take our MN Care insurance. There was only one left in the whole state, and they weren’t seeing new patients. So effectively, we did not have periodontal coverage. So she regrouped and began the begging our way in to a consultation ASAP. She finally was successful and got an appointment for the next day with Tom Wolfe, DDS, in Austin. He happened to be in the same professional building as my oral surgeon Dr Young, and they know each other. Our “plan” was to rule out periodontal, since “dental” had also been ruled out, thereby giving us the chance to appeal to the medical community with these out of the way.

Provider Seen: None

Results of Visit: N/A

Medications:
Dilaudid 4mg every 4 hours
Tylenol 325 every 4 hours
Advil 600 mg every 4 hours
Zofran, 4mg, one every 8 hrs

———-
December 11, 2013 (Wednesday)

Symptoms:
Pain and swelling reducing. Everyone at Mayo is compassionate.

Pain: 5-6

Actions:
They discharge me at noon. I go home.

Provider Seen: Meltiady Issa, MD, Medicine 11 Hospital Service, Mayo Clinic AND a phone call Wednesday night from the ER Oral Surgeon (we think his name is Dr Samir W., and Mary has this phone number, 507-266-0585)

Results of Visit:
Discharged. Once home, we received a phone call from the ER oral surgeon who explained why they won’t see us. He did say that if my original dentists and my original oral surgeon had both said there is no dental issue, that I should see a periodontist (gums). He said, quoting, “You have puss and a periodontal access, and I am unable to find where the puss is coming from.” That’s all he had. So again, I felt stranded and alone.

Medications:
Dilaudid 4mg every 4 hours
Tylenol 325 every 4 hours
Advil 600 mg every 4 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 10, 2013 (Tuesday)

Symptoms:
Inpatient at Mayo, recovering. Still in huge pain. Disoriented and really really exhausted. No interest in anyone or anything. Losing track of day and night. Was afraid they were going to release me that afternoon. My Mayo doctor, Meltiady Issa, met with me to assure me I wasn’t going home since they hadn’t gotten the pain meds dialed in, and I was still on IVs. This helped my anxiety.

Pain: 7

Actions:
Increased my Dilaudid dosage to 4 mg that afternoon, by IV self administered, and was able to finally sleep several hours in a row.

Provider Seen: Meltiady Issa, MD, Medicine 11 Hospital Service, Mayo Clinic

Results of Visit:
Dr. Issa informs me that Mayo Oral & Maxillofacial Surgical practice refuses to see me for follow up, and they insist I follow up with a dentist. They have not seen any dental X-rays, only the CT scan and the draining surgery. Since they could not find an excessive abscess, and had cleaned out what they could find, they felt they had done all they could, and I should go see a dentist. Later that night, I get a phone call from my original oral surgeon, Dr Young, who told me there was nothing he could do, since he knows it’s not a dental issue. He tells me that seeing a dentist will not help, that there is nothing wrong with the teeth. I ask him what I should do. He says I need to make the Mayo oral surgery practice deal with this, since he’s convinced it’s a problem in the jaw. I tell him they won’t see me. He says there’s nothing more he can do. I am deeply depressed now, and lost. I have no idea what to do.

Medications:
Dilaudid IV
Antibiotics IV
Stool softeners
Anti nausea IV

———-
December 9, 2013 (Monday)

Symptoms:
Same as Saturday. Numbness is same or worse. Still constipated. No appetite. No desire to live. Deeply depressed.

Pain: 8

Actions:
I go to see Dr Young (my oral surgeon) who is back in town, at 11am. He removes the dry socket packing (which made it all weekend) and hears all the symptoms and the pain levels and sees the swelling and becomes very concerned. He sends me to Austin Medical Center for CT scan with contrast. It takes 4 hours to get my turn for a CT scan. They send him the results. I meet with him. He sees (as does the radiologist) indications of a deep infection in the gum. He sends me to my own hospital in Albert Lea, ALMC, with a called ahead rx for an intravenous antibiotic, and then I’m to see him again on Tuesday. When I get to the ER at ALMC, Dr Brogan takes over, and after looking at Dr Young’s rx for an IV, she changes it to something stronger. She also informs me I’m not going home, but will be kept overnight because of the nature of the infection and to manage pain by IV. She hooks me up IV to Dilaudid and opens it up. First relief I’ve had for so many days. I almost cry with relief. She disappears and comes back later saying she has consulted with colleagues at Mayo Clinic in Oral & Maxillofacial Surgery, and they insist on seeing me that night. She says hospital regs require I go by ambulance. So I arrive at Mayo Clinic ER at around 9pm. The surgeon (I can’t find his name) is a Resident, I think, as I also meet his Attending. He operates after lots more Dilaudid and plenty of nerve blocking. But when he starts cutting and looking for the infection to drain, the pain is all of a level 9 and I’m losing touch with reality. It felt like a knife on my nerve. He eventually drains some puss, and stitches me up. They admit me to the acute care section of floor six at St Mary’s for pain management.

Providers Seen: Richard Young, DDS, Radiology Dept at Austin Medical Ctr, Dr Autumn Brogan, Emergency Room at ALMC and Rochester Mayo Clinic ER (St Mary’s Hospital), Oral & Maxillofacial Surgery Service.

Results of Visit:
Admitted inpatient to Rochester Mayo, after ER surgery to drain infection, to manage pain.

Medications:
Dilaudid IV
Antibiotics IV
Stool softener
Anti nausea

———-
December 8 , 2013 (Sunday)

Symptoms:
Same as Saturday. Numbness is same or worse. Still constipated. No appetite. No desire to live. Deeply depressed.

Pain: 8

Actions:
None. Giving up.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil, OTC, 600 mg, every 4 hrs
Vicodin 7.5-325, one every 4 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 7 , 2013 (Saturday)

Symptoms:
Woke up with incredible swelling in jaw and gums and side of face and under tongue. Immense pain. Numbness is same or worse. Still constipated. No appetite. No desire to live. Deeply depressed.

Pain: 8

Actions:
Just tried to exist.

Provider Seen: None.

Results of Visit: N/A

Medications:
Advil, OTC, 600 mg, every 4 hrs
Vicodin 7.5-325, one every 4 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 6 , 2013 (Friday)

Symptoms:
The dry socket packing had come out the night before at 8pm. It was a long night. This night I received literally no sleep, not even a catnap. It stayed at a level 8 non stop. I was at my lowest point yet emotionally. The chin numbness got worse and spread a bit farther.

Pain: 8

Actions:
I went back in to see Dr Young’s nurse to repack the dry socket for the weekend. She had trouble packing it deeply because swelling was beginning in the affected area, and my pain was too intense for her to push it deeper, and she was worried about the numbness too. So she called the backup oral surgeon who was covering for Dr Young. He requested I come in immediately to his office in Rochester for exam and packing.

Provider Seen: Kevin Amundson, DDS, Rochester, MN

Results of Visit:
He did a full visual and tactile exam and the exam hurt intensely. As he tapped on teeth, the pain hit level 9 and I was screaming. He was able to determine that the pain seemed to be shifting between teeth 31 and 30 and I couldn’t pinpoint which was worse. Then he gave me a long lasting nerve block (about 6 or more Novocain shots) which he said should last between 6 to 8 hours. These shots hurt intensely. He then replaced the dry socket packing deeply and with a long lasting medicine. He also switched my pain medicine (since I needed a refill) from Percocet to Vicodin and said to switch to 600mg of Advil (OTC was fine) rotating with the Vicodin. The nerve block did not last long. All the pain was back in exactly 4 hours.

Medications:
Advil, OTC, 600 mg, every 4 hrs
Vicodin 7.5-325, one every 4 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 5, 2013 (Thursday)

Symptoms:
Pain gets worse. We think it may be dry socket. It was a miserable night with no sleep at all. I start losing touch. The pain is all consuming. Also, rather alarmingly, a sudden onset of chin numbness that covered my right chin and right lower lip, had happened at about 3am. It was quite “thick” numbness. Creepy.

Pain: 8

Actions:
We call Dr Young’s office and they tell us to come in immediately for a possible dry socket that would need attending to.

Provider Seen: Nurse at Dr Young’s office.

Results of Visit:
She saw exposed bone and treated dry socket with packing.

Medications:
Advil (prescription) 800 mg, one every 6 hrs
Percocet 5-325, one every 6 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 4, 2013 (Wednesday)

Symptoms:
Pain never decreases, and is same immediately after Novocain wore off after surgery on Tuesday. There is initially no numbness after the surgery. (See symptoms on December 5) All the same “ice pick” pain is the same, except there is no molar 31 that is causing it. It centers in that area, but is ill definable in precise location, probably because of the trauma of surgery. I’m not sleeping, and the Percocet, like before, provides barely enough relief to keep me off the ceiling. I am depressed.

Pain: 7

Actions: None. Just lost in misery.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil (prescription) 800 mg, one every 6 hrs
Percocet 5-325, one every 6 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 3, 2013 (Tuesday)

Symptoms:
The same as December 2.

Pain: 7

Actions:
Mary had gotten an emergency work-in to the oral surgeon the day before, so we went to see him at 9:00 am. We were expecting just a consult for phantom tooth pain, since no dental issue was seen by the previous dentist.

Provider Seen: Richard Young, DDS, Austin, MN

Results of Visit:
Dr Young sees a small crack in molar 31 (not seen by the dentist). He taps on and checks all other teeth. Even though pain is in other teeth as well, the epicenter of level 10 (almost pass out pain) happens by lightly tapping on 31. He does panoramic X-rays, then removes tooth 31 (right rear molar). We can see the crack. It’s slight, but it is there. He sends me home advising that dry socket is a risk, and to contact his nursing staff if it happens. He will be out of town at a convention until the following Monday.

Medications:
Advil (prescription) 800 mg, one every 6 hrs
Percocet 5-325, one every 6 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 2, 2013 (Monday)

Symptoms:
Life has pretty much stopped at this point. All thoughts revolve around the pain. I am demoralized and feeling hopeless. The pain is searing and never ending and the narcotic has almost no affect. But I take it because when it kicks in, I get maybe 20 percent relief for an hour or two. I sleep during those windows.

Pain: 7

Actions:
Same as yesterday. But I can’t see my primary care provider Dr Vishwakarma until Wednesday. I’m vomiting (dry heaves) from the Percocet. So Mary gets me in to see a nurse practitioner that afternoon. My pain is making me anxious and disabled from any real life.

Provider Seen: ALMC, Lindsey Gudmonson, CNP

Results of Visit:
She gives me two prescriptions to manage the pain and also the side affects of the pain medication. She told me I had to go back to the dentist, and she offered to give me a referral to an oral surgeon instead if I wanted. While we filled the prescriptions in the medical center pharmacy, Mary got on the phone and explained to the dental office what was going on. They said that since there was nothing they could see wrong in the X-rays, and because we had mentioned to them that we thought it could be “Phantom Tooth” pain, they would refer me to the oral surgeon in Austin, MN, Dr. Richard Young.

Medications:
Advil (prescription) 800 mg, one every 6 hrs
Percocet 5-325, one every 6 hours
Prilosec, 20 mg, once daily
Zofran, 4mg, one every 8 hrs
Senexon, 8.6-50mg, two tabs twice a day

———-
December 1, 2013 (Sunday)

Symptoms:
Life has pretty much stopped at this point. All thoughts revolve around the pain. I am demoralized and feeling hopeless. The pain is searing and never ending and the narcotic has almost no affect. But I take it because when it kicks in, I get maybe 20 percent relief for an hour or two. I sleep during those windows.

Pain: 7

Actions:
Hot and cold packs. Percocet every 6 hours and Advil every 4 hours. Focus on staying calm and deep breathing. I fight the urge to pant and hyperventilate. I lose that fight sometimes and it takes Mary an hour to calm me down. I get almost no sleep, just catnaps.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil OTC 800mg/4 hrs
Percocet 5-325, one every 6 hours

———-
November 30 , 2013 (Saturday)

Symptoms:
Escalating pain all over right side of face, ear and jaw, epicenter is molar 31 and nearby teeth 30 and 29. Like an ice pick in 31, and other ice picks in ear and nearby teeth. Exhausted and demoralized and shaking violently and hyperventilating by late afternoon. Pain is all consuming and I cannot pay attention to anything or any conversation. I cannot complete sentences and have trouble focusing on the questions. Eventually on floor in fetal position screaming and moaning. This also was the last day for a bowel movement. I stayed constipated for another 12 days or so.

Pain: 8

Actions:
Mary dresses me and takes me to the car and drives me to the Emergency Room in the early evening.

Provider Seen: ALMC Emergency Room, Wesley Morris, PA-C

Results of Visit:
Two hours in ER while they ran tests and I think they phoned for consult. Blood pressure was quite elevated with the pain, and they would not give me anything for the pain. Dr. Morris gave me three Novocain shots near tooth 31 as an attempt at a nerve block. It did not work. No relief. Finally he gave me a Percocet, 5-325, made sure I tolerated it for 15 minutes then sent me home with 6 pills and a holdover rx until I could get in to see my primary care physician early the next week. He suspected something (so he said) but felt he shouldn’t share it, that I should hear it from Dr Vishwakarma. Following is his discharge summary quoted:

“Please call your doctor Monday. We will send a referral for you to be seen in the earlier part of next week. We will provide medication for you. We don’t feel this is cardiac in nature, your tooth is not pain free with a dental block so less likely tooth related, you don’t have exquisite pain at your temples which rules out serious problems. You also have less pain at your TMJ than your tooth. If you have worsening symptoms you may always return to this emergency department.”

Medications:
Advil OTC 800mg/4 hrs
Percocet 5-325, one every 6 hours

———-
November 29 , 2013 (Friday, day after Thanksgiving)

Symptoms:
Drove home from out if town visit at 3pm. Excruciating pain. Moaning. Began screaming for the first time anytime molars 31 or 30 are touched even gently. Tooth 29, 2nd bicuspid, is also aching. All other facial pain symptoms previously mentioned worsens.

Pain: 6

Actions:
I quit eating anything solid that night, and for many days thereafter. I go on a 100 percent liquid diet, with some macaroni and cheese tried several times. Still too risky and painful, so gave that up a few days later. So pure liquid… apple sauce, protein shakes, soup.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil OTC 800mg/4hrs. Tylenol, 1000 mg/4hrs, alternating at 2 hour cycles

———-
November 28, 2013 (Thanksgiving)

Symptoms:
Same as previous days. Slept only two hours this night. Pain exponentially increasing.

Pain: 5-6

Actions: Survive.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil, 800mg/4hrs. Tylenol, 1000 mg/4hrs, alternating at 2 hour cycles

———-
November 21-27, 2013

Symptoms:
Same as on November 20th, but ever increasing. Woke up in pain several times (usually twice) every night. Able to get back to sleep within an hour each time. Becoming anxious about the pain.

Pain: 5

Actions:
Gutted it out. We tried researching on our own about TMJ and other dental possibilities as well. We have no insurance for orthodontia, so seeing an orthodontist was out of the question.

Provider Seen: None

Results of Visit: N/A

Medications:
Advil OTC 800mg/4hrs. Tylenol, 1000 mg/4hrs, alternating at 2 hour cycles

———-
November 20, 2013

Symptoms:
Stabbing pain in entire right side of face, epicenter in rear right molar (number 31) and nearby molars and jaw, radiating up to ear and eye and entire face. Pain kept me up the entire night before. Advil/Tylenol not effective. This had begun at ever increasing pain levels sometime the week before.

Pain: 4

Actions:
Got an emergency work-in appointment at a dentist.

Provider Seen: Midwest Family Dental, Wells, MN. Dr. Carlson.

Results of Visit:
They took bite wing X-rays and examined the teeth. Found no crack. The pain seemed to be in both rear molars as he tapped on them, and Dr Carlson suggested it probably couldn’t be two cracked teeth, so must be something else. They found no indication of tooth decay, and no evidence of grinding. The recommendation was to see an orthodontist about possible TMJ or other misalignment of the jaw and consider splints. Beyond that, there was nothing he could do.

Medications:
Advil/Tylenol

—————————————————
NOTES

Tooth Numbers:
http://ameritasgroup.com/OCM/GetFile?doc=093524

Pain Scale:
http://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/0-10_Pain_Scale.pdf

MINOR
Does not interfere with most activities. Able to adapt to Discomforting 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 simulated 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.

—————

My primary care doctor: Dr. Moti Vishwakarma
http://mayoclinichealthsystem.org/local-data/medical-professionals/albert-lea/moti-vishwakarma-md

My oral surgeon: Richard Young, DDS
http://www.semoms.com/meet-us/oral-surgeon-dr-young.html

Website discussing Dilaudid:
http://www.rxlist.com/dilaudid-drug/indications-dosage.htm