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Comment by rixrax | Hacker News Reader

This. Just had friends visiting. Their teenage son had had his wisdom tooth pulled last week. Dentist had then given him (as a standard practice?) prescription for Ibuprofen (800mg tabs?) AND some opioid based pain killer! Needless to say, latter they said went directly to trash after they realized what it contained and for ibuprofen they halved the dosage.

To me and his parents this was pain management gone way over dose! But we’re not medical experts and should not be doing clinical decisions since at one end of this rabbit hole you will find anti-vaccination and other nut jobs.

So what to do?

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I just had wisdom teeth extraction a few weeks back. I was given 800mg Ibuprofen and Norco. The pain was bad enough to wake me up at night when the meds wore off — and I did take both. Oral surgery is no joke. It took me about 8 days to taper to 400mg Ibuprofen.

These doctors don’t just give pills out randomly, they do it for a reason based on evidence and science. A side note is that my pharmacist made it very clear to only use the painkillers as necessary. You should always consult the doctor and pharmacist after major surgery to clarify these things if needed.

The pain varies wildly from person to person. A friend of mine was out of order for two weeks after having a single tooth removed. I had all 4 removed and recovered in a few days and without much painkillers.

IMHO the doctors should prescribe less at first and see if it would be enough, but I also get that they are overcrowded and the same patient coming back for just more painkillers might be a little too much.

> So what to do?

One thing is not to put medicines, OTC or not, into the trash. They are nasty stuff to have in the dump.

As for the drugs: don’t take analegics if you don’t need to; do if you can’t tolerate the pain. Everybody has a different level of pain and tolerance and I bet the prescription said something along the lines of “...as needed”

As for other prescriptions, do your research; odds are you do need it but not always.

Wisdom teeth extraction is a major oral surgery. What was prescribed was not an overdose at all.

What to do? IMO: follow the doctor's/pharmacist's instructions precisely. In my case we were instructed to only break out the opidoid in the event of severe pain (has never happened to me but I guess it's possible), and there were quite specific instructions regarding it. If you don't end up needing it, dispose of it.

Exactly this. Removing wisdom teeth in particular seems to affect everyone in totally different ways that can't easily be predicted, so doctors over-prescribe and give strict only-as-needed instructions.

I had a similar experience. My oral surgeon, who did a great job, highly recommended I fill the painkiller prescription and take it. He recommended this several times throughout the process, before and once before I left, as did the nurses (?) at the counter, as I expressed some concerns about it.

I finally caved and then took a half dose right after the extraction because I was fearing terrible pain, especially since the surgeon said mine was a fairly difficult job that would probably end up causing more pain than is typical.

The half dose of painkiller made me extremely nauseous, and so I decided to just try the 800mg of ibuprofen, and it did the job perfectly. I did feel a little sore and stiff, but never in pain unless I waited too long for another ibuprofen dose. It was the same for my girlfriend, who was also prescribed the pain killer but didn't take it because she didn't feel she needed it either.

The pain killer being prescribed didn't bother me per se, and neither did the recommendation, and I don't think anything nefarious was going on. Also, everyone's body is different. But given the side effects, and potential side effects, I just felt that even a simple "we recommend you get this prescription filled, but please see how the ibuprofen works first, and only take the pain killer if you can't handle the pain on ibuprofen alone" would have been a better way to handle it.

There's probably nothing wrong with taking 800mg of ibuprofen at least for a short period of time. Ibuprofen can have some negative effects from long-term use though.

Regarding opioid based pain-killers... for all the negative attention they get, they're also usually fine for most people - when used as directed and, again, for a short-period of time.

Not everybody who takes a few Oxycodone tablets winds up addicted and then reduced to using heroin to get their fix.

This is why I hate reading these type of posts on HN. Especially like in this case where there's still a lot to be researched on and to drawn conclusions from, and the outlook isn't positive.

My recommendation is to go and talk to your doctor and confront him or her with this "finding".

Also, most importantly, this "finding" has been out for almost a year now. I wonder what's the more recent development on it.

Move to Europe where we don't get as many drugs prescribed? I think the only time you get opioids is after major surgery. Personally I don't know anybody who had to take them.

No opioids after my wisdom teeth extraction would have resulted in potentially suicide. The pain was unbearable, and 3-4 days of hydrocodone was absolutely proscribed.

There is nothing wrong with opiates being used for acute pain relief. They are a modern miracle when put to such uses.

The problem comes when you start using them for long-term pain relief - a use-case in which they are neither appropriate or effective.

A typical 2-3 day prescription after major dental (or other) work is not remotely a problem, and I really have no idea why this is where the focus is. It's always been long-term abuse as the actual problem - the weird overreaction over a few days use for acute pain is utterly absurd and only hurts people in some bizzare way for folks to feel they are "helping" fix the abuse problem.

Definitely varies by individual, and by the nature of the situation. My personal experience, as somebody who considers himself to have a pretty high threshold of pain tolerance, is that I never needed any of the Vicodin I was prescribed after wisdom tooth removal... but I can't imagine how I would have survived without Oxycodone in the first week after rotator cuff surgery.

So you mean like Spain where 800mg tabs of ibuprofen are over-the-counter?

Co-codamol (codeine and paracetamol) is widely prescribed IME in the UK, eg for back pain, muscle pain.

I had Oramorph for abdominal pain (in hospital, no surgery thankfully). The condition may have been caused by medium term use of Ibuprofen (in my non-medical opinion).

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