Opioids Rubbing pulverized opioid on gums/teeth/inside cheek

[DWK]

Has anybody done this? I'm having trigeminal neuralgia, and it's a fucking bitch. I can tone it down a little with some lidocaine orally, but it's still intense. My tramadol prescription barely covers up the pain at all, but I was thinking about maybe crushing the tabs for my next dose and rubbing the powder inside my mouth, covering the parts where the nerve plain persists to try to get the pain reliever directly to the affected area totally, instead of popping the tablets and having them do their work on my whole body.

Are there any negatives I should look out for if I do this? If not tramadol specifically, has anyone crushed an opioid for oral application rather than swallowing and can weigh in on this question?

 

[MDPV_Psychosis]

No, applying directly to the site of pain is unlikely to work especially with something like tramadol which relies on first pass metabolism to generate the active metabolite. They really work best taken orally.

have you spoken to your doctor? They may need to explore alternative medicines, it's doubtful they will prescribe stronger opioids in today's climate but you might benefit from tackling the pain from another angle, seems anticonvulsants are often prescribed for this condition as they can help with the pain. Same with medications that help with nerve pain, like gabapentin for example, one of them could also potentially help as well.

So maybe one of these medications when used along with the tramadol can help a lot. Atleast this way you won't be climbing the opioid ladder and getting addicted to stronger and stronger opioid medications long the way.

 

[Pickledlemons]

Yeah thats not really how opioids work. Have you tried taking the tramadol, lidocaine/benzocaine and an some otc meds like tylenol and Ibuprofen in tandem? I think people underestimate the effectiveness of antiflammatories in cases like this. they might not get you high but they are pretty good at managing physical pain.

 

[Keif' Richards]

Hey DWK! This truly sucks. I have had Trigeminal Neuralgia since a surgery a few years ago. I would say mine is probably a very minor case though. I describe it it my own thought process as "a bitch", not the "worst possible pain" that many others describe the condition as.

I wouldn't recommend trying to use your stuff topically. Drugs can be absorbed through the membranes of the mouth, sines etc., but it's probably easier and ultimately more effective to continue to take the drug orally.

Have you explored other options for analgesia? I get a lot of relief from dedicated nerve-pain agents like Gabapentin (Neurontin) or Pregabalin (Lyrica). I also get better relief from the use of Cannabis when I deal with this pain. I don't think that there is a great advantage to using Opioids for this condition. Although it can be a relief, as Opioids relieve pain and reduce misery regardless of your actual condition, that doesn't mean that it is the most-effective possible treatment.

I really think we can help you find a better solution to your pain if you continue to work with us. There are a lot of different treatments that we can explore and that you can explore with your medical provider. I think there are ways to make you feel better and they won't involve a lifetime of tests and other bullshit. Looking forward to hearing from you!

 

[DWK]

Thanks, everybody, for the replies to a noob like me. I'll try to respond to every point, but I appreciate that the med isn't designed to be used that way and wouldn't have the desired effect.

... seems anticonvulsants are often prescribed for this condition as they can help with the pain. Same with medications that help with nerve pain, like gabapentin for example, one of them could also potentially help as well. ...

I already am on an anti-convulsant (carbamazepine ER 200mg twice a day). I had informed the neurologist just a couple weeks ago that it seemed to be working, and at worst I would have a persistent but totally manageable twinge in my jaw, but yesterday and the day before are the worst I've ever had, and I was sitting awake, only able to sleep in fits (and then only with the aid of tizanidine and doxylamine), which was when I decided to make this post.

I'm also already on Lyrica (pregabalin). In addition to the TGN as I'll call it, I have a host of neurological issues caused by idiopathic syringomyelia (right in the middle of my neck, too -- honestly, I'm of the mind that the TGN is related, if not directly caused by it). I've had surgery a couple times to try to clear that up, 2008 and 2013, but it started getting problematic again in 2019 (so it looks like I could keep having surgeries every 5-6 years, if I felt it necessary). But, I digress.

... Have you tried taking the tramadol, lidocaine/benzocaine and an some otc meds like tylenol and Ibuprofen in tandem? ...

I take Tylenol with every tramadol dose; unfortunately, I have gut issues that generally preclude talking NSAIDs. I actually was trying an NSAID (ibuprofen) under close medical scrutiny, and quickly developed an extremely unpleasant ulcer that put me in the ER for pain and dehydration -- despite that I was also taking Prevacid as ordered by the doctor.

As to lidocaine, I have a 4% cream to rub on my face and a 2% solution to swish and gargle. They kinda help, though during this weekend's attack they weren't doing much, if anything. I also have a tolfinate cream, much safer is it for me to apply an anti-inflammatory topically. I also have a benzocaine ointment, 20% I think, but between it's short-lived effects and the fact that I'm basically smearing it all I've the inside of my left check and gums, it goes pretty quickly.

... I describe it it my own thought process as "a bitch", not the "worst possible pain" that many others describe the condition as. ...

Have you explored other options for analgesia? ... I get a lot of relief from dedicated nerve-pain agents like Gabapentin (Neurontin) or Pregabalin (Lyrica). I also get better relief from the use of Cannabis when I deal with this pain. ...

I really think we can help you find a better solution to your pain if you continue to work with us. ...

I wouldn't quite call it the WORST pain I've ever had, but it is extremely debilitating. (I think the worst pain I've ever had was a day when my intestines decided they didn't need to move things along. I recall at one point in the ER, even after getting pumped full of dilaudid and ondansetron, positively howling "How can anything hurt this much?!)

As mentioned above, Lyrica is one of the drugs I already take. I haven't explored cannabis as an opt-in, though it's available in my state for medical reasons (problem being, I live in a particularly religious county, and many doctors are eschewing prescribing medical marijuana on moral grounds, blah). As an extremely infrequent partaker of the drug (two times, so far, and I'm 37), I can imagine from those experiences that even if it didn't resolve the pain, it might make me care a while lot less about it.

I'd be happy to work with y'all on getting this managed. I wouldn't know where to start, beyond this post, but any advice y'all have (including where to post on this forum or anyone specific to reach out to) would be greatly appreciated!

=========

As of this evening (Sunday, Oct. 4), I'm happy to report that the pain has died down significantly, though it's been replaced with a numb sensation that hasn't appeared in previous attacks. I gotta call my neuro in the morning anyway if I'm to get an increase on my carbamazepine, so I'll talk to him about that then, top.

 

[HeadphonesandLSD]

Opioids won't work for this and will probably cause more damage to your teeth. I do have a tip though; If you can get some Amitriptyline tablets they work really good for what you're wanting to do. You can crush the tablet, add some water, mix until it's a paste and apply directly to a nerve. It'll burn the nerve out and you'll never feel it again. I learned this from one of my local friends and it's very commonly used by us poor people that can't afford the dentist. I have no idea if it's good or bad for you in the long run. We typically use it to kill pain in a tooth that will get extracted in the near future.

 

[MsDiz]

Opioids won't work for this and will probably cause more damage to your teeth. I do have a tip though; If you can get some Amitriptyline tablets they work really good for what you're wanting to do. You can crush the tablet, add some water, mix until it's a paste and apply directly to a nerve. It'll burn the nerve out and you'll never feel it again. I learned this from one of my local friends and it's very commonly used by us poor people that can't afford the dentist. I have no idea if it's good or bad for you in the long run. We typically use it to kill pain in a tooth that will get extracted in the near future.

Thing with that is there’s no exposed nerve with TMJ. That’s why topical application like that just won’t work unfortunately.

 

[DWK]

... I learned this from one of my local friends and it's very commonly used by us poor people that can't afford the dentist.

I've got Medicare, so I have some dental coverage. When this all really picked up about a month ago now, first thing I did was go to a dentist cause I thought I had a massive infection find the pain swooped up from my jaw to over my left eye (my first and second molars, near the primary source of the pain, have a huge gap between them, and the inner sides of each tooth are being abraded over the years). No sign of infection, though, so at least I'm not going to get some inflammation in the brain, but since I have so many factors to consider they sent me to a neurologist.

I'll definitely keep that amitriptyline fact in my back pocket, though -- good to know.

Thing with that is there’s no exposed nerve with TMJ. That’s why topical application like that just won’t work unfortunately.

At this point, if it gets that severe again, I'd happily exposė any nerve to destroy it. That said, there was one less severe attack that actually responded well to TENS treatment, but I only got that recently and it didn't work well on a subsequent attack, and honestly it didn't occur to me to try it during this last attack. I wouldn't call TENSing your face pleasant, but it did seem to work by just overwhelming the nerve until the nerve is exhausted, however that works. I guess it just depends on how "loudly" the nerve is "screaming".

 

[MsDiz]

At this point, if it gets that severe again, I'd happily exposė any nerve to destroy it. That said, there was one less severe attack that actually responded well to TENS treatment, but I only got that recently and it didn't work well on a subsequent attack, and honestly it didn't occur to me to try it during this last attack. I wouldn't call TENSing your face pleasant, but it did seem to work by just overwhelming the nerve until the nerve is exhausted, however that works. I guess it just depends on how "loudly" the nerve is "screaming".

That’s really interesting, yeah tens to the face wouldn’t be pleasant!

I found gabapentin to be better than pregabalin for nerve pain but it has so many side effects that it’s not worth taking.

I’m sorry you’re having such a shit time, I’ve dislocated my jaw before and TMJ pain is definitely up there with some of the worst pain I’ve experienced.