Or: Why I am a medical curiosity, reason 47:
I recently had to have a root canal, and informed my dentist that novocaine wasn’t effective for me (learned from experience after having received 11 shots of the stuff at once with no noticeable effect). He told me they had all kinds of different anaesthetics they could try, and that one of them or the combination of them was sure to work. Guess again. After having received numerous (and I’m talking like 27 total) shots of every drug in his arsenal, I still felt everything, plus the added pain from all the shots. He told me he’d never seen anything like it before. I finally told him to just do the damn root canal with no more anaesthetic. I was also given an endoscopy and colonoscopy once, as I said in another thread, and felt everything (the colonoscopy was especially painful) even though I was drugged; another poster (as well as the doctors) claimed you shouldn’t feel a thing (except maybe high). So what the hell is wrong with me? Is there any literature on resistance to painkillers that anyone’s aware of? I cringe at the thought of going in to the dentist for a follow-up.
Well, I know that if you drink a LOT, and do drugs or even smoke pot, your tolerance level is gonna go up to the point where painkillers just don’t work. I learned this the hard way while in the Army (the drinking part anyway). I ended up having arthroscopic surgery on my knee with ALL the feeling still there. Not fun at all. In any case, it made me start to think about why that happened and after talking to a few different doctors, I learned the above.
Also, by the way, if you take painkillers on a regular basis, you’re gonna develope a tolerance to those also. The doctor will end up prescribing something different and the same thing will happen if you take it long enough.
If you DON’T do the above things, then I guess you just might be a freak 
I’d suggest talking to a neurologist about it.
Nope, Xploder, no drugs, no painkillers, and a few drinks on special occasions. Maybe a neurologist is a good idea.
When I was younger, novocaine did not work when I had dental work. I was told later that my nerve patterns were probably unusual and the injections were not put in the proper place. And I went though pretty much as you describe, including a shot down the middle of my tooth. Now that I’m older, no problem. I do have a more patient and skilled dentist though.
Also, I have never found a narcotic that works for me; they all have no effect except making me throw up. Asprin does nothing, but NSAIDS work, as well as acetaminephen. Also, general and spinal (thank god).
Did you have a general administered by an anesthesiologist with your endoscopy? I did, and the nurse advised me that if I had to have one again, to make sure I had an anesthesiologist because otherwise it could be very unpleasant.
You know, suzie, I did have a general anesthetic for both -oscomies, but I’m not sure what it was. I also tend to puke from narcotics, and I’ve always thought most over-the-counter pain relievers were placebos - nothing from aspirin to Motrin seems to work too well for me. Thanks for the information. It’s good to know I’m not the only freak out there.
I have a similar reaction (namely minimal and fading) to dental pain killers. My personal impression is that my body reacts to the pain killer by sending my metabolism into hyperdrive. I’m fine for a few minutes, but the numbing effects wear off quickly and I can sense my pulse accelerating, mouth flushing with blood, etc…
I have no Earthly idea. Biology isn’t my bag (HS and Collegiate grades, notwithstanding).
Yeah, I suppose some people are immune. It’s pretty rare. As to why, it could be a whole lot of things. Im not suggesting it happened to you but is it possible a person could have got a tolerance from what drugs a mother used?
I have a couple of family members who are not exactly immune but have a high tolerance for painkillers, novocaine in particular. FWIW, they are both ADHD as well, one symptom of which is that “uppers” (like Ritalin and caffeine) calm them down and tranquilizers make them (more) hyper. Doctors, in their infinite wisdom, refer to this as a “paradoxical” reaction. I don’t know if the two phenomena are related. Both respond normally, as far as I can tell, to general anesthetic.
In answer to the OP it seems like you could, in fact, have some odd chemical makeup that makes you immune. Or perhaps you are part Vulcan and the tricorder didn’t recognize this and adjust the hypospray accordingly. What color is your blood?
You know, I didn’t mention it in the OP, because most people (Including those in the medical community that I’ve told) laugh at me and think I’m making it up when I say it, but caffeine does calm me down (not so sure about tranquilizers hyping me up, but they sure make me feel happy, not sleepy). I actually went to a neurologist when I was about 14 ('84) for an unrelated disorder who told me that caffeine had the opposite effect on me than it has on most people, but he didn’t offer any explanation for it, as far as I recall. I’m certain I wasn’t diagnosed with ADHD, but I don’t know if it was even labelled then. This is very interesting. I’ll definitely make an appointment with another neurologist. Thanks.
Do you have any other unusual reactions? How are your relexes, like that patellar-knee-jerk one that I personally don’t have. Do your eyes react to a light shined into them equally, or has one always been smaller than the other? I have a very high pain tolerance—that’s just me. People who have spinal cord injuries don’t react to narcotic analgesics due to an interruption in their afferent pathways. In a surgical situation, you may require an intrethecal spinal injection to block pain impulses instead of localized injections.
And I can drink copious amounts of caffeine and go right to sleep, happy and relaxed…
I think immunity(or at least high tolerance) to Novocaine and anesthetics is much more common than Dentists and doctors think. When I was 12 and went in for my first cavity. The doctor kept giving me shots, and seeing if I was numb. Finally he had given me as much as he was confortable doing, so he sent me home at told me to come back and try agian next week. The next week It didn’t work either, so I figured if I told him it wasn’t numb I’d just have to go back again, So I gritted my teach and faked it. And have done the same everytime since then, just pretend it’s numb. None of them have noticed, except for the I nearly passed out getting my hand set(he was smashing and mushing it around for about 20 minutes), The doctor said my face was so pale he thought I was having a heart attack or something. I told him to just finish it, then I went into the bathroom to throw up for about half an hour.
woodstockbirdybird, you are not a freak, at least not for this, anyway. I have similar non-reaction to a lot of drugs (though not all) and I was never into recreational drugs.
A few weeks ago I had a particularly bad migraine. I was taking Vicodin ES for it. Most people are ready to pass out and go to sleep on just one. I had to take one every two hours, and it’s literally impossible for me to sleep when I take it. In about 12 hours, I took 7 Vicodin ES. I think most people would OD on this amount. And Vicodin has never been effective for me. When I first had back problems, it barely took the edge off. I finally convinced my doctor to let me try Percocet. I am skeptical that it will be any better, but I need something to try when my other medications don’t work, or it’s another trip to the ER.
My reaction to Demerol is not much better. For my back, I needed two shots to make the pain tolerable. It did not get rid of the pain, just distanced me a bit. The last time I was at the ER for a migraine, they put me on an IV drip and ended up giving me two doses of Demerol intravenously. It took the edge off and made the pain tolerable, and alleviated the nausea so I could keep fluids down. But it took me another six days to completely get rid of the migraine.
Luckily, my colonoscopy experience was better than yours. I was out like a light. The preparation, OTOH, was less than pleasant.
porcupine, Vicodin has the exact same effect on me (it also makes me break out in a rash, 'cause I’m allergic to it). I believe it was demerol I was on for the colonoscopy. Have you ever found anything that works for you? I’m almost ready to give up on painkillers altogether.
I’d argue that the most likely reason the novocaine didn’t work is that your dentist missed the nerve. You have to inject that stuff just in the right place, otherwise you get little effect. Another possibility, is that since novocaine is less effective on infected tissue and you probably had an infection, you got little effect.
This is what I think your problem is too, WSBB. Either you have unusual nerve anatomy (possible but unlikely) or a crappy dentist.
Is this a joke? Please tell me this is a joke. For the love of analgesia, tell me Handy is kidding.
The way I learned this it’s children that have the “paradoxical reaction.” In other words, the calming effects of ritalin are unrelated to the condition ADHD, but instead to the physiology of a youngsters CNS.
Man, you gotta understand, you’re working without a net here. You seem to be on the verge of saying CNS drugs work paradoxically on me. Caffeine calms me (BTW, like cyn I can drink coffee before bedtime with no effect-that’s tolerance for ya), novocaine doesn’t block pain, narcotics are ineffective. Your aim seems set at a unifying theory. But you ain’t going to get one. All these drugs work differently. Thay have distinctly different mechanisms of action, serum half lives, modes of metabolism/excretion, side effects, etc. For example (IIRC) novocaine is a sodium channel blocker and works by inhibiting action potentials in nerve fibers, blocking pain transmission. Caffeine doesn’t work this way. Caffeine acts on a different molecule (phosphodiesterase IIRC) and in a different way (ie. it doesn’t do anything like blocking action potential transmision). Therefore, while the novocaine injections you received were ineffective AND you experience a calming effect from coffee, these events are most likely unrelated.
Narcotic analgesics lose their effectiveness fairly rapidly. It sounds from your descriptions that you’ve had reasons to take them (back problems, migraines), so you be experiencing some component of tolerance.
More impotantly, though, don’t take so many Vicodin ES’s. Each pill contains 7.5 mg hydrocodone and 750 mg acetaminophen (Tylenol). Whether or not you are getting pain relief, you cannot keep jacking up your tylenol dosage. In the PDR it says that in adults and children hepatic toxicity may occur following ingestion of 7.5 to 10 grams over an 8 hour period, although fatalities are more often associated with doses over 15grams. You took 0.750 X 7 = 5.25g in 12 hours. That would be cutting it too close for me.
This problem is more common than you think. The problem seems to be that some people are more sensitive to pain than other people. It is also very common place for patients to claim one anaesthetic is far less effective than a very similar one.
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Pain ultimately has a strong psychological component. Medicines are far less effective in patients who don’t think they will work. People with fibromyalgia, patellofemeral syndromes etc. report pain under stimuli that would not discomfort many people.
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Novocaine is a local anesthetic which is quite different from an opiate like Demerol, in terms of its mechanism, half life, side effects or dose. Dosage is key, your pain could be controlled given adequate dose of the right anaesthetic. Patients are wrong when they think control of a pain means that it will completely disappear. It won’t. So these things are to some degree a question of attitude.
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Your dentist could have missed the nerve. Dentists are often worried about side effects of anaesthetic and occasionally use too small a dose. Many people claim painkillers don’t help them, this is not obviously related to genetics, but in fact this probably does play a role – things like malignant hyperthermia and acetylcholinesterase deficiency do run in families.
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“Dcotors in their infinite wisdom call it a paradoxical reaction”. Doctors understand drugs work differently in different people. Individuls have very different P450 enzymes in their liver and metabolize drugs differently. This is one reason why the doctor needs to see you after prescribing medication. In the future, I think doctors will less commonly prescribe a “standard” dose of medication, the way they too often do now.
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You are taking way too high a dose of acetaminophen; choosybeggar is right when he calls it unsafe without close monitoring. If 7 pills doesn’t help more than 3, please see a specialist and get on an alternate drug.
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Are you sure you don’t enjoy, at some level, describing yourself as a medical curiousity? Lots of people do. These patients don’t do as well. Attitude is everything. That said, I wouldn’t laugh at you if you told me caffience calms you down. Me too, until the seventh cup or so.
One more point. Lot’s of narcotic preparations contain acetaminophen. It helps reduce the dose of narcotic required to produce pain relief and also reduces the abuse potential (because of the toxicity associated with high doses). Before upping the dose on your own, check to see if there’s acetaminophen in the preparation you have. Ideally, even if there’s no acetaminophen in your analgesic, run you plans past a MD.
My Drugs & Behavior professor pointed out to our class that the reason some of us didn’t get wired by coffee wasn’t that we’re super-cool supermen of caffeine; we just got tolerant to the arousal effects. He (Bill Mckim, author Drugs & Behaviour, currently on its 4th edition, I think) pointed out that in his research, the only effect he found few people gained tolerance to was the increased need to urinate. Since this would happen with increased injestion of any fluid, and wasn’t incredibly interesting to him, he didn’t study it in depth and concluded that most people would live with going potty more frequently.
I agree with the astoundingly well formulated posts of choosy and Dr. Paprika, and would also add that Ritalin has been found to increase attention span across the board in children; not just in ADD kids. I don’t have a cite right here in front of me; I’m sure a good search of Psychopharmocology journals will yield dozens of hits. I’ll cite later if I get a chance.
There’s been a proposed ‘Nocebo’ effect; noted by Uncle Cecil here: http://www.straightdope.com/mailbag/mnocebo.html
So, if you go in thinking you’re going to be unaffected by the treatment, it’s not unthinkable that your belief will prevent the treatment from working. If the treatment was being confounded by moderate resistance anyhow, you may get no benefit at all.
I also find some painkillers useless; it depends on the severity of pain, what I’ve had to eat/drink that day, the type of pain I’m experiencing, and a bevy of other factors I don’t even know are coming into play. I second the ‘seek the advice of a neurologist’ advice. If he finds nothing screwy, see if you can call the local hospital and talk to an anaesthesiologist, no doubt there’s training in place to deal with folks who are resistant.
Thanks, choosy; it’s possible, but I doubt it. As I said, I was given a whole battery of shots - of different anesthetics - ALL OVER my mouth. Hell, with that many shots, I could probably find a nerve. Also, I’ve had anesthetics administered by a number of different dentists (and doctors) over the years, including dentists at four different Army bases when I was in the service, and I can’t imagine they were all so crappy they couldn’t find a nerve. As I said, I had similar experiences with demerol and vicodin, which I realize are unrelated. And Dr_Paprika, I do understand the psychological aspect; however, I usually go in expecting a drug to work, especially when I’m told (as I was by my dentist) that there are a number of different anesthetics available, and that one of them is sure to work if the others won’t. As I said, it’s not that painkillers have no effect on me; they just don’t seem to have much of a painkilling effect. Vicodin (or codeine, or demerol, or percodan) certainly makes me feel high, so that I might not care so much about the pain, but it doesn’t seem to allieviate it at all. And trust me, I take no kind of perverse pleasure in considering myself a “medical curiosity” (I was trying to be funny with that line); I don’t have any hypochondriacal or martyr complexes - in fact, I wish something would work, and generally assume it will until I’m proven wrong. I’ve had plenty of good experiences with other classes of drugs - it’s only painkillers I’ve ever had trouble with (to be fair, I haven’t taken too many in my life and I’m sure with the proper medication and dosage something’s gotta work).
I also realize that I shouldn’t try to buld a theory out of disparate symptoms such as the effects of caffeine/local anesthetics/narcotics - I just found it heartening that someone claimed they (or family members) had the same reactions to painkillers and threw in the caffeine angle, which I also experience but neglected to mention. Anyway, thanks for all the advice - I guess a consultation is in order.
In that case, I assure you something is out there that can help control your pain. I don’t know what it might be, though. Chronic pain can be difficult; fentanyl is 80 times as strong as morphine and may be effective. Toradol helps some people and is not a narcotic. TIMING of doses is imprtant in painful conditions like inflammatory bowel disease to ensure the level of painkillers remains adequate. Tachyphylaxis (adapting) to doses of painkillers is common, increasing the dose randomly is a poor and dangerous solution.
I also get migraines, and acetominiphen (Tylenol) does nothing for it. I was at a point of taking as many as 4 or 5 at once, 3 or 4 times a day till my doctor told me never to take that many. I need good old Excedrin or liquid gel tabs of Motrin or Advil. He said I can take 800 mgs of the liqui-gels, which seems to work pretty well for the minor ones. The liqui-gel tabs get it into your system faster than the regular tablets.
I have Imitrex, which sometimes work and sometimes doesn’t, but that isn’t a narcotic (I think). I also have some pills with butabital (which IS a narcotic) that also work well.
The two times I’ve been to the ER for a migraine, they wanted to give me a shot of Demerol, which doesn’t help the pain at all, just makes me dopey and light-headed. Demerol does absolutely NOTHING for the pain, for me, at least. And I’ve only had Demerol a few times, so it’s not like I’ve built up a tolerance for it.
Just sharing…