We report the case of a 53-year-old man, who until 1992 when he was 41 years old, had as only personal history of interest the existence of a small hiatal hernia.
Since that date and as a result of a traffic accident, he began to present discomfort in both the cervical and lumbar spine, with pain affecting his shoulders, arms and consequences.
The painful symptoms increased in intensity, and under the diagnosis of lumbar discal hernia L4-L5, a lumbar discectomy and laminectomy were performed, appearing after the intervention a worsening of its symptoms.
Months later, due to lumbar instability, she underwent a new surgical intervention for the fixation of the lumbar vertebrae, and as a result of this intervention the condition worsens even more, leading to post-mycotic constipation and post-surgical fibrosis.
It is operated on two other occasions in 1997.
The first one, for the removal of the osteosynthetic material; and the second one, to perform a cervical discectomy with laminectomy at C3-C4 level, which also acquires neuroptic characteristics, as pain increases.
The severity of the condition and the poor evolution of the patient is determined by the Pain Unit of our hospital where after the initial assessment, it was decided to choose the placement of a spinal cord neurostimulator, which was not satisfactory either.
On the other hand, as a consequence of the analgesic and continuing treatments aimed at controlling pain, the patient developed a duodenal ulcer that aggravated the hiatal hernia and depression.
Recently, after an accidental fall, both heels were fractured by adding a new component of pain to those already reflected, which ended up blurring the patient in moderate depression.
Calcaneal fracture is a consequence of sympathetic dystrophy associated with both disorders.
Nowadays, she is diagnosed with cervical and lumbar post-laminectomy syndrome, and presents continuous pain, of moderate-severe intensity, with frequent exacerbations that increase with the sitting position and throughout the afternoon shift marked by disability, and regions that arrives.
Examination highlights the existence of a positive bilateral Lasegue sign at 30 degrees; severe impairment of sensitivity, which in addition to pain, originates hypoaesthetic and spastic zones that markedly limit the patient's daily life in both lower limbs;
Pain has been treated with numerous drugs, ranging from nonsteroidal anti-inflammatory drugs to steroids, to anticonvulsants, anxiolytics and antidepressants.
Three years ago, she received oral fentanyl citrate therapy to accompany the use of transdermal fentanyl.
Since then, pain and quality of life have substantially improved, although results are still far from optimal, requiring almost every day two 400 μg tablets to control their painful exacerbations.
As a most significant fact to highlight, the patient affirms that months after starting continuous treatment with oral fentanyl citrate there are multiple cavities, which have caused the loss of a total of ten pieces of oral fentanyl.
Their dental hygiene is defective but existing, performing it at some time, almost every day.
In the group of 77 patients that in our Pain Unit also receive chronic oral treatment with fentanyl citrate for diverse pathologies, and that we review as a result of the present case, no other cases of dental disorders have appeared.
The mean age of these patients was 63 ± 8.2 years and the duration of fentanyl treatment was 36 ± 8 months.
The behavior regarding dental hygiene in this group has not been modified when introducing the new drug, and the prevalence of caries is extrapolated to that of the adult population in general, in which it varies according to age 85-99%.
