A rant on pain management, in this country.

[strollingbones]

old fashioned test for ms.....get into a hot tub...dont do this alone....if you pass out its most likely ms....if you dont....its something else....

 

[geauxtohell]

I don't dispute that she has chronic pain. I dispute that narcotic pain pills are the best treatment for her chronic pain.

Show me the evidence based literature that disputes that, and I will take a look.

She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......

Effexor. Cymbalta. It takes a while to get enough in the system to work. I dont know about Lyrica. It is mostly used for diabetics. Pristique. Not more efficacious thatn Effexor.

Lyrica is a GABA analogue. The current notion is that people with FM have low thresholds for pain. So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.

 

[Quantum Windbag]

Not really. You are trying to make it about that, but that was never the OPs complaint. You perceive that her physician won't give her narcotics because the DEA is up their ass with a microscope.

I percieve that because the DEA is up every doctors ass with a microscope. If you don't believe me go into pain management and see ho difficult it is to comply with DEA regulations v patient needs. If you can provide evidence that her doctor is the exception to the rule feel free to provide it, until then I will assume that everything I have read, and experienced, is true.

Just like you do when you demand I provide clinical studies to refute your position.

That's a separate issue. As it stands, I have my doubts that drugs are going to be universally legalize in the next decade, so the problem still stands.

Exactly, if we could get the government out of determining what is, and what is not, valid treatment we will continue to have a problem doing proper pain management in this country.

Yes. That's a separate issue. If I were in charge of the world, I just skip the canard of medical marijuania and legalize it. Before you ask I would not legalize cocaine, opiates, or amphetamines that carry the potential for acute overdose.

Legalization does not mean selling it in gas stations. All drugs should be legal, and regulated.

In regards to narcotic pain pills, you are wrong.

You just believe that because your moral position is that hard drugs are bad.

Oh lord....... You have access to google, right? I am not trying to "assert" anything. Medicine is an "evidence based" venture. That means decisions are made, not on what you or someone believes in their gut, but on what the research shows. I am not being snooty or flippant, I am asking if you can produce a shred of evidence beyond your opinion that would make me reconsider what I have been taught or researched myself.

That is addressing the issue in an academic matter. If we were on medical rounds, the standard would be the same. Stomping your feet and insisting that you are right and I am a dick is not.

I am not disputing that physicians do the wrong thing. I am just pointing out it's the wrong thing. We frequently have patients who try and extort pain pills by saying the same thing: "I am just going to get them off the street". That statement will turn even the most pain-pill liberally minded doctor into a draconian and you can bet your ass we are going to document that statement and that patient isn't going to get any pain meds from any provider with access to our records again.

Google, if I am lucky, has a synopsis of an article, the rest is behind a pay wall because journals lock up copyright, often after making researches pay to have their work published in the first place.

I know medicine is evidence based, never said it wasn't. I am just pointing out that your demand that I provide evidence of things I am not saying, since I never claimed that narcotics is the first choice in pain management, is cheating.

You still aren't grasping the point I am making about using narcotics on a chronic basis (i.e. daily for years) versus occasionally for acute pain.

I am getting the point, it is just irrelevant because I never said that. I said that anyone who needs pain meds should have access to them, without having to jump through hoops that the government puts in place to control the availability of narcotics. Making them illegal only inconveniences the people who obey the law, not the addicts.

Capitulating to a patient's every wants and needs isn't "sympathy".

Because you are better able to judge a patients need than the patient who actually ahs to live in their body, right?

 

[Quantum Windbag]

Last time I had any pain pills was when I had a root canal. I got the prescription filled and then read the warnings. No way would I take those pain pills after I read the possible side effects. Called the dentist and told him. He said I needed to take them for the inflammation. I said what about Bayer aspirin. He said okay, so that's what I took. Put the pain pills in my emergency survival kit.

However, the pain wasn't that bad. If a person is in a lot of pain they deserve to have relief. That is for sure. But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs. Ghost pain, I guess, but very real to him. He told me that out of desperation he had finally learned to block the pain out of his mind. What power that would give a person, if they could learn to block pain that way. Much better than pain pills.

Ever read about the side effects of aspirin?

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aspirin:

Heartburn; nausea; upset stomach.

Seek medical attention right away if any of these SEVERE side effects occur when using Aspirin:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe or persistent stomach pain; unusual bruising; vomiting.

This is not a complete list of all side effects that may occur.

They are required to list side effects by law. You did not need the pills, which is great, but not taking them because you are afraid of a side effect is a bit like not leaving the house because people get hit by cars. IF you get one of them worry, otherwise take the pills if needed.

Yes, I am aware of the side effects of aspirin. I think it's pretty obvious that I'm the type of person who reads labels. I am not allergic to aspirin, so that isn't a problem. As for the other possible side effects, I've never had so much as an upset stomach from taking aspirin. Even so, I take it rarely.

If I hadn't read the side effects, I probably would have just gone ahead and taken those pain pills. which is what most people probably do. But that would have been ridiculous...I didn't need them.

I'm not the kind of person to gaze with wide-eyed trust at my doctor while he writes prescriptions for me. I had a doctor give me a free sample of Welbutrin to take because I have panic attacks. He said if I "like it" he'd write me a prescription. I didn't take them, I did some research first. Came to find out that Welbutrin makes many people's panic worse! Thanks, Doc, but no thanks. I've learned to manage the panic on my own, without drugs.

I should have deleted this post, I apologize. After I read further I realized we are kindred spirits when it comes to meds.

 

[Sunshine]

She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......

Effexor. Cymbalta. It takes a while to get enough in the system to work. I dont know about Lyrica. It is mostly used for diabetics. Pristique. Not more efficacious thatn Effexor.

Lyrica is a GABA analogue. The current notion is that people with FM have low thresholds for pain. So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.

Look up the DSM-IV criteria for Somatoform Pain Disorder.

 

[Quantum Windbag]

I think you should go to the pain clinic. What's your problem with the pain clinic?

That's the purpose of a pain clinic...managing pain. You should at least give it a try.

What happens with other people suffering from MS? Do they also have pain? How is it treated? Sounds like a forum for people with MS might provide you with some help and answers. Maybe?

There is a stigma attached to pain clinics. I'm just recalling how many people I've intubated and treated from OD's from pain clinics. In THIS state, they are considered legal drug pushers; and this area....not very highly respected.

I have and do belong to an MS forum/chat. The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue. I'm here, because this to me, is a political issue. And because I belonged to this forum LONG before I was diagnosed with MS.

And yes, I'm totally with Ron Paul on the "War on Drugs". I believe it has been a disaster. Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).

And no, it's not constant pain. But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore. This makes perfect sense to me.

Now there is constant numbness in certain areas, but pain? Only after a flare. And it sux.

There are non narcotic drugs that will help the muscle contractions. Aren't they giving you anything for that?

I go to Vanderbilt for this illness I have. Have you been there?

I understand what you mean about the pain clinics, though. When I was practicing in Nashville, one of them called me up and insisted that I guarantee that the patient they were seeing would not kill herself with her pain medicine. LOL. I just laughed, but sent a statement that there is no guarantee that anyone will not suicide, but the patient did not have any drug abuse history, was not suicidal, nor psychotic.

Which is all you can do.

 

[strollingbones]

i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds? really? why?

and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf? and look at the kids on drugs in this country...adderall...the poor man's cocaine

look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks

seems the end of your life is the fucking time doctors care about how addicted you are

 

[Sunshine]

old fashioned test for ms.....get into a hot tub...dont do this alone....if you pass out its most likely ms....if you dont....its something else....

MS is diagnosed by the use of MRI scanning. Deterioration/disruption of the myelin sheath around the nerve cell is the cardinal sign of MS.

 

[Sunshine]

I have had numerous patients on Oxycontin who come in for treatment of depression. I just have to tell them that I can't treat their depression as long as they are on Oxycontin. They are not depressed. They are narcolyzed.

Couldn't agree more. Also can't figure out why you would every give a depressed person a depressant.

You might as well hand them a 1/5 of whiskey.

They would enjoy it more, that's for sure!

 

[Quantum Windbag]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.

He is not the only 'medically trained' person on this thread. And I don't think that is what he is saying. I have seen my share of drug seekers as well. Probably more in my 23 years as a nurse than he has. They exist. They are out there. They have a pattern of behavior, usually.

I did not know you were trained.

My experience with drug addicts is that you can usually spot them. My guess is that, as a nurse, you are even better at it than I am. One thing I have noticed, people in severe pain usually do not feel better until after they actually get a med and it has a chance to work, addicts can react to the knowledge that they will get what they want.

 

[Sunshine]

She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......

Effexor. Cymbalta. It takes a while to get enough in the system to work. I dont know about Lyrica. It is mostly used for diabetics. Pristique. Not more efficacious thatn Effexor.

Lyrica is a GABA analogue. The current notion is that people with FM have low thresholds for pain. So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.

Yeah, it's usually a chicken/egg thing.

 

[Quantum Windbag]

i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds? really? why?

and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf? and look at the kids on drugs in this country...adderall...the poor man's cocaine

look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks

seems the end of your life is the fucking time doctors care about how addicted you are

BINGO. If the guy is dying from terminal cancer give him whatever he needs to interact with the world instead of laying in bed all day in pain.

 

[strollingbones]

and now did they do it before mri's? just cause its an old trick doesnt mean it doesnt work

and i am very much aware of ms and how its diagnosed and treated

the abc's of ms

 

[Sunshine]

and now did they do it before mri's? just cause its an old trick doesnt mean it doesnt work

and i am very much aware of ms and how its diagnosed and treated

the abc's of ms

Like everything else that doesn't have an objective test for it, by signs and symptoms:

Signs and symptomsMain article: Multiple sclerosis signs and symptoms

Main symptoms of multiple sclerosisA person with MS can suffer almost any neurological symptom or sign, including changes in sensation such as loss of sensitivity or tingling, pricking or numbness (hypoesthesia and paresthesia), muscle weakness, clonus, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis including phosphenes,[13][14] or diplopia), fatigue, acute or chronic pain, and bladder and bowel difficulties.[1] Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common.[1] Uhthoff's phenomenon, an exacerbation of extant symptoms due to an exposure to higher than usual ambient temperatures, and Lhermitte's sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS although not specific.[1] The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.[15]

Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups"), in a gradually progressive deterioration of neurologic function, or in a combination of both.[6] Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above one and a half per year.[1] Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer.[16] Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.[1] Stress may also trigger an attack.[17] Pregnancy affects the susceptibility to relapse, with a lower relapse rate at each trimester of gestation. During the first few months after delivery, however, the risk of relapse is increased.[1] Overall, pregnancy does not seem to influence long-term disability. Many potential triggers have been examined and found not to influence MS relapse rates. There is no evidence that vaccination and breast feeding,[1] physical trauma,[18] or Uhthoff's phenomenon[16] are relapse triggers.

Multiple sclerosis - Wikipedia, the free encyclopedia

Some old wives tale is not an objective test for a medical illness.

 

[strollingbones]

While I don’t have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test” was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.)

Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS

you are such a fucking dumb bitch at times

 

[geauxtohell]

I percieve that because the DEA is up every doctors ass with a microscope. If you don't believe me go into pain management and see ho difficult it is to comply with DEA regulations v patient needs.

I think "Pain Management" is the last thing I need to go into, LMAO. Though, my mentor doctor, who I have worked with weekly and then on a daily basis for one month out of each year, is board certified in Pain Management. So I have encountered a lot of patients who are pain management issues and know how things need to be charted to be kosher with the DEA. So I am not completely ignorant of this issue.

Showing an indication and then the name, number, and amount of refills for a narcotic is not asking too much of a doctor.

Physicians that do pain management full time should understand that the DEA is going to be watching them as the potential for fraud and abuse is highest there.

If you can provide evidence that her doctor is the exception to the rule feel free to provide it, until then I will assume that everything I have read, and experienced, is true.

I take exception to you claiming that your opinion is the rule. This is a cause and effect issue. We both understand the effect. We disagree on the cause. You think doctors are stringent about prescribing narcs because they fear the DEA. I think they are stringent because over prescribing narcs is bad medicine that leads to universally bad outcomes.

Just like you do when you demand I provide clinical studies to refute your position.

*sigh*. I haven't demanded anything. This is, at heart, an academic issue. If you don't want to treat it as such, then fine. However, don't lambaste me for trying to elevate it from a matter of opinion to a matter of science.

Exactly, if we could get the government out of determining what is, and what is not, valid treatment we will continue to have a problem doing proper pain management in this country.

For the most part, the DEA is out of what is and is not proper treatment. Though, if you feel that prescribing narcotics to prevent someone from getting them on the street is a proper indication for their use, then perhaps you would get some heat from the DEA.

As you should. That's just boneheaded.

Legalization does not mean selling it in gas stations. All drugs should be legal, and regulated.

Okay.

You just believe that because your moral position is that hard drugs are bad.

No it's not. You have no clue what my "moral position" is, thank you very much.

My position is that physicians should not contribute to harming their patients if they have the opportunity.

That means avoiding giving them addictive and potentially lethal medications if their are better alternatives.

I could give a shit less if someone wants to smoke pot for whatever reason (to include simply getting high). I resent medical providers being drug into the issue under the guise of "medical need" simply because people want to get high. Marijuania for anxiety? Give me a frigging break. Marijuania for cancer patients on Chemo or HIV patients on HAART to reduce nausea and stimulate appetite? I am all for that.

However, to avoid the stupidity of the people that want to simply get high and will invent new and fabulous indications that only marijuania can treat (in their opinion), I think they should just legalize it.

Google, if I am lucky, has a synopsis of an article, the rest is behind a pay wall because journals lock up copyright, often after making researches pay to have their work published in the first place.

I know medicine is evidence based, never said it wasn't. I am just pointing out that your demand that I provide evidence of things I am not saying, since I never claimed that narcotics is the first choice in pain management, is cheating.

I am not trying to "cheat". I don't want you to pay for something (obviously) and not every article is behind a pay wall. I should know, I linked a clinical guideline for FM from pubmed.

However, if you don't think narcotics are first line drugs, then the point is moot (as that is the point I am making).

I am getting the point, it is just irrelevant because I never said that. I said that anyone who needs pain meds should have access to them, without having to jump through hoops that the government puts in place to control the availability of narcotics. Making them illegal only inconveniences the people who obey the law, not the addicts.

That's your opinion. The issue of "who needs narcotics" is the obvious sticking point and if that was clear, there would be no need for debate.

Because you are better able to judge a patients need than the patient who actually ahs to live in their body, right?

No. At the same time, I would be negligent if I simply gave people what they wanted without consideration for the pros and cons of the issue.

Just a basic tenant of treatment.

 

[geauxtohell]

Effexor. Cymbalta. It takes a while to get enough in the system to work. I dont know about Lyrica. It is mostly used for diabetics. Pristique. Not more efficacious thatn Effexor.

Lyrica is a GABA analogue. The current notion is that people with FM have low thresholds for pain. So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.

Look up the DSM-IV criteria for Somatoform Pain Disorder.

I know what it is. I don't think that is the issue for most people with FM.

 

[geauxtohell]

i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds? really? why?

and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf? and look at the kids on drugs in this country...adderall...the poor man's cocaine

look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks

seems the end of your life is the fucking time doctors care about how addicted you are

BINGO. If the guy is dying from terminal cancer give him whatever he needs to interact with the world instead of laying in bed all day in pain.

And you wouldn't have any sort of debate on that issue as everyone excepts that hospice care is about making people comfortable (even if it shortens their life).

This issue is not about hospice care.

 

[Sunshine]

Lyrica is a GABA analogue. The current notion is that people with FM have low thresholds for pain. So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.

Look up the DSM-IV criteria for Somatoform Pain Disorder.

I know what it is. I don't think that is the issue for most people with FM.

Not for MS. But the symptoms of FM sound a lot like it. It is a neurosis.

 

[geauxtohell]

While I don’t have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test” was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.)

Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS

you are such a fucking dumb bitch at times

And hysterectomies were used to treat ill behaved (read: "women who don't want to have sex with their husbands) at one time.

The link between latitude and MS incidence (sun/heat exposure) has been disproven.

I really think a hot bath is a wives tale. It's a hell of a lot cheaper than an MRI w/ T2 Flair, and if it were at all accurate, would be a better test.