A rant on pain management, in this country.

[Gagafritz]

That is you and your opinion. There are people who have pain after a root canal. People have different levels and thresholds of pain. Just because you didn't have pain doesn't make someone else's pain less legitimate.

 

[Gagafritz]

I thought i could "hee hee hoo hoo" through childbirth as well. Well, after 5 cm or so screaming seemed like the thing to do.

 

[Gagafritz]

I also take issue with the "i am tougher than you are " kind of thing when it comes to pain. As if someone is being a wimp or something if they need pain medication. Maybe people are wimps for needing cholesterol meds, BP meds, diabetes meds. Maybe they should just toughen up a bit?

 

[Kooshdakhaa]

I also take issue with the "i am tougher than you are " kind of thing when it comes to pain. As if someone is being a wimp or something if they need pain medication. Maybe people are wimps for needing cholesterol meds, BP meds, diabetes meds. Maybe they should just toughen up a bit?

Most people who take cholesterol, BP and diabetes meds could have avoided them through healthy lifestyle. And may even be able to get off those meds through healthy lifestyle.

I thought I had high blood pressure a couple of years ago and immediately went on a diet. Not meds. A diet. Turns out I had a faulty blood pressure cuff, not high blood pressure. But my first reaction was to go on a diet, because I wanted to avoid medications if at all possible.

I don't really care what other people do and I don't think I'm tougher than other people. I would be the first person screaming bloody murder if someone I cared about was in pain and the doctors did nothing to help them. Personally, I've never seen that happen. Any family or friends I've known to be in pain had no trouble getting the help with the pain that they needed.

I actually thought medical people were obligated to treat pain. I thought it was a law. If not, it should be. People should not have to suffer pain. It's not necessary. I choose to suffer small pain rather than immediately take aspirin. The pain usually ends up going away on its own. But if I was in severe pain, I would expect some help with it. I would consider it a right.

Obviously, I think other people have the same right.

But I can also understand the dilemma doctors must face when the possibility of patients becoming dependent on the pain meds exists. They need to monitor that and make sure the patients aren't asking for pain meds even after the pain is gone.

For terminal cancer, etc. who cares. Give them all the meds they want. What difference does it make if they become addicted?

 

[Gagafritz]

OK. And, there is a balance of things. And, there are people who want medication for everything and anything and times when we need to learn to tough some things out as well. I agree.

 

[Kooshdakhaa]

I thought i could "hee hee hoo hoo" through childbirth as well. Well, after 5 cm or so screaming seemed like the thing to do.

Haha...see, now you know the secret. If I ever really, really need pain meds I will gladly resort to screaming if that's what it takes. : )

 

[Kooshdakhaa]

That is you and your opinion. There are people who have pain after a root canal. People have different levels and thresholds of pain. Just because you didn't have pain doesn't make someone else's pain less legitimate.

P.S. I DID have some pain after my root canal. But the pain was temporary and tolerable, the possible damage to my heart and other side effects from the pain pills would have been permanent.

But you're right, people have different levels and thresholds. I don't have an issue with people who take prescription pain pills when they need them. It is just my own personal choice to avoid them if I can.

Pain gets bad enough, I'll take them too!

Well, I'm going to bed. Don't need sleeping pills. I have warm, snoring dogs...they make me sleep like a baby. : )

 

[Gagafritz]

I thought i could "hee hee hoo hoo" through childbirth as well. Well, after 5 cm or so screaming seemed like the thing to do.

Haha...see, now you know the secret. If I ever really, really need pain meds I will gladly resort to screaming if that's what it takes. : )

Well, that didn't work for me. I wasn't allowed to have any pain meds as a VBAC.

 

[Douger]

Sorry to hear that Muskafa.
Tennessee huh ? Isn't that where Jesus was born ?
It's the heart of murka and drugs is only fer them thar pussies and demoNrats.
Try another state or better yet, go to a country where you'll be treated like an adult. I can walk in a farmacia and get you a basket full of goodies for 1/10 of what your "Chosen" are charging you. The only "permission' I need is a wallet and be tall enough to see over the counter.

 

[geauxtohell]

That's where the drug-seeking-addict label comes from, tho....

My daughter has Fybro and no insurance.
She has share-cost medicaid but no income.
Sometimes the only way she can meet her share of cost is to go to the ER.

Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.

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.

What works better? Massage? Acupuncture?

SSRIs, gaba analogues like lyrica and NSAIDs (which are anti-inflammatory), all of which are supported by the literature as being much more effective than narcotics. Believe it or not, pain control doesn't begin and end with narcotic pain control.

In fact, before they came onto the market in pill form in the early 90s, people, in fact, did not die of pain.

 

[geauxtohell]

That's where the drug-seeking-addict label comes from, tho....

My daughter has Fybro and no insurance.
She has share-cost medicaid but no income.
Sometimes the only way she can meet her share of cost is to go to the ER.

Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.

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......

No offense, but that's because she is misusing the EMERGENCY room as a primary care center. That pisses off every EM physician.

In doing so, she is putting the EM doctor in an untenable condition: Let her leave while suffering or be force to mismanage her medical condition with narcotics. Since EM doctors don't have their own patients and don't do follow up, they aren't going to start her on a long term medication like an SSRI or pregabalin.

Your daughter needs to establish care with a primary care physician for long term management of her chronic condition so that it can be adequately managed. Since EM physicians are required by law to give patients a follow up appointment with a PCP, I can't imagine they haven't tried to do this.

 

[geauxtohell]

You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.

How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.

Do some doctors and patients abuse the system?

Yes.

Does that justify the government restricting everyone?

No.

Did you read either article? The first article was about how the clinic was back in business a few days after the raid. The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.

In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts. That's a leap of faith. You can make it if you want, but it's hardly a "slam dunk" for what you are arguing. I am not going to try to convince you of anything. A jury has already decided this case. I am just pointing out that this is a house of cards. There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics. I am sure this guy was in obvious pain. That doesn't mean he should get whatever he wants when it comes to pain pills. You see one side to this story, I read between the lines and see another based on the patients I have dealt with. Who knows what the truth is.

The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical. However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.

I think Oxycotin is #3 on the "most prescribed list".

I can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.

[ame=http://www.youtube.com/watch?v=0PqfXc4XtXM]Will The Feds Ban Your Pain Meds? - YouTube[/ame]

You did?

At any rate, I found holes in the two examples you provided. There are usually holes. As I said, if you think the DEA is preventing patients from getting narcotics, you are not aware of the reality of the situation. The DEA tries to focus on the "worst case scenarios". Most patients, even the bad actors, get their fix.

 

[geauxtohell]

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?

Did it ever occur to you that someone that will go into a dangerous part of town in the middle of the night to score has an addiction.

Did it ever occur to you that EDs are, in fact, not Pain Management centers?

Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system? (I once saw someone wait for 8 hours to be seen for "insomnia".

Don't take my word for it:

Treating a Nation of Anxious Wimps

Have you ever seen someone withdraw from opiates? Guess what? They are in extreme pain. I've seen people with gunshot wounds in less pain. Ain't that a bitch? Withdrawal causes the exact symptom you are treating. Which means, after a point, you aren't actually treating the underlying condition, you are treating withdrawal.

Wow. We just went down the rabbit hole.

It's almost like the physicians who refuse to feed addictions are actually trying to do what is best for their patients.

 

[MikeK]

I have a spinal condition (cervical stenosis) which makes falling asleep and staying asleep virtually impossible because of pressure on the spinal cord. I've been taking 5mg. Percocet twice during the night (to fall asleep and stay asleep) for the past two years. I recently switched to Vicodin because it works faster (but doesn't last as long).

The reason my GP is willing to prescribe so readily is I'm 75 years old and my condition was confirmed by MRI. Otherwise, because of the DEA's mandates I would have to suffer or destroy my liver with excessive Tylenol.

The American public is blind to the fact that the War on Drugs is wholly counterproductive and has become one of our Country's most serious problems. Those who are inclined to drug addiction will become addicted to drugs regardless of any government efforts to prevent it.

 

[Gagafritz]

First, there are NO alternatives. There are no house calls. No middle of the night visit to the doctor's office. No lower level care facilities for people to seek treatment at. So, blaming the patient is Unfair. In addition, a layperson does not know a medical emergency from a pain in the ass which could also be a medical emergency. You are expecting patients to diagnose and treat themselvles. Unfair. Going to the ER with heartburn and pain is a legitimate trip to the ER even if it is just gastritis. So, laypeople know they don't feel good. They don't know which ache, pain or symptom is a medical emergency and which is not. If the health care system was REALLY interested in quelling, this, there would be 24 hour doc in a boxes and so for that were readily available but that is really the case. In addition, addiction and withdrawal can have severe life threatening consequences. Yes, they may have created their own problem, but it is not the job of the ER doctor to begin detoxification and rehab unless the patient is put in a proper facility and level of care to do so. There is alot of blaming the patient when clearly the health care system has not risen to meet these needs.

 

[geauxtohell]

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.

1.) I never said that people who want pain meds are "usually addicts".
2.) Addicts most certainly should not get "whatever they want". There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting. What addicts should get is psychiatric help for managing their addiction as psychiatry is the only field of medicine that is trained to manage addiction. The "less paternalistic" approach to medicine is all good and fine until patients start demanding you start doing things that are bad medicine. Then it is time to put your foot down and say no.
3.) I personally would have no problem with using T3 for shingles. Shingles sucks. You are apparently not getting the difference between acute and chronic pain management.

 

[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.

I think we can show you plenty of evidence that opioids treat pain. As for chronic pain, there are many components to chronic pain which can also include acute pain. Just because it is chronic doesn't mean that there isn't acute pain involved that is amenable somewhat to opioids and acute pain type treatments. Sheesh.

Of course opiods treat pain. So do NSAIDs and a bullet to the head. Obviously, along this spectrum of pain management, we can come up with a reasonable approach to pain management.

What you are talking about is "breakthrough pain". I am well aware of how pain management works. Here is a good example of your example: Sickle Cell Anemia is a genetic condition that causes severe pain. Most people with it are in some degree of pain daily with the occasional vaso-occlusive crisis that causes severe and debilitating pain. A reasonable approach to SCA pain management is scheduled long acting low dose narcotics with high dose narcotics for "breakthrough pain" and if that doesn't work, admission for IV dilaudid and hydration for pain control.

For softer pathologies, as I said, show me the literature where narcotics are considered the first line treatment for chronic pain, and I will take a look. You can save yourself the trouble, it isn't there.

This isn't just "my opinion", it's based on the evidence.

It's almost like a science or something.

 

[geauxtohell]

You wouldn't take a pain pill because you read the nasty side effects? Do you not think there are side effects and reactions to every medication in the world? Tylenol has caused liver failure. No drug is benign. Nsaids can cause kidney failure and opioids may be a better choice for long term use. As for mind over matter, yes there is a component of pyschology involved in pain. But, pain is real and to not treat it is inhumane. You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain. But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real. Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.

I believe people should be given all the pain meds they need.

In my case, however, I avoid taking all medications and drugs whenever possible. As it turned out, the pain meds the dentist prescribed for my root canal were totally unnecessary...all I needed was a couple of Bayer aspirin. And I only needed that for a day or so, which is good because I don't even like taking aspirin. Will not take Tylenol. So why take prescription pain pills with all those risks of side effects? Hmmm? The side effects were not just nuisances...they were baaaaad side effects. Not worth it for pain pills that weren't even necessary.

I like watching out for myself. Obviously the dentist wasn't. He just mindlessly wrote a prescripton that I didn't even need. A prescription for some pretty bad shit.

As tylenol and opiods have no anti-inflammatory properties, your intuition was correct. NSAIDs are better for inflammation.

As for what you can tolerate personally, that is a personal decision. Some people have higher pain tolerances than others and the point at which pain need to be treated is different for every person, and pain should be controlled to a reasonable point.

The issue is at what point does it become unreasonable. It's reasonable to take narcotics for an acute pain event for a short term. To take them for years and years is not reasonable.

 

[geauxtohell]

First, there are NO alternatives. There are no house calls. No middle of the night visit to the doctor's office. No lower level care facilities for people to seek treatment at. So, blaming the patient is Unfair. In addition, a layperson does not know a medical emergency from a pain in the ass which could also be a medical emergency. You are expecting patients to diagnose and treat themselvles. Unfair. Going to the ER with heartburn and pain is a legitimate trip to the ER even if it is just gastritis. So, laypeople know they don't feel good. They don't know which ache, pain or symptom is a medical emergency and which is not. If the health care system was REALLY interested in quelling, this, there would be 24 hour doc in a boxes and so for that were readily available but that is really the case. In addition, addiction and withdrawal can have severe life threatening consequences. Yes, they may have created their own problem, but it is not the job of the ER doctor to begin detoxification and rehab unless the patient is put in a proper facility and level of care to do so. There is alot of blaming the patient when clearly the health care system has not risen to meet these needs.

There are certainly alternatives. If you think otherwise, you have fallen into the trap that narcotics are the only solutions. I also didn't say it's unreasonable to go to the ER for pain. For acute pain that arises out of the blue, there ought to be an underlying issue that caused the pain (I.E. "I rolled my ankle and think I might have broken it") which is completely reasonable to be assessed in the ED. I said it's unreasonable to use the ED to manage chronic pain in the ED. The kind of pain that doesn't pop up out of the blue. For that, you need a PCP and should have the proper medication in your medicine cabinet.

Withdrawing from opiods is not a life threatening event. Alcohol is another situation. That will kill people.

Refusing to feed an addiction is in no way "detoxification" and the only physicians that can legally treat withdrawal are psychiatrists. However that does not mean every other doctor has to feed an addiction. It's a physician's license. They get to decide what scripts they want to write and not write. When it comes to "not writing" a script, they don't even need a good reason. On the other hand, if a physician writes a narcotic script to "treat narcotic addiction" as the indication, then (unless they are a psychiatrist) they have broken the law.

I am not blaming the patient only. As I said, it's a two way street.

 

[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.