A rant on pain management, in this country.

[Quantum Windbag]

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. : )

I am like you. I rarely take pills, even aspirin. Funny thing though, when a doctor offered me a prescription for pain pills after my kidney stones I took it, those suckers hurt aqnd I wanted to be prepared. Hopefully, I won't need it, but I have it.

 

[Quantum Windbag]

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.

The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.

 

[geauxtohell]

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.

The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.

Using narcotics to treat kidney stones is a no brainer. People pass kidney stones and it is reasonable to use a big gun to help them through the process. People also clear post herpetic neuralgia.

You are apparently not comprehending what I have actually written: which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.

I have also not lectured you on when you "need a pill".

 

[Quantum Windbag]

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.

Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?

 

[geauxtohell]

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.

Will The Feds Ban Your Pain Meds? - YouTube

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.

Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?

The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street. The reason is fairly obvious. Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.

 

[Quantum Windbag]

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.

1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.

 

[Quantum Windbag]

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.

The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.

Using narcotics to treat kidney stones is a no brainer. People pass kidney stones and it is reasonable to use a big gun to help them through the process. People also clear post herpetic neuralgia.

You are apparently not comprehending what I have actually written: which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.

I have also not lectured you on when you "need a pill".

I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.

The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.

I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.

 

[Quantum Windbag]

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.

Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?

The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street. The reason is fairly obvious. Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.

It isn't obvious to me, and it just drives up the cost of medical care.

 

[geauxtohell]

1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.

1. Once again, I never claimed all, or even most people, who use narcotics are "addicts". That the potential for narcotics to create addicts coming into a discussion on narcotics should be obvious.

2. It's not my "personal belief". Sorry to break it too you, but medical professional do not in fact think it's better to simply give into addicts to prevent them from committing felonies. Refer to "Anxious wimps".

3. I also addressed the issue of breakthrough pain and the whole issue that chronic pain shouldn't be managed in the EM. You might no like hearing it, but it's the truth.

Since you have chosen to make this personal: your 20 years of pain control don't equate to a medical education or a medical license. You also seem to suffer under the delusion that patients call the shots and physicians exist to act as a rubber check on medical scripts their patient's demand. I hate to burst your bubble.

 

[geauxtohell]

Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?

The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street. The reason is fairly obvious. Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.

It isn't obvious to me, and it just drives up the cost of medical care.

Really?

How?

 

[geauxtohell]

The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.

Using narcotics to treat kidney stones is a no brainer. People pass kidney stones and it is reasonable to use a big gun to help them through the process. People also clear post herpetic neuralgia.

You are apparently not comprehending what I have actually written: which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.

I have also not lectured you on when you "need a pill".

I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.

The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.

I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.

An X-ray for kidney stones?

You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics. That's not the case. Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated. It has nothing, or little, to do with fear of government reprisal.

 

[Quantum Windbag]

1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.

1. Once again, I never claimed all, or even most people, who use narcotics are "addicts". That the potential for narcotics to create addicts coming into a discussion on narcotics should be obvious.

2. It's not my "personal belief". Sorry to break it too you, but medical professional do not in fact think it's better to simply give into addicts to prevent them from committing felonies. Refer to "Anxious wimps".

3. I also addressed the issue of breakthrough pain and the whole issue that chronic pain shouldn't be managed in the EM. You might no like hearing it, but it's the truth.

Since you have chosen to make this personal: your 20 years of pain control don't equate to a medical education or a medical license. You also seem to suffer under the delusion that patients call the shots and physicians exist to act as a rubber check on medical scripts their patient's demand. I hate to burst your bubble.

1) The potential for addiction is a concern, but the fact that addicts exist is irrelevant to a medical discussion of pain management, just like the fact that people who bomb abortion clinics exist is irrelevant to medical discussion of abortion.

2) It is your personal belief, not all doctors agree with you.

3) It might not equate to it, but your medical license means squat to me, or anyone else I know, who deals with chronic pain. Unless a doctor specializes in pain management all they know is theory. The ones that do specialize in it spend a lot more time talking to patients and explaining options than others, you all just want to try something because you read something somewhere.

There are exceptions on both sides to that, but that is the general rule.

 

[Quantum Windbag]

The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street. The reason is fairly obvious. Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.

It isn't obvious to me, and it just drives up the cost of medical care.

Really?

How?

How? It forces doctors to do more tests before dealing with the issue, which is pain.

 

[Quantum Windbag]

Using narcotics to treat kidney stones is a no brainer. People pass kidney stones and it is reasonable to use a big gun to help them through the process. People also clear post herpetic neuralgia.

You are apparently not comprehending what I have actually written: which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.

I have also not lectured you on when you "need a pill".

I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.

The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.

I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.

An X-ray for kidney stones?

You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics. That's not the case. Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated. It has nothing, or little, to do with fear of government reprisal.

I got an ultrasound as part of a study, which was inconclusive, and a CAT scan in San Francisco. Forth Worth used X-rays 15 years ago, I have no idea what the procedure is now.

 

[geauxtohell]

1) The potential for addiction is a concern, but the fact that addicts exist is irrelevant to a medical discussion of pain management, just like the fact that people who bomb abortion clinics exist is irrelevant to medical discussion of abortion.

You are just wrong about this. The thread is, more or less, about why some physicians won't give out narcotics. Their addictive properties is the reason why.

2) It is your personal belief, not all doctors agree with you.

As I said, feel free to find the evidence based literature or clinical guidelines that disagree with my assertion.

3) It might not equate to it, but your medical license means squat to me, or anyone else I know, who deals with chronic pain. Unless a doctor specializes in pain management all they know is theory. The ones that do specialize in it spend a lot more time talking to patients and explaining options than others, you all just want to try something because you read something somewhere.

Good. Then go to a "pain management" doctor. In the meantime, don't delude yourself into thinking that you are going to demand narcotics out of me in seven months or that I just suffered through four years of medical school to become a medical Burger King.

In fact, you basically, on your own, come around to my way of thinking: go establish care with a physician that will follow up with your condition (as opposed to an ED) for your chronic problems.

There are exceptions on both sides to that, but that is the general rule.

Yes, we only know what we've been taught in the formal education process and that pales in comparison to your anecdotes.

 

[geauxtohell]

I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.

The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.

I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.

An X-ray for kidney stones?

You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics. That's not the case. Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated. It has nothing, or little, to do with fear of government reprisal.

I got an ultrasound as part of a study, which was inconclusive, and a CAT scan in San Francisco. Forth Worth used X-rays 15 years ago, I have no idea what the procedure is now.

They must have not had a CT scanner available. CT/US is better now. It's reasonable to start with US, and if that is inconclusive, to go on to a CT scan which is more sensitive (but exposes people to radiation).

 

[geauxtohell]

It isn't obvious to me, and it just drives up the cost of medical care.

Really?

How?

How? It forces doctors to do more tests before dealing with the issue, which is pain.

That is wrongheaded thinking. The issue is not the "pain", it's what is causing the pain. No physician should simply treat "pain". Pain is a symptom of an underlying problem. So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.

If a person's back pain is a metastatic cancer, and a physician doesn't even look, they have committed malpractice.

 

[Quantum Windbag]

You are just wrong about this. The thread is, more or less, about why some physicians won't give out narcotics. Their addictive properties is the reason why.

The tread is about how the government interferes in medical choices involving pain meds. Do you honestly think that the first thing you learn in an ER would be about addicts scamming you to get drugs if it were all drugs, even addictive ones, were legal? Why sin't cocaine, one of the best pain meds known to man, legal to prescribe? Is there a medical reason not to use it in cases where it would clearly be effective? Why does the DEA and the FDA insist that there are no medical uses for marijuana at all? Do you think some pain patients would be better off if marijuana was legally available to everyone? Do you think the OP might be better off with marijuana to help manage chronic pain?

Please, tell me again I am just wrong about the problem being the government.

As I said, feel free to find the evidence based literature or clinical guidelines that disagree with my assertion.

I do not have access to medical journals, but I do appreciate the way you are trying to assert your authority instead of actually addressing the issues. Do you dispute that some doctors would rather give addicts a fix than see them steal, or murder, to get one?

Good. Then go to a "pain management" doctor. In the meantime, don't delude yourself into thinking that you are going to demand narcotics out of me in seven months or that I just suffered through four years of medical school to become a medical Burger King.

In fact, you basically, on your own, come around to my way of thinking: go establish care with a physician that will follow up with your condition (as opposed to an ED) for your chronic problems.

I do not need help dealing with chronic pain, I learned all I need to know over the past 20 years. What i need, occasionally, is access to opiates to deal the the acute pain that occurs without someone telling me I need to learn to manage chronic pain I already manage. I also know people who are in acute pain on a chronic basis, and they need your advice even less than I do.

Yes, we only know what we've been taught in the formal education process and that pales in comparison to your anecdotes.

Are you denying that some doctors are more sympathetic to patient than others?

 

[hortysir]

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.

No job, no income, and nobody wants to piss with share-cost medicaid.
I've tried to get her to at least go to the county health dept.
She's too deep into the pill-mill culture, though.

 

[MikeK]

[...]

[...]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.[...]

[...]

Your reference to co-ingestion concerns me because the makers of both hydrocodone (Vicodin) and oxycodone (Percocet) add acetaminophen (APAP - Tylenol) to this narcotic, which might soon be affecting my requirements.

While my daily limit of either narcotic is 10 mg. I'm forced to co-ingest either 700 mg. APAP with oxy or 1G APAP with hydro. I'm on the safe side because I'm well under the dangerous dose level of APAP, which is 4G. But what if my condition worsens, which it is sure to do, and/or my tolerance for oxy or hydro increases and I need more?

The only alternative treatment for my condition is surgery, which my GP (and another) believe is extremely risky because of the position of the growth within the vertebra. So it seems that unless I die within the next few years I'll be banging heads with these goddam DEA constraints on the medical profession and the legitimate distribution of narcotics.