True story. I took a class once. And they said in the text book doctors are hesitant to prescribe pain killers because they don’t want to be seen as drug dealers. That’s what it said. (And I hope you can see why it would be impossible to provide a cite:). I don’t even remember the name of the text book.)
I don’t know about the rest of you. But if I am ever in severe pain, I am going to demand opioids or whatever in the strongest dose possible.
And I do have to add. I think the hysteria surrounding pain killers, much like the hysteria surrounding predatory males (i.e., the #MeToo movement) might be a little blown out of proportion. Note well I said might be.
From what I understand, when you are in severe pain, even if you take opioids, the pain killer just suppresses the pain. Addiction and substance abuse only come later, when you take beyond what is required. Again, sorry no cite. But they did interestingly bring it up in a TV news magazine show, probably Prime Time Live. (Yeah, some doctor in the story prescribed a large amount of opioid to man in severe pain, cause let’s face it, that’s what it takes. Disciplinary action was taken against the doctor. But fortunately no criminal action.)
Again, I am not trying to minimize the struggle some people go thru with addiction. But it shouldn’t smother the rights of people in terrible pain. Sorry, but I had to say it.
I think you’ll need the good luck to never be in chronic pain. Because Doctors just won’t take the chance. Unless your legs hanging off, or something, you’re not gonna get very many pills if at all. Demand all you want.
ETA- IANAD or any kind of health care worker. Just a patient.
I’m not a doctor either, but my understanding is that, for most people, opioids don’t work for chronic pain anyway, so those prescriptions shouldn’t happen anyway (most of the time).
I think there’s reason for concern that the “war on opioids” will translate into less effective ways of handling pain, especially in the acute setting (i.e. post-operative, following trauma) and in some chronic settings. As mentioned in another thread, people who make money or otherwise have a vested interest in promoting unproven or sometimes downright quacky “alternative” methods (acupuncture, reiki, cannabinoids) are jumping to cash in. Someone with chronic unremitting pain from (for example) metastatic cancer who was offered reiki might be excused for wanting to teach the reiki practitioner what real pain is.
On the other hand, based on my profound expertise on the subject of chronic pain (taking mandatory medical licensure courses), it seems that for a number of chronic pain sufferers, long-term/abused opioids may actually make pain worse, so lowering doses and using proven non-opioid methodology is advised.
Here in the UK, I recently had severe pain.
I called a paramedic who gave me a dose of morphine. (It was highly effective in stopping the pain!)
I then went to hospital where after tests the problem was identified (it turned out to be gallstones.)
The marvellous National Health Service sorted the gallstones out with keyhole surgery.
During the tests I was on codeine and afterwards just paracetamol (which is available over the counter.)
All is now well with me (and I’m not addicted to anything (well apart from chocolate )
One difficulty is that there isn’t a “one size fits all” solution. I know people–people I trust, who are not idiots–for whom acupuncture has effectively relieved pain. Ditto for cannabinoids. (Not so much for reiki, bleh.) That may be a lot of placebo effect, sure–but that’s important when pain is so very subjective.
The “proven non-opoid methodology” is a holistic approach: medications, psychoeducation, mental health interventions, movement (yoga, pool, tai chi, etc), strength training…hell, even acupuncture and reiki and smudge sticks. Throw enough shit at the pain to find out what works for the individual. Because at the end of the day, what works is what works. I want to go ahead and offer that cancer patient reiki-- not as “the” solution but as part of a suite that might include effective pain management tools.
Of course, this sort of broad approach costs money. Throwing pills at someone costs considerably less…and throwing no pills at them less still.
As a physician who specializes in treating patients in the long term care settings (nursing homes) here is my take on the situation.
You have to consider the type of pain. There is acute pain, for which opioids are appropriate if the pain is severe. In this category are things like broken bones, kidney stones, the above mentioned gallstones, etc. Of course in these situations there are also treatments to address the underlying pain, and responsible doctors will treat the underlying problem. Once the acute issue is resolved the patient should no longer need opioids. Then you have chronic pain due to cancer. In this situation opioids are also appropriate, and I don’t know any doctors who would hold back on narcotics in this situation.
The problem comes in when you’re dealing with non-malignant chronic pain. The big problem here is that often you have patients that have pain out of proportion to their findings. I’ve seen people who complain of severe chronic back pain who have normal x-rays and MRIs. Others have some small abnormalities on their studies, but then again other people with the same findings have no or very mild pain. Now this is anecdotal, but in my experience the patients that have severe pain in this type of situation are far more likely to have underlying psychiatric problems (depression and bipolar disorder in particular). There are also patients with chronic pain from non-malignant conditions like rheumatoid and osteoarthritis. These two groups is where the proper approach is more difficult to determine. Some of these folks do well with a low dosage of narcotics like hydrocodone taken as needed. Others continue to request higher and higher doses of narcotics. For this latter group there is sometimes no dose of narcotics that will control there pain before they reach the stage of severe respiratory depression. What is the right treatment for those patients? Unfortunately right now there is no one correct answer, things have to be taken on a case by case basis.
To make a long answer short, I can say that there are patients with pain who giving higher and higher doses of narcotics is not the correct approach.
And I’m thinking you should spend more time in Appalachia. Having lived in the region - in the mountains of Maryland, the mountains of Virginia and southeastern Ohio (all within a mile of the West Virginia border) - I know just what harm can be done by opioids. It’s worse than heroin there. It’s to the point where the number of overdose deaths - mostly opioids - is actually lowering the life expectancy of Americans. Not just in those states but overall life expectancy.
Check those numbers for 2016. There are counties where it’s simply impossible to NOT find someone related to an overdose victim.
As for availability? I had cancer last year. Throat cancer - technically on my tonsils - and it hurt like hell. Months of radiations and some weeks of chemo. My damn radiation oncologist was hugely cavalier about prescribing opioids. I told him I didn’t want them. He insisted. He had his people give me a bottle of 50 tabs just from their own holdings - I assume there’s a pharmacist somewhere involved but I didn’t meet one. He told me that when I’d used those up in a week I should ask for more.
I disposed of them. I used OTC painkillers. The pain was rough at times. Radiation in the throat results in what can best be described as a permanent, high-level sunburn on all the tissues inside your throat that never goes away. And it results in scarring. I still get pain when I yawn and stretch that part of my throat. So don’t talk to me about difficulty in availability. So long as there’s demand, some doctors will find a way to supply it.
Fun fact, those 80 milligram tabs have a street value of about $70 a tab. So that first set of 50 could have been sold for $3500. There’s going to be people willing to supply for that sort of money.
Opioids aren’t strictly speaking, painkillers. They lessen the experience of pain indirectly. Probably any pharmaceuticals which strongly stimulate pleasure will have the effect of lessening pain. Supposedly they became favored mostly do to being aggressively marketed as non addictive. I’m not sure how this happened, since they don’t significantly differ from earlier relatives like opium and morphine.
Depending on the person and the amount, physical addiction can occur in just a few days to a week. Some people are more genetically or otherwise predisposed to have their reward pathways booby trapped. For people taking opiates for the first time, especially in a hospital setting, they may not even be aware of what withdrawal symptoms are like, and just dismiss their crappy feelings as a lingering part of their original injury or sickness.
There is also a strong cultural aspect to how people experience and interpret pain.
Plus, physiologically, we don’t yet understand fully the mechanisms involved. Even the standard scale we have for reporting pain is ridiculous.
Oddly, same here, years ago, when they treated my cancer. They suggested opioids, I asked for 800MG ibuprofen. I wanna tell you that those 800Mg monsters kill pain like no ones business.
I still take some for my arthritis. Pretty safe, not 100% safe, but sure as fuck safer and less addictive than opioids.
Pain medicine is interesting to me because its such an undertreated field of medicine and it destroys quality of life.
What does work for long term pain? Do anti-epileptics work in your experience? Topical creams? anti-depressants? electrical stimulation? Intentionally damaging the nerve?
I was reading an article about RTX, that could be an interesting pain treatment.
No shit. I visit an infusion center on a regular basis for treatments. A reiki person comes around regularly (somebody funded their services). I tried it once, thinking at least I’d get a massage out of it. I was sadly misinformed. I pass on it now, but I think practitioners are quacks. The medical staff at the clinic agrees.
Why the answer is, of course, to diagnose them with fibromyalgia (or myofascitis, or somatoform disorder, or psychogenic pain disorder, or a combination of all those and more!), and refer them to a pain specialist who will prescribe narcotics and administer injections to the fullest extent paid for by whatever applicable insurance, and certify their eligibility for disability benefits!
Not to get to far off topic, but adding things like acupuncture, reiki, and smudge sticks dilutes funding for treatments and research on things that actually work. There are a lot of convincing reasons that people believe in these things*, but at best they don’t work. Even if funding were truly unlimited, they have a downside. Chiropractic adjustments can cause strokes, acupuncture can cause infections, and even treatments like homeopathy, which by definition have no active ingredients, undermine faith in actual medicine an cause people to put off real treatments. Even really smart people like Steve Jobs can fall prey to that.
*If you are interested in the mechanics of this, I highly recommend the book Snake Oil Science. It was written by a statistician, so the style may not be everyone’s taste, but I found it very engaging and informative.
I think that while that is what medical personnel are all taught, it is a bunch of B.S. I think that anyone can easily become dependent on opioids, regardless of whether a person is in pain or not.
My take is from dealing with my wife, who is an RN who has now been through three back surgeries (spinal fusions). Her last back surgery was just three weeks ago, and she is still on prescribed opioids. She is still in severe pain, but is taking steps to gradually wean herself off of them. We are both hyperaware of the dangers of opioids.
Anyway, even though she is still in severe pain after the last surgery, she also fears that she is becoming dependent on them. She has a plan to gradually cut the dose in steps over the next couple of weeks. Unfortunately, when she tried to cut the dose more quickly, the pain is unbearable and she also feels she is experiencing withdrawal symptoms (hot and cold sweats, feeling unbearably alternately hot and cold, nausea, irritability, etc.).
One problem is that they haven’t yet given her any pain medicine to replace the opioids.
Anyway, I’m sure she’ll get through this. She went through something similar the last time she had back surgery three years ago, and was off of the opioids within 4-6 weeks after the surgery (can’t remember exactly).
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What cite?