Well, I’ll tell you this; I found out on the 23rd I had a kidney stone, and I found out the traditional way, by experiencing a type and level of pain that no words in the English language suffice to describe.
They sent me home with a prescription for 15 1-mg hydromorphone pills; the recommended dose for an adult is 2mg. That prescription is long gone, and I haven’t been overdoing it; I don’t take any until the pain is really terrible. Most of the time, naproxen (Aleve, as most know it) does the job, but sometimes it just blooms in incredible pain. Fortunately my brother in law had the same prescription for his gall bladder stones and ended up with extras after the gall bladder was removed, so I may have enough to last until Monday. The urologist still has not called, and I have no idea when I will see the guy and maybe have the stone zapped or whatever they do. So, if on Monday nothing has been done, and and stone still hasn’t gotten out of the ureter - which it feels like it isn’t doing - I’ll be back in the emergency room, in agony, just because they wouldn’t give me 30 pills instead of 15.
There has to be a better way. It is self-evidently a huge waste of everyone’s time and resources for me to go to the emergency room again and waste the time of a doctor and nurses to accomplish something that I could have done in five minutes at Shoppers Drug Mart. It’ll cost the health care system a lot of money to have professionals spend time with me, give me an IV and saline solution and probably a shot of Toradol and then liquid hydromorphone and then write a prescription. (Obviously the first time was necessary, I didn’t know what the hell was wrong.) I am not in any way addicted to opiates; they don’t even make me dopey or high. The reluctance to prescribe a needed medication causes me pain and wastes a shit-ton of money - and hell, I’m a MINOR case. It’s a kidney stone, it’s not like I have cancer.
You are correct, this is typically what is done, but I don’t think it’s the right answer. I suspect that the problem is that we still don’t know enough about how the brain works to have come up with the optimal treatment for this type of pain, so we are left with what you describe. Just because for some people their pain is in there head doesn’t mean it’s not real pain, it just means that treating their back, knees, shoulders, stomach, etc. won’t produce the desired result because the pain, while definitely real, is due more to something not working right in their brain rather than something not working right in their back. What is my cite for this? More anecdotal evidence, people who have back surgery but just keep worse, people who have abdominal surgeries but just keep getting worse, and so on. It’s not that the surgeons messed up, it’s that the problem in some patients is more complicated than a herniated disc or abdominal adhesions, and as of yet medical science hasn’t figured out a more effective treatment than narcotics.
My sympathies. In my experience as a patient, having been through multiple bouts with kidney stones, the mistake was in being sent home. Unless the stone is really small, they usually need to be removed. Being sent home with narcotics usually won’t help the stone pass :(, at least in my case as a patient it never has.
Pain patients are definitely being punished, and restricting their access to medication they need is doing absolutely nothing to reduce opioid misuse and overdose deaths.
My sister is a chronic pain patient. Although her pain doctor will prescribe the level of opioids necessary to control her pain and keep her functioning, her insurance will only pay for a dosage that is far less than what she has been using. Her insurance provider suggested she try acupuncture instead (which they don’t cover, mind you), so she dutifully spent $1,000 on an alternative treatment that did not work for her.
My sister is not some slacker who has talked a shady doctor into prescribing whatever she wants. She works full-time for a university as a grant administrator and is an active volunteer. When her pain is not appropriately controlled, she literally has difficulty getting out of bed. Pain does destroy quality of life. You can find plenty of examples out there of pain patients who committed suicide rather than live with intractable pain that could not be controlled with the amount of medication they had been reduced to.
Pain is not character-building. Someone who can manage with Ibuprofen or reiki or gritting his/her teeth is not morally superior to someone whose pain can’t be controlled without opioids.
Not a doctor and it is quite possible one will come in shortly to contradict me. However as a multiple-time sufferer of kidney stones( none in recent years, thank you lord ), IME I found taking pain medication at the first tell-tale sign of impending agony was far more effective than waiting until it was full-blown. For me it usually wasn’t completely sudden - it would start with an escalating sensation of having been kicked in one testicle than migrate up to that awesome flank pain. If I responded when it still in that kicked nut stage it was anecdotally more efficacious. But everyone is different when it comes to pain.
My sympathies for your situation. Kidney stones truly suck.
It doesn’t start in the testicles; it always starts in the back.
It’s a difficult tradeoff. Trust me, I am not waiting until the pain is a 10; if I do that the little hydromorphone tablets won’t be enough. On the 26th I waited until it was about an 8 and that was clearly too long; I was a hairsbreadth from going to Emergency again. But sometimes, the pain never gets above, let’s say, a 4 or a 5, especially if it’s towards the end of the naproxen window and I can just move than up an hour.
So now having maybe 8 tablets left, every time the pain comes it’s a difficult decision; is this the time I NEED to take them? Or if I pop them now, am I wasting them, and won’t have them when a really bad spell comes later? I need to stretch it out until Monday, at least. If it’s bad do I do a proper adult doze of two tablets? Or do I just do one, which saves one, but runs the risk it’s not enough and I’ll take another in two hours and it still won’t be as effective as taking two at once when the pain wasn’t as bad?
To pull this back on topic, all this worrying and decision making is solely because of the opiate panic. I am quite aware opiate addiction and death is a real thing and a huge problem, of course, but just “let’s not give Rick enough painkillers” is a pointless thing and seems like it will not really solve the actual problem. The opiate epidemic is not the fault of the ER doctor who helped me, who is self evidently disciplined about it. I don’t know the solution here but I am sure this isn’t it.
Update: my wife was completely off of all of the prescribed opioids within about 5 weeks of the surgery. She initially had trouble cutting the dose smoothly, so she got a pill splitter to more gradually reduce the dose (from 10 mg to 7.5 mg to 5 mg to 2.5 mg to zero). She’s now essentially pain-free.
Since others have shared their anecdotes about their experiences with opiods, I thought I might share mine. Or, more accurately, my mother’s.
When I was in high school, my mother was having a horrible time with acid reflux so bad that her vocal cords were getting burned with stomach acid. She had a surgery called Nissen fundoplication to treat her acid reflux and things went horribly horribly wrong. During the surgery, they made to major mistakes. They made the opening into her stomach too small and they damaged her vagus nerve. Over the next year, my mother lost a lot of weight as she developed dumping syndrome and went between not being able to vomit when food got stuck in her esophagus and not being able to stop pooping after she ate. She went to a variety of doctors and, for some reason, my mother was prescribed opium and then Vicodin and benzos to treat her stomach problems. She started asking all the various specialists she had for her drugs and they all complied. And she got very addicted. Even after it was apparent to everyone in her life, even my 13 year old little brother, that she was addicted, the doctors did nothing. My dad wrote them letters and called them, pleading for help, to no avail. Finally, my dad and my mom’s friends took away my mom’s drugs and weaned her off themselves. I’m not sure how they convinced my mom to do this but they must have as it wouldn’t have worked without her consent and help.
Her addiction was monstruous. She wasn’t buying street drugs, thankfully, but she did so many horrible things when she was jonesing. She ruined my sister’s wedding by both being high out of her mind and then decidedly not. She changed a lot.
I have a lot of very good reasons to hate opiods but I recognize that they have very valid and necessary uses. I just wish that stories like my mother’s weren’t common.
I am a chronic pain patient. I see a pain specialist. I have two compressed/herniated discs in my lower back. My insurance only pays for a portion of my meds, so I pay out of pocket. I also get periodic steroid injections. At this point, I am not a candidate for surgery.
I don’t think I’m addicted. Sometimes I forget to take my pills, and my back pain will tell me I forgot. I don’t get withdrawal symptoms - hot flashes, anxiety, whatever. I also do stretches for the sciatica.
There must be a physiological mechanism that makes some people crave them and not others; I’ve had opioids prescribed to me no less than four times that I can recall in my life- twice for left knee surgery related stuff (vicodin & tylox), once for right knee (norco), and once for wisdom teeth (darvocet).
At no time did they do anything other than relieve pain and (sometimes) make me sleepy. No euphoria, nothing pleasurable at all.
And then I hear about people getting addicted to them and scratch my head and wonder how/why that happens? Is it a really long-term thing where they sneak up on you over the course of months or do some people really get addicted fast to them?
As I noted upthread, my wife started noticing withdrawal symptoms (hot and cold sweats, feeling unbearably alternately hot and cold, nausea, irritability, etc.) as her last dose wore off. This was about 2 weeks after her back surgery. (Prior to this, she mainly noticed the resumption of her post-surgical pain as the dose wore off.)
She never indicated any euphoria or anything like that – just pain relief and immediate relief of the withdrawal symptoms. As the pain gradually subsided, she starting tapering her dose to avoid the withdrawal symptoms.
She is also a registered nurse. I can easily see how a layperson could become dependent, especially if they are not properly counseled on how to manage their prescribed medication. I also think that many medical providers think their patients can just stop their prescribed medication cold-turkey, with no thought about the effects of withdrawal.
Yes, the crackdown due to the opioid epidemic is scaring me and my wife shitless. She has chronic Neuropathic pain and through the help of a pain doctor has been on a high dose methadone treatment for about 15 years. She has never once taken over the prescribed amount and has been on the same steady prescription for probably that last 10 years. She gets zero in the way of high off it and only craves it in that when she forgets to take it the pain comes back. Some other medications seem to provide some help but it is clear that the methadone is really what helps her the most, and a few times when she has run out, say due to a snow storm on the day she was supposed to get a new perscription she can only lie in bed and feel as though her legs are on fire. Now some state are regulating that doctors can only prescribe the equivalent of half what she is currently taking. If that happens in our state or goes national I don’t know what we’ll do. Suicide isn’t off the table.
It seems that the powers that be would rather have you off yourselfto escape daily torture, than risk that you might accidentally become addicted. Or alternatively try heroin and fentanyl to stop the torture which are much more likely to lead to addiction and overdose.
Sorry if this came off as over the top, but as you can tell this is a very emotional issue for me.
After two weeks? Was it a particularly large dose or very frequently? I took the norco 2-3 times a day for a month, with another month refill on the prescription if I wanted it (this was January 2014, BTW), and just decided that my operated-on knee wasn’t hurting so bad that OTC naproxen and ibuprofen couldn’t take care of it, so I quit.
Same thing 25 years before when I had my other knee operated on, except on a smaller scale- I think I took those for a couple weeks and quit because I didn’t like being drowsy, and started taking my dad’s 800mg ibuprofen that he’d been prescribed for lower back pain.
So I’m a bit amazed and curious that people started seeing withdrawal effects after such a short time.
I don’t believe it was a particularly high dose. I believe she was initially taking extended release hydrocodone, before switching to oxycodone a few times a day.
No cite, but I read somewhere that dependence can start developing in as soon as 5 days.
Ditto.
My dad was a physician (before he passed away), and told me I could take 800 mg of ibuprofen as often as 4 times/day for severe lower back pain. While the military actually prescribed me those 800 mg ibuprofen pills years ago, now I just take 2-4 of the OTC 200 mg pills, depending on my degree of pain (generally no more than once or twice a day).
Part of the problem seems to be America’s addiction to magic pills. Whatever the condition, we want instant relief that involves little to no effort on our part. For awhile many doctors were willing to indulge this with large quantities of opioids for relatively minor pain. Lots of these drugs became available for recreational use, and as we’ve seen before in depressed areas with very limited work opportunities for many residents, people use these things to escape the miserable lives they lead.
Just as individuals want quick fixes with little effort, our governments want the same. It’s really easy to make it harder to get an opioid prescription, but it’s way harder to fix systemic social inequalities or to put the opioid-addiction genie back in its bottle since there are so many alternative means of getting one’s fix (as if it fixes anything).