Unfortunately you are going to be seen as a drug-seeking patient if you go in there asking for one of the most commonly abused opioid medications on the market. You won’t likely be able to convince him to renew the vicodin unless he is planning on discharging you as a patient shortly after. I would ask him for a referral to a pain or orthopedic specialist and discuss your pain treatment options with them. Do not mention any medication specifically when you discuss it with them. There may be better medications out there that work on your issue more effectively. Do not poison the well with the information that you have had good results with one specific medication, it will raise red flags.
You can’t take vicodin long term for pain without taking tylenol for pain. Vicodin is tylenol and hydrocodone. They’re packaged together to inhibit hydrocodone abuse and because they’re potentiators - they enhance each other’s pain fighting powers.
When Farmer Jane said, “There’s no reason why anyone should be in chronic pain,” you responded with, “Other than the horrible effects of narcotic addiction.” But the addiction potential of opiates is not a good excuse to let a patient suffer from chronic pain. That’s why I suggested non-opioid pain medications in response to your post. I’m not making up a long conversation that’s irrelevant to your post… I’m providing a response to your claim that it’s okay for people to be in chronic pain, due to the horrible effects of narcotic addiction.
Her doctor *should *have taken her request for vicodin seriously, provided her with the reasons he felt vicodin was a bad idea for chronic pain, and offered to prescribe something stronger than tylenol. The reason she said vicodin was likely because it’s the only strong pain med she’s ever taken–if he’d taken 2 minutes to discuss the request with her, he’d have found that out. If he gave a good god damn, she’d be on something else rather than having her pain downplayed. That’s not right.
I don’t respect a doctor who won’t prescribe it to someone with two bad knees, several injuries, and has been their patient for 20 years.
I don’t disagree with any of that. There are more options.
A friend of mine whose sister worked as an ER nurse told him they had a policy (perhaps unofficial) of never giving patients a specific narcotic medication that they requested by name. They’d always try to prescribe something else instead, and not necessarily something less strong, just not the one they asked for.
I guess I understand the rationale for this. It does feel odd and a bit demeaning, though, when I have surgery or an injury that requires medication and have to play dumb about what I’m being prescribed (when in fact I try to read up and be reasonably well informed) lest I sound like a drug seeker.
I have 2 bad knees. I took oxy for about 5 days after my last knee surgery. That’s it. Going straight to the addictive option is not very smart. In some cases it is the best option. It is not the only option.
My ex-sister in law was very possessive of her pain. Told everyone about it any chance she got. Went to the doctors that would give her the most pills. She didn’t die because of her back pain. She died at 35 because of her opiate addiction. All of it obtained legally from doctors.
The alternatives you list are pretty useless for bone on bone pain.
Tylenol is safe in folks with normal livers in doses of up to 3.5 grams a day, if not used with chronic alcohol consumption.
Another problem with opioids is that the dose required to relieve the sort of chronic, non-malignant pain described by the OP generally rises with time until the person is taking enough to kill an elephant, is laxative dependent for each bowel movement, is groggy and not participating in their life due to sedation effects, and is finally in just as much pain as before they started on the opioid. Not a good place to be.
“There’s no reason for anyone to be in chronic pain”? Sadly, there are all too many reasons. Lots of chronic, irreversible, untreatable diseases cause chronic pain, and our best tools rarely provide safe, effective, long-term relief.
And if opioids were to be used for a person with a specific source of pain, such as one very, very bad joint, vicodin is still a lousy choice. Better to use long-acting opioids (MS contin, methadone, oxycodone long-acting) in the lowest dose that improves function acceptably. And if functional improvement is not seen on opioids, stop using them for chronic pain, because once the doses go up to try to overcome the tolerance that will inevitably develop, bad outcome rates skyrocket.
I’ve been struggling with managing chronic pain in my patients for decades, taken the latest seminars to learn the latest theories and approaches, seen new meds and procedures become popular, then disappear as they fail to work as promised, see people’s lives dwindle not just due to pain, but due to side-effects of the treatments, and seen my patients die of opioid overdoses, and seen their family members and associates die when they get their hands on Grandpa’s pills. And this is not just anecdotal, evidence demonstrates more and more folks are dying from use of legitimate opioid prescriptions.
What works best? Lifestyle changes. Stop smoking, lose the weight, do the appropriate exercises, meditate, biofeedback for stress reduction, distraction with other activities, occasional nerve blocks for particular types of pain, TENS units, sex, rock and roll. Judicious use of proper medication is also useful but frankly is only a small part of the picture.
So I sympathize with the OP, but the answers to such problems are seldom simple.
Thank you QtM. Very concise and informative.
Not everyone is like you or your SIL. Every person I can think of has probably had Vicodin one time or another. Only one person I know ever had issue with it, and he had a pretty reckless personality in his 20s, anyway.
If I take a Vicodin, I’m not buzzed. My pain just goes away. (A joint would make me buzzed and unable to drive. Same with a shot. But a Vicodin? I just go back to normal.)
If I take a regular Tylenol OTC, I’m still limping. I could never understand people who ‘got off’ on opiate drugs, so maybe this is part of my reasoning.
With the availability of modern medicine, there’s really no reason why a doctor shouldn’t be concerned with someone’s chronic pain. People shouldn’t have poor quality of life.
A doctor certainly should be concerned with addressing chronic pain problems. I spend a lot of my time working on improving the function of my patients with chronic pain, educating them about their situation, trying to motivate them to do their part.
Maybe they shouldn’t, but they do. Modern medicine is not so advanced as to be able to end all suffering (short of euthanasia). To think otherwise is unrealistic.
And I’ve not said there is no role for opioid use in chronic pain. It is but one tool in the toolbox, but it is one that should not be reached for first, and in many cases should be avoided completely.
Fair enough. Do you think the OP should live in chronic pain and poor quality of life in the meantime while looking at other options?
Also curious how you feel about chronic pain and the elderly. Now that one pisses me off quite a bit.
I don’t know where should enters into it. It may just be the way things are. I wouldn’t prescribe vicodin to someone just because they felt they needed it while they were looking at over options. I would try to effect some sort of pain-reduction plan in the meantime which might or might not include opioids.
Be as pissed off as you like, it won’t alter the unrelenting reality of that particular combination. Old age and chronic pain frequently go together, that’s the way the human body works. And I’ve seen all too many old folks suffer from the complications of their chronic pain treatment plans. That includes old folks who died from stomach bleeding due to normal doses of ibuprofen or naproxen, old folks sedated so much by muscle relaxers that they fell and broke a hip and saw their overall chronic pain level and disability level go up by orders of magnitude, and old folks whose cognition was so impaired by their opioid meds that they caused an auto wreck, killing themselves and others.
So I’m intimately involved in the problem of chronic pain and the elderly. It’s a lot like the problem of chronic pain with younger people, only more common, more complicated, and with fewer good outcomes.
Uh-huh.
So… people who suffer from genuine chronic pain in this country basically have two choices:
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Go to a regular doctor who won’t prescribe what you need and simply suck it up and suffer
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Go to a place that supposedly exists to treat chronic pain and be treated as an addict and a criminal from the moment you step in the door.
Really, both choices completely suck.
I’m currently on the county grand jury for a few more months. Without getting into specifics, based on what I have seen come before us for indictment doctors are looked at VERY closely these days by law enforcement, and their licensing boards re the quantity of pain meds they are prescribing. Mainly because of concern that they are acting as de facto conduits for street sellers.
I understand their caution, they are under a microscope these days re prescribing pain meds.
Yes, I am aware of all that. I worked for four years in the administration of a methadone clinic, please do not lecture me on the horrors of opiates, I’ve seen them first hand.
I am also aware that there are people in this country suffering genuine pain every single goddamn day of their life, which is ALSO horrendous, horrible, hellish, and a bunch of other things.
Antiobiotics are also tremendously overprescribed, but when you have a medical need for one you can get it without being treated as a criminal.
I took that tone with you because of how you replied. Do not presume to think you are the only one here with experience with the subject.
Unfortunately those with medical need are treated like criminals because of the actions of an overwhelmingly large number of criminals who are also trying to get those drugs. Not the same as antibiotics.
Disproportionately from methadone, as I read recently, because of its particularly long half-life which makes it both beneficial and potentially dangerous for treating chronic pain.
(Not meant as a “gotcha” because you mentioned methadone; it just reminded me that I read that article recently.)
You assumed that because I do not come to the same conclusions as you do I must be ignorant. I am not.
I don’t think it is right to treat people with a medical condition as criminals when they have done nothing wrong. It’s like assuming everyone with HIV is a promiscuous pervert and “deserves” their disease.
The bottom line is that the puritanical approach to drug addiction in this country increases pain and suffering among the injured and ill, who are expected to suffer because someone else is misbehaving. I find this loathsome and unethical. Those with medical needs should have them treated without being humiliated or subjected to restrictions normally reserved for hardened criminals.
Methadone’s both a great, and very scary chronic pain drug.
Great because it produces a relatively minimal “high” while delivering a big wallop of pain relief.
Scary because it lasts so damn long, is slow to kick in, and as a result, one must understand the dosing very, very well when taking it. And that applies to doctors and patients.
I used to think I had a pretty good handle on prescribing it. Now, while I don’t think I’ve made any big errors in doing so, I’m a lot more leery of it than I was before that mortality report came out. Long-acting morphine or delayed-release oxycodone both have better safety profiles, and with the new oxys harder to crush and get an instant super-high out of, I’m starting to consider their role in chronic pain again. Mostly for malignant pain, however. Especially with the problems of morphine and methadone being exacerbated in end-stage liver disease…