It’s anecdotal and may vary by individual, but in the past I’ve found hydrocodone/APAP to be much better at relieving pain than codeine/APAP (which also tends to give me a lot more nausea). I’d be curious to see a study using it instead of codeine.
One thing that may help in the future is that electronic medical records are supposed to eventually be ‘centralized’ in a way that your doctor (who ever, what ever kind) will have access to all of your medical information at the time that you are being treated.
When this happens, they should be able to see that patients are not shopping around for prescriptions and see the full scope of what a patient is being treated for. Theoretically, it should be a simple matter to allow certain levels of medication even adapted for the individual’s specific diagnosed conditions. This would at least allow the doctor to safely (as in NOT have a DEA agent at their door or a family member accusing them of over-dose) prescribe medications to patients. This could also act as a monitoring system to protect patients from over-prescriptions that get them into trouble.
I agree that we need better pain management systems, but (even though I’m not fond of the health care system) I can’t paint the doctors as evil because right now, they have to place a lot of trust in what a patient tells them because they have no (few?) other source of information.
Tramadol effectively equals opioid, despite the fact that the DEA doesn’t consider tramadol a narcotic. Drug reps will argue differently, but it’s a problematic drug not only for people with a history of substance abuse, but also for folks on lots of other meds, because tramadol has a LOT of interactions with many different medications, far far more than other opioids. I’d rather prescribe someone hydrocodone than give them tramadol.
Hydrocodone is more effective than codeine, and less likely to cause nausea (not unlikely, but less likely.) It’s my go-to prescription when an opioid is needed for moderate to severe acute pain.
Anyone who thinks Tramadol is safe and non-habit forming simply google “tramadol addiction”. It’s both scary and informative for anyone who may be on or considering treatment with this drug. It’s a drug with some beneficial uses, imo, but definitely not something that should be treated with the cavalier disregard that it has been and continues to be treated by many in the medical community with (patients, doctors, pharmacists, drug reps, etc.).
I don’t doubt what you say Ambivalid, but it really mystifies me as to why. I had Tramadol for quite a while after an operation about 5 years ago, and I really felt it did very little. I was certainly had no problems ending up using it and could not imagine pursuing obtaining any more of it.
Different strokes I guess.
Well of course not everyone who ever uses it is going to have a problem; I use it myself. What I am saying is that the potential for addiction and abuse is very real and very high with this drug and basically the opposite is believed by many in the medical community.
I had no trouble getting Vicodin from a doctor for kidney stones. it took 2 tries with 2 different medications to arrive at that but when I got the 2nd stone I immediately got the Vicodin because it worked best the previous time. I’ve also found out that large doses of Ibuprofen are pretty effective so I wouldn’t discount that as a starting point.
The reality of the world is that people abuse drugs like Vicodin and doctors who over-prescribe them come under a microscope.
there may also be limitations that doctors have based on their medical proficiency. I’d like a doctors input on this. I have a feeling that pain meds require a constant level of recurrency training in order to prescribe.
And while I don’t mean to make light of addiction, it is possible to kick it after the original issue that caused the pain is resolved. The patient may have to undergo a detox treatment but that’s better than years of excruciating pain. The period of recovery from those knee replacement procedures can entail a great deal of pain.
(Sample of one, family member who had both knees replaced, and was up to Fentanyl patches before going off it.)
I did ask the specialist prescribing the drug about it and mentioned a bit of concern of a dependency. His answer was along the lines of “It is unlikely because you are concerned about it.”
I’m telling you; google tramadol and addiction. Or other similar combos. It is appalling.
Oh, I don’t doubt you. I’ll trust you on this- no need for me to look it up. (I can’t understand addiction to smoking either but it is also pretty real).
Given that, is it prescribed so often simply BECAUSE it’s not considered an opioid by the DEA? I’ve actually had it offered several times for kidney stones-- I never filled the scripts because there’s a really scary history of addiction in my family and any prescription painkillers terrify me, and really, the pain wasn’t as bad as I expected. But it kind of seems like a first line pain relief drug here.
Bingo.
The ability to check patients current and past medications doesn’t require EMR. There are many programs the physicians can implement that will give the entire prescription history under certain conditions. Our practice regularly uses such a program but the problem is, the patient would have to give their real name and/or have put the medications through insurance. Abusers that know the system are aware of this and attempt to keep track of their providers and remain self pay with a portion of them.
I don’t think there will ever be a fail safe way to prevent doctor shopping.
I fully understand what you’re saying, but it seems in conflict with your opening statement:
It seems like access to complete EMR would, in fact, address the very problem you mention. As for fake names, why isn’t requiring photo ID the standard, for access to care or meds?
I know that this is about pain medication and drug seeking behavior but I’m wondering if there is a bigger issue at hand. Maybe after all of these years of drug companies running commercial to ask out doctor about Ambian or Xanax or Concerta our doctors have decided that they will not give us anything if we ask for it.
My own case was not a narcotic but T. I was suffering from erectile dysfunction and had all of the symptoms of low-testosterone that I believe comes from chronic epididymitis + being 41. I asked if I could get the test just to see what the number was. Not only did my doctor refuse to do the test, he said that he would refuse to give me testosterone no matter what the number was and that “With all of these Low-T Center commericals everyone is coming in for testosterone. It’s the flavor of the day.” I felt exactly like he thought I was exhibiting drug-seeking behavior.
I went to another doctor and my testosterone was near eunuch levels.
I’m afraid there’s some truth to that. Doctors are, indeed, human, and they can be defensive and jealous and petty sometimes.
My SO has had the same experience as you. Rather, he’s not at “eunuch” levels, but he’s symptomatic and his numbers are down below what the current numbers indicating intervention are, according to the current published stuff in endocrinology journals (not even the very high numbers “Low T centers” are pushing). But his doctor is using guidelines from 30 years ago and refuses to consider updating them. Presenting him with studies and informatics makes him dig in even harder - we’ve now evidenced ourselves from “we’ll retest in six months” to “you don’t qualify, period.” Very frustrating, and yes, I think there’s an ego thing going on.
FWIW I wasn’t trying to argue that Tramadol wasn’t habit forming, just that it was what was factually given to me after long months of getting pretty much zero assistance with pain whatsoever after I had the audacity to ask for help. They definitely warn right in the instructions that it can be habit-forming, to take exactly the right dose at the same time of day (even to the point of always taking it with food or without food), and to not stop taking it without talking to your doctor. It’s not necessarily intended as a long-term solution but to deal with the functional issues I’m dealing with right now, while I’m still waiting for them to figure out what treatment to use against the disease itself.
My point was really that it’s very odd for a doctor to basically go a 180 from offering help with pain to not offering any in this situation. It was so odd that I didn’t even realize until later on why she had brought up narcotics.
FWIW, when I told my current doctor I was using Tylenol “as needed” as directed by my other physician, he made an incredulous face and said “Uh, is that doing anything for you?” My level of pain and function is pretty clear from even the slightest observation.
Honestly, when a patient is at the point where they’re losing enough function that they can no longer take care of themselves to do things like cook or wash their own clothes, access large portions of their home, when they’re missing work due to extreme pain, and they can barely dress themselves – and that’s the point I was at – being terrified of a potential dependency to the point of providing no help or guidance seems to be misplaced priorities as far as I am concerned. I get the need for precautions and oversight. I don’t get just basically telling a patient to go screw.
Your body is different from people with a normal digestive system.
Because so much of your small intestine was bypassed when you had your weight loss surgery, not only do you malabsorb nutrients, but also certain medications. Anything that is slow-released is pretty much useless to you now. Medications that require a highly acidic environment to break down will also be less effective for you. Your stomach is significantly smaller and you no longer have a functional pyloric valve, so drugs that would typically be absorbed in the stomach and duodenum won’t work as effectively.
With some meds you might find that you get pain relief, but it will wear off much more quickly than expected. With others you might find that it takes a higher dosage to get any relief from your pain. Individual experiences vary. Chronic pain management becomes much more complicated after having gastric bypass surgery.
You might want to direct your doctor to some literature regarding malabsorption and bioavailability of medications after gastric bypass. Pharmacists are also good information resources.
Best wishes.