Narcotic Pain Meds Only Good For Certain Pains?

I’m thinking there’s a factual answer to this question. If not, a kindly mod may choose to move it to another forum.

I have frequent bouts of kidney stones. Some of them require extraction because they’re too big to pass. My current one is 7mm and is scheduled for removal on October 30th.

I’ll be at the hospital at 7:45AM, but will take some of my Percocet before I leave the house, because they won’t give me any morphine at the hospital until they get an IV started, and that can take hours.

Last time I went through this, the first nurse to try to start an IV stuck me three times before going to find another nurse who might have better luck. I made several sounds indicating that what she was doing was hurting me.

When she left to find another nurse, my hubby said to me “Didn’t you take pain meds before we left the house?” and I said yes. So he said “So, why doesn’t that help with the pain of starting an IV?” and I said “Ummmm, well, I don’t know; it just doesn’t”

But it was a reasonable question. The Percocet deals with some fairly serious pain (as anyone who’s had kidney stones can attest to), and yet does nothing to dull the pain of being repeatedly jabbed and probed with a needle.

Why not?

I am not a doctor, but I am certain one will wander past shortly…

I have discovered that pain meds are funny things. they help with long term pains, not quick sharp instant ones [in other words your stone may be sharp and there, it is a long term pain.] Needle jabs are short instant pains. The narcotics dull the chronic pain because it ‘tones down’ your perception of them, and relieves anxiety. As I once put it when on percocet “It still hurts like hell, but I just don’t care” as the pain was still intense, just I wasn’t totally ‘there’ and the pain was dulled down to a reasonable tolerable pain.

Think of it another way … if you know that the nurse is going to jab you with a needle, you just groan a bit when she stabs. If you were not expecting it you would probably respond with a large wince movement [to flinch away from the pain] and add a scream or shout of invective like ‘what the fuck are you doing’ very loudly. The difference is that you are expecting a sensation, so you put your own control on your reactions.

Now a nerve blocking like lidocaine injected into a nerve is entirely different [though it is blessed relief once the nerve is deadened, the shooting up can be incredibly painful. Think of how painful the novocaine/lido injection for getting a filling or any form of oral work done is - and if you can contrast the needle going in with and without the little swab of topical anaesthetic all the better.

I just had my parathyroids cut out under local and light sedation. I was awake for the whole thing, and was pretty alert except for when they were actually injecting the lido [they had me really spacy and on a touch of versed to start with, and just the sedative after they shot up my throat with the lido. All I really felt was the occasional wet swab to catch drips down the sides of my neck, and sort of pressure and tugging as she peeled the parathyroids from around the nerves controlling the vocal cord. hey want you awake as there is a cough reflex if they get too close to the nerves that is supressed under a general. My gas passer knew a lot of good jokes=)

It’s just as aruvqan said. Intermittent, sharp pains are not masked by drugs like morphine (opiates). They are much better at reducing dull, constant, “boring” (as in boring through something) pain.

Underlying this phenomenon may be the nature of the chemical signal for the specific pains and the receptor for that chemical (think of the key and lock analogy, with the key being the chemical and the lock being the receptor). Morphine, and the other opiates, only block certain chemical keys. Chemical signals which are not blocked by opiates may be involved in the pain of a needle prick and the like. Those other chemical pain signals which are not blocked by opiates include things like substance-P, glutamate, kinins, prostaglandins etc.

Ditto what aruvqan and KarlGauss said. Opioids work quite well for some types of pain – the long-lasting pain that occurs after the initial pain. Like when you’ve broken your leg; it won’t help you if you’re on opioids when you break your leg, but the constant pain you’re in for weeks afterward as it heals will probably be treated quite well with opiates. Similarly, you wouldn’t want to get your wisdom teeth extracted with just opioids in you, but they work well for dulling the pain later.

As aruvqan also mentioned, they seem to do a very good job at masking the emotional component of suffering, making you calmer and better able to cope with the pain rather than completely removing the sensation itself like a nerve-blocking local anesthetic does. This goes well with the reason opioids work at all, since they’re just externally-introduced versions of your body’s natural painkillers like beta endorphin; if your endorphins were capable of completely numbing your pain after an injury, you’d probably injure yourself even worse as you go about your normal activities without taking special care of the healing area. But on the other hand, you don’t want to be rendered completely useless by agony either. So they take kind of a middle ground.

That’s why on one Matlock episode I watched, I was irritated when the victim turned out to have taken some Percocet and then beaten and stabbed himself in an alley. My wife was quite surprised when I yelled “That wouldn’t numb him, he’d just slow down his reaction time a bit!”

I’ve heard that pain that doesn’t go through the spinal cord - for example, the facial pain of trigeminal neuralgia (sp?) - doesn’t respond well to narcotics.

I’ve had 40-something kidney stones as big as 13 mm, and many surgeries and extractions and blastings. In light of the various pains of kidney stones I’m surprised you’d mind somebody poking around for an IV.

The last stone I passed, a 4 mm one, hardly seemed any less painful after percocets and morphine. However, after the poink sensation of it clearing my ureteral-bladder junction, the pain subsided at a rate of about 20 thumbhammers a second (you know what I mean), and then I noticed how dim and slightly dizzy the meds were making me feel.

Oh, and one thing I was going to mention that I forgot – neuropathic pain doesn’t seem to respond well to opioids at all. And it appears that the incredible pain caused by platypus venom is pretty much entirely unresponsive to opioids, even when the dosage is very nearly high enough to become dangerously respiratorily suppressive[sup]1[/sup]. If you get stung by a platypus, a complete numbing via lidocaine or its ilk is about the only way to relieve the pain. According to the anecdotes I’ve read, that is.

[sup]1[/sup]Hopefully my meaning is clear, although the phrasing is rather awkward – I mean that it doesn’t work even when people are given a morphine dose so high that the doctors are uncomfortable giving them more, for fear of driving their breathing rate down too low.

Well, there’s some ignorance fought, chorpler. I did not know platypode are venomous. And in researching said fact, I came across this tidbit. (Oh, those British medical journal editors and their trenchant wit!)

"The platypus (Ornithorhynchus anatinus) and its venomous characteristics in particular, have experienced a long history of being treated with disbelief or ignored completely…a recent case report of platypus envenomation (Tonkin and Negrine, 1994) in the British Journal of Hand Surgery was accompanied by the following, apparently facetious, Editor’s note: “A spate of Dodo bites has recently been recorded in a remote area of New South Wales and will be reported by Dr Tonkin in the next issue of the Journal”.

Satisfying answers folks, thanks. I actually ended up in the ER this morning, because the pain of this particular stone had flared again, more than I thought possible with a stent in place.

Fortunately, they were able to get the IV in on the first try; unfortunately, the pain got so bad because the infection is back. Fortunately, they got the pain under control with a combo of Toradol (non-narcotic NSAID) and Dilaudid (powerful, fast-acting stuff); they also gave me IV antibiotics, and one to take home with me, as well as a 'script for more. I’ll stay on them for the next week, but as the antibiotics kick in, the pain should back off.

Right now, I’m still pretty much under the influence of the ER drugs, so I’m not too uncomfortable.

Oh, fuck. I’ve had one. I cannot conceive of going through that 40-odd times. If I had the choice between 40 more stones and a .44 mag, I’d say load that bitch up.

'Course mine was the size of a '72 Buick Electra.

Well, I’ve had a couple dozen of them or so. I have gone so far as to look for do-it-yourself kidney transplant kits on ebay! :stuck_out_tongue:

Seriously, though, all you can really do is focus on the times you don’t hurt, and be grateful for those times. Not to mention being grateful for things like morphine and Dilaudid. I can’t even imagine what the ER docs must think of me. Our conversations seem to go like this:
ER doc: What seems to be the problem?
Me: flank pain on the (left or right) characteristic of a kidney stone. The pain is sharp and stabbing. I’m nauseated and have/have not vomited. I need 4mg of Zofran for the nausea and either 4mg of morphine or 2mg of Dilaudid; I’d prefer you didn’t use Toradol, except maybe as a one-shot deal, as Toradol is hard on the kidneys, and my right one only functions at about 15%.
ER doc: :eek:

As far as size goes, it might be different for men than women, but I truly cannot tell the difference between a 2mm and a 10mm by the amount of pain it causes. Seems like you’d be able to, but they all hurt like a sunnybeach.

>can’t even imagine what the ER docs must think of me. Our conversations seem to go like this:
ER doc: What seems to be the problem?
Me: flank pain on the (left or right) characteristic of a kidney stone. The pain is sharp and stabbing. I’m nauseated and have/have not vomited. I need 4mg of Zofran

I imagine the ER docs think you’ve had multiple stones.

Size does matter, speaking broadly from just my own experience. I’ve passed a 2 mm stone while driving, whereas the largest ones have sort of knocked me out. I also find the feelings are very different for stones in the renal pelvis versus high in the ureter versus approaching the UBJ, and stones in the bladder and urethra produce other sensations that are perhaps uncomfortable but not painful.

According to my taste, kidney stone pain makes me wish it would pass, but it doesn’t make me want to die. It feels limited in time and space, though intense. I’ve had back pain from a blown disk that, while never as intense, was more incentive to check out because it lasts and it threatens the future.

Kidney stones can’t kill you. They can’t even do much permanent damage, if you have access to surgical removal before the kidney dies (which is hours or days, not minutes).

Well, they sort of can, and I only know this because one almost did. I had a stone, went to the hospital, they sent me home with pain and nausea meds and told me to come back if I got a fever. By the next day, I had a fever, but between the fever and the meds, I was convinced I didn’t really need to go to the hospital, I just needed to sleep. By the time I was finally strong-armed into going back to the hospital, my temp was 104.7 and my blood pressure was 80/60. The stone had created a complete obstruction in that ureter, and urine had backed up into my blood stream, creating a systemic infection that would, indeed, have killed me. My doctor said if I’d stayed home a couple more hours, there’s very likely nothing he could have done for me.

Of course I do realize that’s complications arising from a stone, and not the stone itself.

Random thoughts

As noted different drugs for different kinds of pain, plus everyone responds is AT LEAST a little different.
Kidney stones are a rock passing through a flexible tube, size matters, you can pass one without knowing it or it can be worse the natural childbirth, at least a dozen women have confirmed this to me*

Narcotics have a central nervous system effect that alters pain perception. I’ve had many people tell me it still hurts, but I don’t care anymore.

*Granted it’s a subjective experience

Childbirth: “oooh I got a baby,”
Kidney stone: “I got a rock”

It is possible that what I am really experiencing when I say size doesn’t matter is, if it’s big enough to cause an obstruction (which is the part my urologist assures me causes the pain), then it’s big enough to hurt like hell. If it’s too small to cause an obstruction, then, yeah, it’ll just pass unnoticed. In fact, I’ve been surprised by small (under 2mm) stones laying on the inside ledge of the toilet before when I’m done using the bathroom.

If it’s a lot smaller than the ureter than it can pass unnoticed, if it’s a lot bigger it can completely obstruct the tube and flood the kidney, if it’s just right (so to speak) it’ll pass, but boy will you know it.

IANA urologist

Meh. I’ve had fairly small ones that they had to retrieve because they refused to pass (or were just causing too much trouble). Then again, I’ve dealt with five different urologists, and they all agree I’m anything but a “by the books” kind of patient. :wink:

It’s just been my experience that you cannot tell the difference, from the amount of pain, between a 4mm and an 8mm (and I’ve had both). They both just hurt, a lot.

Also, while it’s all well and good to talk about the sizes although they were pearls or something, they are very irregularly shaped, which also creates part of the problem. Which way they turn when they cause the obstruction, etc.