Why do doctors give you only enough pain medication to “take the edge off” and not enough to fully relieve the pain?
My granddaughter had her tonsils out and could only take hydrocodone every 4 hours. Also, she could only suck on a lidocaine lollipop every three hours.
I felt so bad because she was miserable and I could do nothing other than try to distract her. Is this really the best we can do for pain? How come they can’t prescribe something that will totally eliminate the pain? I have heard that oxycontin is a major pain reliever, so why could she not get something like that?
The difference between oxycontin and hydrocodone is trivial.
The limiting factor in giving pain meds is the side effect of the medicines and not a reluctance to eliminate all pain.
Among the side effects associated with narcotics is a depression in the patient’s level of alertness. This can result in an increased risk of nasty things such as getting secretions down your windpipe (triggering pneumonia), as an example. Unfortunately narcotics aren’t really anesthetics. They make you stop caring about the pain as much, but they don’t get rid of the pain itself. If you give so much the patient is unaware of their pain the risk of respiratory depression and aspiration become unacceptably high.
Lidocaine, which is an anesthetic, is toxic in high doses.
It’s probably not comforting to let your granddaughter know how much bad you and I had it 40 or 50 years ago when we got our tonsils out…
60 Minutes did a story a while ago about how doctors are afraid of over-prescribing possibly addictive pain medication for fear being raided by the feds and thrown in jail. It’s happened before, so the thinking is that it’s better under-prescribe just to be safe.
I had surgery 6 weeks ago and when I was asked pre-op to describe my tolerance for pain, I answered “average.” The doctor wrote a scrip for hydrocodone for me to use post-op as needed. Because I didn’t want to develop a taste for this notoriously easy-to-abuse medication, I stuck with Tylenol and did fine.
So next time I’m asked, I guess I’ll answer “above average.”
If I had been in more extreme pain, though, I would have gotten into the scrip, and if that didn’t do the trick, I’d have damn sure gotten the doctor to move my dosage up or move me onto something that worked.
Right, hydrocodone might not sound impressive (as oxycontin tends to get all the press), but - for instance - hydrocodone plus acetaminophen (Tylenol) are the active ingredients in Vicodin. Your granddaughter is on a fairly high-end medication.
I can also attest that my recollection (admittedly poor) of this surgery 30 years ago was that I had no pain reliever. Not that this’ll make a hurting little kid feel better, but this does represent a decent improvement.
You have to worry about overdosing on a lot of medication. If the Hydrocodone/APAP was a commonly perscribed strength, 5/500 or 10/500, taking one pill every 4 hours would be 6 pills in a 24 hour period, which is 3000mg of tylenol. The amount for overdose is 4000mg IIRC.
Hydrocodone, oxycodone, and other opioid painkillers certainly have a reputation for being easy to abuse, but very few people placed on pain medication for real pain actually do end up abusing them. Several studies have shown that the rate of people developing “problem usage patterns” is quite a bit less than 1%. Something like 1 in 2-4000.
In my experience, people don’t really develop a taste for opiates – either they like them right away the first time they try them, or they don’t feel much, or they feel a negative reaction (my wife is among this last group; she hates it when she has to take painkillers; they make her nauseated, tired, and dizzy, like antihistamines). Of course, if you fall into the first category and really enjoy opioids, it’s definitely in your best interest to not use them any more than you absolutely have to.
Uh … seems like there was something else I wanted to say, but I can’t remember what it was.
Oh yeah, I wanted to actually address the OP. There are a lot of doctors I’ve talked to who are afraid to prescribe more than a bare minimum of pain medications because they worry about getting in trouble for it.
And then of course there are the doctors who are just jerks who say things like “Pain is a part of life, get used to it” and “suck it up and quit whining” and the like. My wife’s close friend had a doctor like that, when she went in complaining of leg pain; when she went to the hospital a couple months later because her leg pain flared up late at night, the ER doctors contacted him, and he told them he thought she was just a whiner who might be drug seeking or who might be suffering from “hysterical pain.” She was dead less than a week later from some kind of cancer that had started in her leg and spread to her organs.
Fortunately most doctors aren’t pure balls of scum like that, but a lot of people do have a hard time getting treatment for chronic pain; that’s the hardest kind of pain for doctors to treat with opiates, because the doctors that do are usually the ones who get targeted, raided, etc.
In the case of your daughter, in higher doses there is a risk of poisoning due to the acetaminophen in Hydrocodone/APAP. IIRC, the best you can get without being hospitalized is 10/325. Thats still a lot of Tylenol.
And there have been ‘Pain Doctors’ who have gotten raided who were (according to the reports) legit.
I would like to see a cite for this. I’ve never used street drugs and I don’t even like to take Advil but I have had a nasty encounter with pain meds prescribed by a doctor. And I’ve known others who have as well. The chance of dependancy is just to great unless there is real unbearable pain.
I’m suprised they gave her hydrocodine for that at all. Every four hours is the shortest time interval between doses. The doctors don’t want the kid dying from respitory distress, because they became to relaxed to breath. To get maxium non life threatening pain relief it has to be adjusted over a long period, much longer than you daughter will need them.
I was under heavy pain medication a couple years, and when the super pain was over, I didn’t have a desire for the meds afterwards.
That’s the popular perception, but the actual chance of dependency from medical treatment with painkillers is very, very low unless the person has a history of drug addiction to begin with.
Here’s a page which discusses a lot of the studies I was thinking of–the particular study I was referring to above was the Porter/Jick study, where the rate of addictive behavior in patients who had been treated with opiates was 4 out of 12,000. The Medina/Diamond study showed a rate of 3 problem cases out of 2,369 patients.
I’ve got a lot of notes on the subject; I’ve been researching the issue and interviewing people for a book about pain patients and drug addicts in America. One of these days I’ll get my notes organized and start the actual writing.
Everyone has pretty much explained it, but just to add: not only are painkillers (which are opiates) addictive, but they fetch a good price on the black market. So it’s understandable why doctors would be conservative in their prescriptions of them.
Oh God, here’s my thread. When I first started taking vicodin for back pain, I realized that I had a very different reaction to it than most people do. It made me euphoric and it was like taking amphetamines. I’m an addict/alcoholic.
After the birth of my 2nd son, I had PPD, and self medicated via hydrocodone. For more than a year & a half and about $18K later, I admitted my problem and have THANK GOD, quit the nasty drugs.
I would sooner see docs under-prescribe so as to avoid having this happen to ANYBODY in the world - even the dirtiest scumbag of the earth I wouldn’t wish it upon.
And the addicts-in-disguise will often claim to be allergic to NSAIDs in order to try to get a prescription for opiates out of a doctor. Those people piss me off.
I’ve heard that people who become addicted to Vicodin suffer problems from the acetominphen as well as the narcotic. It’s even a little bit like the relation of tar to nicotine in tobacco. This makes me wonder if you can get pills that are only hydrocodone–i.e., no acetominiphen. What happens when a person tries to manage their pain with just Tylenol, then decides it isn’t enough so they better get that prescription filled? Then they take Vicodin on top of the Tylenol, which means they’re getting even more acetominophen.
I’m unaware of any hydrocodone-only pills (hydrocodone with APAP or aspirin or the like mixed in is schedule III, but plain hydrocodone is schedule II, subject to more restrictions), but there are plain oxycodone pills which are basically the same thing – stuff like OxyContin.
That said, I’ve met at least one people in my interviews who, from all indications, suffered from Tylenol-induced liver failure … by which I mean liver failure that happened only from taking the Tylenol in Lortab and Vicodin and the like. (I’ve met a lot more people who’ve had liver damage that may have been aggravated by Tylenol, but they were generally heavy drinkers as well so it’s hard to say.) She was a Mormon who didn’t drink or smoke (because that was against the Word of Wisdom) but had no problems with scamming doctors for painkillers.
And there speaks someone who is not a chronic pain sufferer. I have had migraines bad enough that if I had been able to actually move without throwing up my toenails and find a gun I would have blown my head off to get rid of the pain. I have back pain bad enough that some mornings without meds I have been known to crawl into the bathroom and use the super overnight napkins like depends because I cant even stand up long eneough to get to the toilet, and once in the bathroom I cant get u off the floor. I have had to curl up in the bathroom and wait for someone to come home to help me get back to bed.
Tylenol, naprosin and aspirin are about as useful as M&Ms normally. I can manage to function on the max prescription dose of motrin if it is not a bad pain day [like the barometer bottoming out] but for many days oxy is about the only thing to get me upright and functional. My back has been getting worse since I hit 40 … I am not looking foreward to my 50s.
I also cold turkeyed myself off morphine in the hospital after my major back screwup. Took arguing the nurse down and demanding to see my hospitaller though. I though it would be better for me in the long run to reduce to motrin when I felt that the pain had decreased to where it was managable with motrin rather than do morphine until someone else thought I was finished with it.