I’ll personally never quite forgive my LASIK surgery people, because while on the whole they were fantastic (Emory, I’d never go anywhere else), when telling me about post-op discomfort they said “It’s like a dry contact, most people don’t even fill this prescription we’re going to give you.” So I didn’t fill the prescription. And, I mean, sure it wasn’t the worst pain I’ve ever in my life felt, but it was like a dry contact that didn’t go away for a bit less than a day and I definately needed the pills. My mom had to run out and get them for me.
Special place in hell for the dentists, who always say “You’ll feel a little tingle” for the horrible nothing-else-like-it sensation of the novocaine needle. I would always rather be prepared for whatever level of pain is expected for a given procedure.
[nitpick]Nurses don’t “prescribe” aspirin or anything else. They can only follow the doctor’s orders. I feel it’s important to clarify that so you don’t blame the nurses too much.[/nitpick]
The doctor’s orders with regard to pain meds often allow the heavy-duty opiates ONLY if the patient verbalizes pain above a certain level on the 1-10 scale, and anything lower just gets aspirin or Tylenol. It’s possible that your wife’s doctor ordered morphine if her pain was 7 or greater. Trust me, opiates are nothing to take lightly.
And NOT giving opiates for significant acute pain (especially traumatic and postoperative pain) is far more fraught with danger of resulting in long-term chronic pain issues than giving an occasional opiate when NSAIDS or APAP might have sufficed.
IME, opiates are not dispensed often enough for acute pain, and far too often for chronic pain.
And Jackmannii hits the nail on the head when he states that local anesthesia does not hurt as much as just going ahead and doing the procedure. I would like to strangle a few idiot colleagues who don’t bother with locals for seriously painful procedures. If they’re right, they should have their vasectomies done without the benefit of locals!
Are you saying that not treating acute pain with opiates can cause chronic pain? Seriously, I’m asking. That’s very interesting, and I can bring that up at school.
Fair enough. They gave her aspirin because the doctor told them to give her that if she wasn’t in very much pain, but that if there was a lot of pain, give her morphine.
On one hand, the dentist was misleading you if “he” implied there would not be a chance of significant pain. Obviously, there was a lot. If he prescribed a bottle of Vicodan, he knew this to be a possibility.
But pain is hard to predict. I do a lot of minor procedures (and almost always use local). Some people go nuts when you clean their wound with a little chlorhexidine, most do not. When people ask if the disinfectant is painful, I tell them that some people find it painful.
I haven’t heard of the “mod 10 pain score” of DoctorJ but it is true. The 10/10 pain people tend to be melodramatic. That said, I think the pain score is largely only significant for large changes in pain (e.g. reduction of 50% or more). Deciding to use morphine based on a 6 vs. a 7 is foolish, however. Plenty of folks are stoic and play down their pain, and really you can’t tell how much pain someone is in.
Qadgop is saying some chronic pain syndromes are caused by insufficiently treated acute pain, yes.
OTOH, if going to work on a certain day is very important, I would not schedule a medical procedure the day before. :dubious:
That is absolute crap. If a doctor told me that a procedure might result in anything from mild discomfort to excruciating pain, i’d hope for the former and try to prepare myself for the latter.
And if i were lucky enough to get only mild discomfort, i wouldn’t blow it up into excruciating pain out of some psychological self-fulfilling prophecy.
I’m glad that at least one medical professional in this thread believes in being honest with his patients, rather than treating them like a bunch of psychologically-crippled hypochondriacs.
Yep. Severe acute pain that is not adequately treated (with topicals, or NSAIDS, or even opiates, whatever works) can lead to permanent changes in nerves which results in chronic neuropathic pain.
Note that it can lead to this, but doesn’t always. Unfortunately, it leads to it often enough to be a significant problem. That’s why I just gave a guy some vicodin for acute localized Herpes Zoster pain, in hopes of avoiding a post-herpetic neuralgia. Ibuprofen just wasn’t cutting it for him.
And we had a thread running a few days ago about the problems of treating chronic neuropathic pain.
Over the years I’ve had my share of surgical experiences. In my observation, at least our local hospitals and doctors are getting much better about meds for pain relief. I think they have come to realize that people get better faster if they are not tensed up with pain, or the fear of pain. In my most recent experience, they told me that they expected some degree or other of post-op pain, and to ask for the meds when the pain was starting, rather than waiting until it was excruciating.
On the pain meds prescription: In my house, the policy is if a doctor gives you a prescription for pain meds, fill it. First of all, you may need it, and if/when you do it will most likely be at 2 a.m. when the drugstore is closed. Second, if you end up not needing it now, there may come a time later when you do need it until you can get to the doctor. Yes, I know that latter is not really kosher, but we know ourselves, we’re not abusing the stuff, and if it gets old we dispose of it.
In the same vein, I once sat in an urgent care clinic with blood and pus running out of my ear. The doctor prescribed antibiotics, but when i hestiantly brought up pain issues, he told me advil. Big weenie that I was, I didn’t push the issue because he was a strange doctor andI was a college student and I didn’t want to look like a druggie. Now, it was my responsibility to push the issue and I should have–I would, now. But that man could have helped me avoid 24 of the most excruciating hours of my life if he’d had the insight to realize that I was downplaying the pain.
Dentist just didn’t register on my radar of things I need sick leave for. The only day they had was monday, and when i asked if I’d be able to go to work on Tuesday, they said yes. If I can’t trust my doctor to answer the question of “How much time will I need to recover?” who can I trust? If I’d popped into GQ and sent the query out for say, yourself or Qadgop of “I’m having X done, how much will it hurt?” it would have been shut down in a HEARTBEAT by a mod admonishing me to ask my Doctor. Well, I did, and this is what I got.
If I’d gotten an honest answer, I’d have tried for a different appointment, or arranged for someone to cover my desk at work and put in for a day off. The time to tell me that being in severe pain & not ebing able to open my mouth was “not abnormal” was NOT tuesday morning when I call you sobbing afraid I have dry socket or a bone infection or something. It caused my needless fear, and made me look like an idiot at my workplace. ALL he had to say on monday before I had the procedure when I mentioned work was, “There’s a possibility you’d be more comfortable at home.”
Yeah, now I know to take that stuff with a grain of salt, but how much salt? How do I know what pain in worrisome and what is normal? How do I alot my sick time if there’s no where to get an honest answer?
The medic I worked with a few months ago at a summer camp would tell kids it would.
“Will it hurt???”
“Oh, yeah it will! I hurts like a you-know what”. He would say this no matter how much it actually would hurt (he wasn’t doing surgery, so the potential for extreme pain was limited). The kids always cheered up because it never hurt that much, and they felt like they were more manly for having endured it.
Years ago, when my now-grown-up daughter had to get a blood test for mono, the doctor told her, “This is going to hurt. You may yell and scream all you want, and you can sit on your mom’s lap, but you must not move your arm, because we don’t want this needle to break.” Well, she did yell bloody murder, but she also kept the arm still and it was over fairly quickly. If they had told her it would only hurt a little bit, she’d likely have flailed about, with awful results.
You wouldn’t…others would. Unfortunately, we live in a litigious society, and giving someone unnecessary opiates opens up a whole 'nother can of worms.
It’s unquestionable truth that people’s pain experience varies. One person’s 10 might be another’s 4. Doctors and nurses can’t read anyone’s mind, so that’s where the 1-10 pain scale comes in, and it’s wide open for subjectivity. Some will exaggerate so they can get high for the sake of getting high, others would rather grit their teeth and bear it. But as long as the patient’s self-assessment can be documented, everyone’s covered. If the standing orders specify morphine or whatever if the patient’s pain is 7 or greater, and she verbalizes 6, no nurse is going to say “Only 6? Are you sure? Could it be 7? Come on, say 7 and you can get a nice high.”
Anyway, I’m just telling you what I’ve been taught. Don’t shoot the messenger.
Qadgop, it’s not that I doubt you - I don’t - but do you have any cites I can present? I’m sure it won’t change what’s “officially” taught at my school, let alone any doctor’s habits, but it’s worth bringing up.
Because YOU know how much pain the patient is really in, right? You can tell by looking at them. After all, it is not like pain is an internal freakin’ sensation, is it? That varies by individual, even for the same injury/surgery/procedure/whatever the cause? But you know better than the person actually experiencing the pain.
I hate, hate, hate this attitude. You don’t know how much pain anyone is in, and in the absence of clear proof (selling their meds, for example) you shouldn’t assume someone is lying when they tell you their pain is bad. I hate it when patients give a 12/10 type of response, but they do it because of doctors like you. They have learned that you will downgrade their numbers, so they give you higher ones. You, buddy, are making it worse.
Why do most doctors (I have worked with enough to know you , not QTM, are in the majority) have this stupid attitude about pain? There is ample literature out there about the undertreatment of pain, about how undertreating acute pain leads to chronic pain, about how suspecting everyone of exaggerating pain is NOT conducive to good medicine, but do most doctors know this literature? Act on it? Hell, no. Apparently the good old boys require that you be a hard ass about pain meds, so most doctors toe that line.
I was thinking about this, and one of the things that drives me crazy is, as I’ve said, I have somewhat chronic pain. One of the most important things about managing it without being always doped up is knowing it-- how the pain grows, where the peak is and how to slowly work my way back down. It makes it managable and keeps me sane. Not knowing what to expect from this makes it hard to handle.
I also hate that so few doctors want to discuss the options that exist between tylenol and opiates. Just because I say “NSAIDs aren’t helping, what can I do?” doesn’t automatically make me a drug seeker. I stumbled around for years before I finally found a neurologist that said, “Look, it really stinks how much you hurt, but you can’t spend your life chained to a bottle of darvocet. You’ll probably have to live the rest of your life with this pain, so I’m going to teach you how to manage it and still go on with your day to day.” It was eye-opening, and life changing. (She was also one of the few doctors who said “pain”-- though if you can look a migraine sufferer in the eye and call that headache that had them laying on the floor of a public bathroom vomiting and screaming “discomort” you probably should be beaten with your stethescope)
Licentious Ectomorph start with Margo McCaffery’s Pain: Clinical Manual . It is a fantastic manual that includes much better pain assessment tools than the 1-10 scale, handouts to copy for patients, and the latest research. They have it on Amazon used for $36. It will be the best $36 you ever spend on a professional book.
Pain is a pretty subjective thing - obviously “some discomfort” is useful only when talking about getting your legs waxed, or something similar, but I’m not sure telling someone that something is going to hurt like a sonofabitch and you’re gonna wish you were dead is particularly helpful either.
OP - if the dentist had said “You’re going to need a bottle of Vicoden and to take a week off work” would you have had the procedure? Many people probably wouldn’t.
Personally, I have really limited experience of pain - I don’t feel minor cuts, bruises or burns at all, and have had oral surgery, and whatnot and experienced what most people would probably described as “some discomfort”. I’m one of those freeky people that dentists and doctors wish that all their patients were like.
All this is completely irrelevant to the issue raised by the OP. The OP was not asking for more drugs. In fact, the OP already had vicodin.
What the OP was asking for, and what i was supporting, is simply greater honesty from health professionals in letting their patients know how much pain they might expect to experience after a procedure. If there’s a good possibility that the patient will spend the next two or three days in severe pain, the ferchissakes tell them that, rather than describing it as “some discomfort.”
This simple level of communication is completely separate from any question of a physician’s responsibilty in prescribing opiates.
