Usually both. Most of the ones I’ve dealt with are quick to get patients started on at least small doses of narcotics, but they also use other modalities like joint injections, physical therapy, and psychologic counseling.
The good ones around here are EXTREMELY strict. There’s a monthly urine drug screen and monthly KASPERs (Kentucky’s narcotic-reporting system). They do occasional “pill counts”, in which a patient is called mid-month to come in that day with their medication to make sure they have as many left as they’re supposed to. It doesn’t take much to get kicked out, but it doesn’t take that much to stay in, either.
By the way, we have four such clinics in my little town. By contrast, we have seven sit-down restaurants.
Necessary evils, IMO. They’ve done wonders for a few of my patients with non-narcotic treatments, but more than anything they’re where I send someone who needs more narcotic than I’m comfortable writing. I could write the narcs just as well myself for appropriate patients, but I don’t have the time or staff to monitor everything properly, especially with the onslaught I’d get once word got out that I was loose with the pain pills. (Word would get out in about fifteen minutes.)
Qadgop, I’m just curious about something you said back at the top of the thread:
I’m wondering why the inadequately treated pain results in nerve remodeling changes.
Is it because the pain causes one to unconsciously favor the affected area, causing atrophy and posture shifts? Or does severe acute pain actually burn out nerves? Or something else?
They gave me Darvocet for a massive dental abscess after they jammed wax in the broken tooth spot without any novocaine or pain relief of any kind (my second abscess in a few months, I’m going through major long-term dental work, and no matter how clean I keep my teeth, they keep getting reinfected). I was in the ER screaming in pain, crying so hard I couldn’t breathe, and that’s what they gave me. It did absolutely nothing. They told me to call my dentist, who wouldn’t touch the tooth because it was in such bad shape I needed an oral surgeon, and the surgeon wouldn’t see me for a month. Oh, and a child’s dose of Penicillin.
I went back a second time a few days later after not being able to eat anything and drink more than water, and they just gave me a second antibiotic.
I get a handful of generic, lowest dose possible Vicodin every month for my endometriosis, and I only got that after almost 10 years of pain and two surgeries that couldn’t get rid of it all.
But I’ve talked to people who got morphine in the ER for a stomachache.
Things like asprin and ibuprofen don’t do anything to the pain in my foot, but Darvocet does. I was taking 100mg doses, about 2 weeks after surgery, and it got rid of pain that was preventing me from sleeping. Same thing now, no side effects. Is it the same stuff as extra strength tylenol? Cuz it certainly doesn’t behave the same.
It probably happens on the molecular level of the nerve fibers involved, involving gate theory and a few other principles that as a generalist I’m no longer up on.
It’s unlikely to involve asymmetric use and posture shifts, although those things do cause acute and chronic pain elsewhere.
And the nerves rarely burn out, they just get re-programmed to send pain messages in response to all sorts of non-painful stimuli.
And darvocet (propoxyphene) is a relatively sh***y pain med, but it is an opiate, so causes some euphoria, and tends to cause habituation and if stopped after habituation occurs, will result in a withdrawal syndrome.
It was also one of my early opiate experiences, back in college. I loved it, after getting it for back pain. I hadn’t known what to expect at all, I thought it was some sort of prescription aspirin. It didn’t take my back pain away very much, but it made me feel wonderful.
It’s also got metabolites that are somewhat toxic to the liver. I’ve had it taken off the formulary in our medical system for the above reasons.
I know that in several cities I have lived in there were shady pain managment clinics and dr feelgoods … I used to live near a clinic in Norfolk VA that had a full on DEA raid once. I got to watch it from a couple of parkinglots away. Fascinating!
