What treatments for dealing with postoperative pain would not require having narcotics laying around in pill form or any other easily abused form? For example, is there such a thing as time release shots or little dissolvable implants? I’m looking for something with zero abuse potential.
No medical advice, please - I’m looking for things to ask a doctor about.
Thanks!
You might look into the patches. It depends on what your exact concerns for abuse are.
Fentanyl is the brand name that I’m familiar with.
There are also self-dosing pumps that have pre-set limits. Again, depends on what you’re worried about.
You should also ask about being referred to a Pain Medicine specialist. They can provide other (non-drug) treatment options, also.
My first thought was a Fentanyl patch too…but it is narcotic and has aduse potential, so I suppose that won’t work.
I believe you can buy them in a single-dose patch at a time, though.
Speaking as a physician who regularly treats folks for all kinds of pain and really, really avoids using opiates when possible:
Basic post-op pain control principles: Ice (if okayed by your surgeon) and elevation, alternating use of non-narcotic meds like acetaminophen and/or ibuprofen or similar NSAIDS, fixed dosing of those meds to stay ahead of the pain, relaxation techniques, meditation techniques, interactions with supportive friends, distractions like TV, video games, or whatever floats your boat, etc. Topical analgesics might be of limited benefit, if you’re not putting the stuff onto a surgical or other wound.
Okay, that’s the easy stuff.
I encourage even my recovering opiate addict patients to consider using opiates for significant post-op pain. If one has had a femur fracture stabilized surgically with hardware, or had their abdominal organs forcibly restructured, there is really no better pain reliever than opiates. To fail to use opiates appropriately for significant acute pain may end up resulting in chronic pain due to nerve remodeling.
For such patients, I also recommend arranging for someone else to be in charge of the pain meds, and to work closely with the surgeon to ensure everyone’s aware that dosing needs to be appropriate.
I don’t typically involve pain specialists for treatment of significant short term acute pain, unless it’s a situation where there are going to be multiple surgeries or other painful procedures.
Ah, hadn’t thought of that. Everyone I know that’s doing pain meds is in a chronic situation*.
And yes, the most popular option so far is simply having someone else control access to the meds. Whether that’s handing out each dose, or giving a limited number of doses and saying “don’t call me until X, you can’t have more 'til then”. Again, depends on the person and situation.
Clarification: the people I know are the ones handing out the meds, not the ones taking them. It’s weird bossing your parental units around, lemme tell ya.
There are time-released opiates - MS Contin is one brand of morphine. I don’t know for sure, but I doubt it is viewed as desirable by those who abuse drugs. It’s a twice-a-day capsule. However, you would still want something on hand for acute episodes of breakthrough pain.
mmm
I’m living with a pill addict who is trying to stay clean and so far apparently succeeding, though still shaky and feeling some physical symptoms. I know I could have tempting pills here that are under lock and key, but what I would really like to do is not provide any triggers or make it any harder. It would be pretty shabby to be baking cinnamon rolls at the fat farm, whether or not I could keep them locked up.
In my estimate of the situation, opiate pills would be a trigger, and also my mere presence might be if an experienced addict can tell I’m taking them. Perhaps, anything with an abuse potential might be a bit of a trigger. I’m almost as much concerned about making this more unpleasant for the addict as I am about the possibility of triggering a use.
Quadgop, your basic principles sound good. Got any more tricks up your long white sleeve? Or any other things I ought to consider?
Not that I am expert in these things, or want to know as much as I already do, but I think these are popular for abuse. I think they chew them up, or grind them, or something. Though I might be confusing this with some other…
Where can I learn more about these two concepts? Thanks!
To address the bolded part as a physician and as a recovering opiate addict (clean and sober over 21 years now), let me say this: Do NOT sacrifice your own needs for the addict. Don’t leave the pills under his nose, but don’t feel you must forego adequate pain relief to keep from threatening his recovery. It’s his recovery, he’s not going to live in a bubble where he’s kept completely safe from risk. He needs to devise a plan for how to deal with someone else’s legitimate and necessary use of opiates. That may mean co-operating with you in a plan to keep him away from your medications. I’ve done that when my wife had surgery in our early days of my recovery.
Any addict needs to learn the ways of keeping him or herself safe in a risky world. Expecting loved ones to have surgery without opiates is not a reasonable strategy.
I apologize for the hijack, but I’d also like to know about this. Googling the phrase “nerve remodeling” doesn’t bring up anything written in laymen’s terms. Does chronic pain somehow affect axon regeneration or growth? What are the mechanisms involved?
Thank you for your attention to the bolded part. I feel a little cheap, now, without remarking that the addict has told me I absolutely should take care of my pain without regard to her situation. She explicitly does NOT expect me to go without. Making this part easier on her is MY idea. I’m hoping there are approaches that cover both issues, or at least that I can make things even slightly less troublesome for her and still acceptable to me, if I try. She seems to be doing well in HER struggle today, as with the past dozen days, one at a time. If I can help in any minor way I want to.
And thanks for the reminder not to sacrifice myself. I can use that!
Lockbox. Keep the key on a bracelet that you cover with an ace bandage. Lock your meds up so whomever can not access them. Handcuff the lockbox to the leg of your bed. tie bells to it so it makes noise if someone rattles it.
Or you could leave the majority of your meds with a friend to bring over the days dosages every morning on their way to work.
Why yes, I did have a roomie stealing my meds back when I screwed my back up and first got home.:rolleyes:
While it’s true you can’t live in a bubble, depending on the stage of recovery that may be the best option for the addict.
Think of it as being the only fat person in a household of thin people, who keep telling you it’s their right to bring chocolate cake into the house and only eat one crumb of it.
And then at night that delicious chocolate cake is calling the fat guy, ‘eat me I’m so delicious.’
I think it’s very nice of the original poster to show so much concern for their friend. Not many of us would do that in face of pain.
I agree you shouldn’t sacrifice your recover, but it’s a tightrope.
On one hand you don’t want to put temptation in reach of someone, but it could be insulting to say, ‘I am not going to take pain pills, coz you’re too weak willed.’
Addicts have little enough self respect as it is
My wife has had some significant surgeries on her feet. One doctor paired pills with an electrical stimulator. Basically, electrical pads that would go on specific spots around the ankle. The doctor claimed the electrical stimulation would block the pain nerves and reduce the need for medication. My wife says that it did nothing but tingle and annoy her, and the need for pills was basically the same as for similar surgeries where she didn’t have an electrical device.
Until Quadgop comes back and explains this better:
Recent research over the last decade or so has shown that if after a big trauma - an accident or an operation - a big pain exists and isn’t immediatly adressed with chemical means, then a feedback loop can start that will keep on even after the initial pain response from the damaged cells is gone because the cells are repaired, because the loop has become embedded between the spinal and the brain.
So it’s not a literal nerve remodeling that the growth of the nerve routes is different, but rather the route through the nerves is remodelded.
The research has brought about both a 180 degree turn in dealing with pain - previously, many doctors were worried about bringing on the heavy stuff because of addiction; now they want to kill the pain first before it sets; and even old people with short life expectation get heavy duty - and established “dealing with pain” as its own specialty field, so if after an accident, a disease or surgery somebody has pain that normal methods can’t deal with, the specialist is called in early to try the more exotic methods.
Oh, the OP could also look into acupuncture. I know that nobody on the Dope believes in acupuncture; but three of the big German public health insurances did a voluntary study for chronic disease patients taking pain medication. The groups with acupuncture and pills used less pills than before.
I don’t know if you can get the same level of certification and training that acknowledged acupuncturists in Germany must go through in the US, though.
Starting point on wiki about pain undertreatment
THANK YOU! I appreciate all the helpful posts, and I especially appreciate this one for so perfectly understanding the whole situation as I understand it.
There is a great deal of useful stuff here. Keep 'em coming, folks! I think this will be at least noticeably helpful and possibly extremely so.
My surgeon is suggesting the following:
Nucynta (tapentadol)
Ultram or Tramal (tramadol)
Toradol or Sprix (ketorolac)
I’m finding stuff about them on the Web. Does anybody have any suggestions? My surgery is pretty humdrum, to remove calcium buildup in a tendon in my shoulder.
Thanks!