Pain is really tricky. When it robs you of sleep and makes concentration tough it seems to be the only thing you can focus on. It’s unfortunate that Western medicine traditionally has not embraced pain management strategies more holistically, including physical manipulation, physical therapy, eastern complementary and alternative treatments, AND medications.
My H has found great benefit in manipulation, PT and assorted hand held massagers. They sure beat surgery for him and allow him to function with fewer pain Rx.
Pain management is not as well understood and treated as desirable, sadly.
I remember reading Keith Richards’ autobiography and how much trouble he had with painkillers that he was given after suffering a head injury a few years ago. He didn’t realize they were opioids but his body sure did. It seems like a better question and answer protocol would be helpful in this situation.
I would also be careful with OTC pain meds. I remember hearing about a football player who was worried about addiction after an ankle surgery so, on the advice of his doctor and of the manufacturers, he took regular doses of Advil for months. He ended up on dialysis.
Yes, OTC meds are NOT innocuous. Taking anything daily for years (or shorter) can cause some serious damage.
I know someone who has to be very careful not to cause further liver damage from the damage she got by combining some Tylenol with a combo OTC Med that also had Tylenol.
My daily Zyrtec caused me an annoying chronic cough for years that I have only recently been able to get rid of, after carefully weaning myself from Zyrtec. My niece can’t get off Zyrtec, despite many attempts.
Note that some common prescription opioids are mixed with acetaminophen (the active ingredient in Tylenol). So pay attention to the dose of acetaminophen when using prescription opioids to avoid going over the dose limit for acetaminophen when also taking other drugs containing acetaminophen.
Vicodin includes hydrocodone and acetaminophen.
Percocet includes oxycodone and acetaminophen.
Maybe not prove 100%, but again, when I was in hospice, we were trained to look for non-verbal signs of pain in people who were determined ‘not to become a drug addict’ (yea, we’re usually talking about people in their 80s and 90s who have a few weeks left to live, and they’re worrying about becoming a drug addict!). People in pain usually have elevated heart rates, elevated blood pressure, elevated respiratory rate, exhibit guarding, and show signs of agitation. So even though grandma may be saying she’s not in pain, a good clinician will be able to tell by looking for other signs.
As for pain meds, I’m a middle of the roader - I think several dozen pills after wisdom teeth extraction is overkill. If someone is still having severe pain more than a few days after this, then they need to be seen by their oral surgeon, not just be given more narcotics. However, a couple of years ago, when I had my hysterectomy, I was offered narcotics, which never go well for me when I have an empty stomach, and well, when you have a hysterectomy, you practically do the same bowel prep you do for a colonoscopy, so there’s nothing in your stomach to coat it. And you just have no appetite. And narcotics have a way of slowing things down in your digestive system that you don’t want slowed down, which create a whole 'nother problem, especially if you’ve had abdominal surgery. So I took my Tramadol for about three days, then switched to alternating Tylenol and Advil, and did fine. I also have a belief that pain is sometimes our body’s way of telling us we need to slow down, and it’s not always good to cover up pain… it can be informative. If I have aggravated or injured a muscle doing something, but am going to the gym to work out, I don’t want to mask the pain with drugs and do something to further aggravate an injured muscle. Same thing with post-surgery… I don’t want to mask the pain too much and overdo things, leading to complications. So there’s a fine line between getting pain relief so you can get up and down from the couch/bed enough so you’re not completely immobile, and making it all disappear so you don’t feel anything.
I think a lot of this discussion needs to be parsed out into categories of why people have been prescribed the pain meds in the first place. There is no ‘one-rule-fits-all’ when it comes to the prescribing and taking of pain meds. People on either extreme of the debate (take none at all, or find a doctor who will write almost endless supplies) are not doing themselves any favors.
I work with seniors and a surprising number of them tell me that they hesitated to take prescription pain meds after a KNEE REPLACEMENT, for God’s sake, because of their fear of addiction. If I can pick one procedure to avoid in my older age, I pick knee replacement - by most accounts I’ve heard, the recovery period is agonizing. But maybe those accounts are due, in part, to patients trying to white-knuckle through without proper pain management.
I don’t know if @Nrdsb4 or any of the other health professionals on this thread could weigh in on the idea of pain “getting ahead” of the patient - in other words, becoming more intractable and difficult to deal with when the patient decides to wait until it gets really bad (whatever that is) before taking their prescription meds.
Common sense isn’t all that common but I do think some of that could carry us through this crisis. No one needs 50 Vicodin immediately after a tooth extraction; people DO need prescription pain meds for many legitimate reasons and I don’t want to see their suffering increased in an effort to decrease prescription painkiller/heroin addiction.
I don’t know about these patients, but some of the older generation patients we would see refused pain meds because their religion taught them that suffering is redemptive. It would break their adult kids’ hearts to see their parents suffer because of this. So while we may be seeing a generation of people who are milking the system to get more narcotics, there are plenty who really need them and won’t take them. Health care professionals need to be prepared to work with people on both sides.
Thank you oldmom4896, I had read that article and was just looking for it. People with chronic pain are put in a bind because they are not exempt from the new regulations but they need relief to function and work. The article focuses on people who may have sciatica or stenosis of the spine but still have to chop wood for heat in the winter or drive a truck or whatever.
And there’s this from last month (the comments are quite illuminating):
Something that people in health care often forget or just refuse to take into consideration:
People in acute pain will display physical symptoms of pain, such as increased heart rate, blood pressure, diaphoresis, etc. However, those criteria cannot necessarily be extrapolated to people with chronic pain syndromes. They may no longer display those symptoms over time, so looking for those and making judgments about the patient when they are absent is INAPPROPRIATE. But still standard of practice in the industry for many nurses. My nursing forum is full of threads about patients and their “fake pain” and how disgusted nurses get with these patients. “She claims she has 10/10 pain, but she was SLEEPING 10 minutes before that!” “She was laughing and carrying on with her friends on the phone, then tells me she has 8/10 pain! BS!” Fact of the matter is that people who have coped with pain for years have been able to keep on living, laughing, and sleeping in spite of their severe pain. I don’t know if nursing schools are not teaching these people about the differences in vital signs, observable physical symptoms, and affect between patients in acute or chronic pain, but it’s pretty sad how much judgment there is towards patients who ask for (and are entitled to) the pain meds that their doctors have ordered for them. I mentioned earlier the passive aggressive tactics nurses will use to avoid “rewarding drug seeking behavior.” It’s rampant and becoming a problem all its own imo.
This is not to say that nurses don’t also run into patients who actually are addicted to pain meds when they really are no longer indicated or are just already maxed out in terms of their benefit. Frustrating, I’m sure, particularly given that nurses are often assigned too many patients nowadays (another thread all its own). But I think there is a huge over reaction going on in the industry. Just as lay people overestimate the addiction potential of narcotics, so do professionals who should know better.
@frazzled1, Yes, particularly with postop pain, if you try to be stoic and hold off on pain meds, the pain may get so severe that the prescribed dose won’t be enough to relieve the pain. Also, pain meds should be taken in anticipation of things like physical therapy, deep breathing exercises, etc. A patient in pain won’t be able to participate as fully in important activities such as therapy, walking in the hallway, deep breathing and coughing, etc., and failure to participate in those important activities can lead to complications.
Pain management is so tricky because it can vary so much from individual to individual. I’ve always had issues with anesthesia, for example, just not really working for me like it does for others. I almost always need more. I will tell medical professionals about it ahead of time and sometimes they just don’t take it seriously. An example is getting an outpatient medical procedure done and fainting from pain despite trying to tell them what I was feeling during the process and them insisting I shouldn’t be feeling that much pain, not something you want to happen when long needles are being stuck into your back. Or, they try to tell me I have a low pain threshold (which might be also true) despite published research showing that certain genetics can require different levels of anesthesia.
I had a jerk of an endodontist who insisted that I couldn’t possibly be feeling pain during a root canal that hurt so much I was trying to scream – not so easy with a dental dam in place. That experience left me fearing dental pain so much that any trip to the dentist required great willpower and Lamaze breathing. Meanwhile, my husband gets smallish cavities filled with no anesthesia. He’d rather a little discomfort during the procedure than the needles and feeling numb.
I have a friend like that. She needed an emergency root canal and I took her to someone we were both unfamiliar with because he had an opening. He didn’t believe her when she said she would need extra medication. Who wants more novocaine anyway? It was horrible.
I need a lot of anesthetic during dental work and I also have the tendency to feel like I’m going to faint sometime during the first few minutes after it’s injected. It’s good that I’m lying down when this happens.
Post 86-- I used to be in charge of pain pumps in the hospital which were used post surgically. They were wonderful if correctly used. We taught each patient how to use it emphasizing the need to STAY out of pain.
Pain pumps work by using very low doses of injectable meds on a very frequent basis.rather than a normally higher prescribed dose on a longer frequency basis. And the patient was in charge so no waiting, not the nurse. But no heroics.
The initial dose of narcotic had to relieve the pain. So it’s a strong dose and should never be less than adequate pain relief (many nurses wanted to give less). There is no “catch-up” in pain relief. If the dosing and frequency was correct someone looking at it might say “that’s too much!!!” But it wasn’t and never was.
In practice (and there were many studies which led to the pumps use), patients used LESS narcotics (some MUCH less) than those subject to asking the nurse for pain relief. It just takes a lot more medication to get out of pain than maintain a comfort level. And putting the patient in control is a big factor.
They were able to maintain pain to a comfort level dictated by them, receive it immediately (we taught how long it takes before expecting relief), and when to anticipate pain–waking in the morning after a long period or getting out of bed for example. The problem was never someone who wanted to push the button all the time it was patients who were “stoic”. We had a lot of patients who never pushed the pain button at all but were extremely happy to have it available–“just having it in my hand makes me feel better. I know I can get it when I want and don’t have to ask which makes me feel better.” Fear of pain without ability to get relief makes pain worse.
Yes, after I had each baby, the nurse had to remind me to stay ahead of the pain, so that lower doses taken in advance would keep things much better tolerated. It worked. I have a very very high pain threshold, but once it’s passed, it is very hard to get any relief.
@gouf78 I’m a big believer in the patient controlled pain pumps the 2 times I’ve had one although I had a hiccup with one about 8 hours post C-section. Despite hitting the pump, the pain kept getting worse and the nurse kept poo-pooing it. It took a change in shifts and a new nurse to figure out that the delivery tube had disconnected from where they had placed the epidural. Turns out I’d not been getting any relief for several hours. That sure sucked!
How long does it take to get dependent on Percocet?
I can’t find much so take this info for what its worth. But it makes sense which is why I’m going to go ahead and post it.
Most of the websites I could find with this question are anecdotal forums with little input but one site (an addiction blog) mentioned 2 weeks to a month of daily use and that many people say at least over a month of daily use (but no dosages listed) to become dependent (meaning you could have withdrawal symptoms if you stop the drug).
If one uses the drug to get high (versus its intended use as pain relief) then addiction can occur on the earlier side (maybe two weeks) of daily (and probably higher use).