arabrab–Try having a C section when the anesthesia doesn’t work right. Can’t move at all so no leaping off the table but–just feel everything and they’re about to cut you open. Can hardly talk. Fortunately it worked out okay and docs figured it out. Twilight Zone moment.
Something someone pointed out earlier that more people need to realize.
– The fact that patients can laugh and interact with others then seemingly collapse into pain doesn’t mean they haven’t been in pain all along and anything has improved in their condition.
I used to think “mom is doing okay” (she had cancer) but when I visited she seemed to .be doing very well. My
dad straightened me out on that score. “She’s ALWAYS fine when you talk or visit. She sucks it up to enjoy the time. So call and visit more and take her mind off her condition. The minute you leave it can be hell again…”
http://www.webmd.com/pain-management/features/pain-medication-addiction?page=2
From another source: don’t confuse dependence with addition.
https://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg9.html
Many people who abuse pain killers did not receive them as a result of a legitimate medical condition, but actually sought them out from friends or family members:
http://www.webmd.com/pain-management/features/prescription-painkiller-addiction-7-myths?page=4
A higher percentage of opiate users who become addicted is noted here, but it is not clear that they are not including physically dependence rather than addicted:
http://www.pbinstitute.com/2-percent-americans-addicted-prescription-painkillers/
This makes sense that someone who looking to abuse a drug for a euphoria effect is much more likely to become addicted to opiates than someone who simply uses it to control pain. That same person would probably easily become addicted to benzos or any other medication or substance with an abuse potential.
I have had three C-sections and a few other minor surgical procedures that required both anesthesia as well as pain killers . My personal experience with an opioid prescribed for post surgical pain really scare me. It of course dulled the pain but the next day when I was still supposed to take it , my body felt like I needed it , but not because of the pain. I wasn’t really that aware of prescription drug dependency at that time, but I know that I was really scared about my body’s reaction to that pill…I took a benydryl , slept it off and it ended there. I didn’t even discuss it with my Dr or even my husband because I felt like I could easily become addicted to the way that made me feel, and there were several more pills in that bottle that I could have taken , despite not actually needing them. My surgery was on a Friday and on Monday I was feeling great and went out to lunch …
I have been prescribed painkillers , opioids for other ailments since and felt somewhat uncomfortable taking them, knowing what I went through with the surgery .
My conditions were temporary and I have no point of reference with dealing with long term scripts for chronic pain.
I don’t think that patients that are being treated for debilitating illnesses should be caught up in the restrictions .
What is the incidence of drug abusers in the general population? About 1 in 12 is an alcohol abuser. So, ballpark, maybe 1 in 8 people is an abuser of some kind of drug. So if I’m a doctor, there’s a significant chance that the person I’m writing the prescription for is a drug abuser.
So let’s say I’m a doctor. I prescribe Oxycontin to 100 patients in a year (I just made that number up). I’ve created three opioid addicts that year.
I can see why doctors would be concerned about addiction. Most people don’t get addicted to opiods, but the ones that do get addicted tend to have terrible problems.
“About 1 in 12 is an alcohol abuser. So, ballpark, maybe 1 in 8 people is an abuser of some kind of drug.”
Are these truly accurate numbers? Seems too high to me. I guess I am fortunate in those I associate with.
I don’t see how physicians who prescribe opioids properly “create addicts.” As recent posts have pointed out, addiction is a complex condition, different from dependence, and many addicts don’t obtain prescription pain meds from an MD. See @Nrdsb4 's post 102 above.
If you’re a doctor who properly prescribes opioids to 100 patients in a year, perhaps you’ve prevented 3, or more than 3, patients from killing themselves in despair over their inability to find relief from pain.
@Nrdsb4 " '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."
This is so true! Ironically, in my experience as a disabled person who has chronic pain, I’d guess that people who don’t have chronic pain are more likely to overestimate how much pain they’re in, simply because they can’t conceive of living like that for an extended period or because they’ve never felt any significant amount of pain before. I tell people that if they were in as much pain as I am in at any given moment, they’d be rushing to the ER wondering if they were dying and begging for relief. I rate my “average” level as a 6/10, but an able bodied person who never lived with this much pain would rate it as an 11/10. (I know that before I became disabled, I would have!)
So what’s the solution? Deny pain relief to the 97 other patients on the possibility that 3 of them become addicted? And that statistic that you mentioned is talking about patients who are put on opioids for chronic conditions. A whole lot of people are getting short term narcotic pain relief prescriptions with no refills for short term problems. The chances that those people get addicted is pretty remote. Yet people on this thread are talking about fear of getting addicted after taking a week or two (or even one or two pills) of narcotics (typically not oxycontin by the way) after a surgery or other procedure. It’s just not that likely. If a patient has an alcohol or other addiction problem (and this question is often asked of patients pre-op or at some point in the provider/patient interaction) and lies to the provider about it, the provider can’t be expected to have an internal lie detector capability.
It’s a problem with no easy answers.
The fact of the matter is that there are no pain medicines, prescription or OTC, which do not have the capability to exact a price of some kind, some minor and some potentially fatal. So what to do for people in pain? You examine risk/benefit. You monitor, you use multiple interventions, not all of them medications. You re-visit when problems arise or results are unsatisfactory.
I keep thinking of The Eagles founder Glenn Frey. He was taking drugs for his rheumatoid arthritis. Most likely it was some form of NSAID and/or steroids. Many people in chronic pain refuse narcotics because of the issues with long term use, not all of them dependence or addiction related. They search for a solution that doesn’t involve chronic opioid ingestion. I happen to be one of those people. I’ve had back and neck problems for decades, and going down that path is not something I ever wanted to do, for my own personal and professional reasons. I’ve used them without reservation for short term issues like after surgery or for painful conditions like gallstones and shingles. But long term, no. My choice and not necessarily the right choice for someone else.
So Glenn Frey apparently paid for this choice with his life, as his RA meds allegedly directly contributed to the development of severe colitis and fatal pneumonia. These are the risks we take when we choose to take medications. I imagine if he had known what was waiting down the road, he might have tried to find a different solution. Very sad deal.
Again, it’s a complex problem with no specific, easy solutions.
Yes, it’s all a balancing act.
I’m probably on the same medicine (or very close) to what Frey was taking. It suppresses your immune system and leaves you vulnerable to infection. After just my first dose, I contracted an URI and was in urgent care for nearly 4 hours on Friday making sure I hadn’t developed pneumonia.
The medicine for my Lupus can cause me to go blind.
But these are the risks we take. It’s a balancing act and frankly, I’d rather let my doctor find that balance than government bureaucrats. But that’s just me…
I had assumed Glenn Frey was using a biologic (rather than NSAIDS or steroids) which suppresses the immune system and allowed the pneumonia to take hold. But he may have had many years of remission from his autoimmune conditions before he got the pneumonia. Let me add that I don’t have any actual knowledge about what drugs he was or wasn’t taking.
How are physicians, nurses, etc. instructed on how to distinguish between addiction-based drug-seeking versus non-addiction-based pain relief needs?
Physicians are instructed to look for cues. It is actually fairly simple to tell the difference. The problem is sometimes you are fooled both ways. For instance, the friday after hours calls, the frequent ER visits rather than doctor appointments, the demanding of only certain meds, the demanding of meds or they will find it on the street threat, the positive drug screen for illicit drugs, the intoxicated individual, the threat that they will kill themselves if they do not get XYZ drug only, these are a few examples of drug seeking. The problem arises when culturally you are not tuned in to requests and pain. Some cultures are so passive about the need for pain meds you could miss the pain problem. Some are so guilt ridden to ask for pain meds that even if you recognize the need they will not take it.
Rheumatoid Arthritis is an autoimmune disease which can be both very painful, disfiguring, and have dangerous systemic complications.
Treatments for it can include:
We don’t know what Glenn Frey took. Probably combinations of all of the above, depending on what stage he was experiencing at any given time.
The point was that no matter the strategy for addressing pain and chronic conditions, there is a price to pay for just about any medication taken, whether it’s an NSAID or biologic, a steroid, or a narcotic.
Frey had still been recently touring, who knows what stresses and what he was exposed to. The web is a great source of info, but we still have to find some perspective in individual cases. Eg, this:
In all the patients that Dr. Ostrowski (Loyola University School of Medicine) has treated, she recalls only two that suffered serious medication side effects.
“For every Glenn Frey, I’ve had 50 to 100 patients whose lives have changed for the better and they are doing well,” she said.
One tip off is the patient who is allergic to every narcotic but Dilaudid, and he demands that you push it “very fast” or it won’t work.
I’m sure the ERs see the frequent flyers, the ones coming in all the time with symptoms of kidney stones, etc. Doctor’s offices will receive multiple calls from a patient stating that he “lost” his pills, they fell into the toilet, someone stole them, the dog ate them, etc.
But what really burns me up is how some nurses decide that someone is a drug seeker because “they watch the clock, and the minute they can have their prn dose, they are on the call bell.” Well, this could actually represent a patient who a)isn’t receiving adequate pain coverage, so he is anxiously awaiting his next allowable dose, or b)he’s not in agony yet, but he’s been told to “stay ahead of the pain,” and he knows that 5 hours after his dose, he’s hurting pretty bad, so he asks for it after 4 hours so that he won’t get behind. Or any number of other valid reasons. Sometimes when a nurse tells me her patient is addicted to narcotics, I’ll respond “yeah, maybe. Or maybe he’s addicted to pain relief.” At any rate, after a patient has had abdominal surgery is not the time to try to “cure” a patient of his narcotic addiction. It’s not our place. We can discuss these issues with a doctor, try to get a referral to a pain specialist, etc., but denying a patient medicine that has been prescribed for them is inappropriate. Some nurses will see a prn order for pain medicine “1-2 tabs q 4 hours prn” and will always give the lower dose, even after it’s been demonstrated that the patient tolerates the drug yet his pain control has been inadequate.
There are all kinds of legitimate reasons why people request pain medicine that have nothing to do with trying to get high. But there is such a stigma about narcotic pain relief that many nurses carry extreme biases about it. I’ve had nurses tell me to my face “Sorry, I just have a problem with narcotics. He can just deal.” The backlash against narcotics is not a good thing imo.
Wow. My daughter is a nurse and just started work in February. She’s in a cardiac care unit so I’m not sure if this is a frequent topic of conversation there but I’m going to ask her about it.
I had a neighbor who was a surgeon and she actually told me, “If a patient doesn’t ask for pain relief, he or she doesn’t need it so I don’t prescribe it and if a patient does ask for pain relief, he or she is a drug seeker and I don’t prescribe it.”