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I am laying here, recovering from a surgery yesterday. The doctors made sure that I had pain meds, thank goodness. I don't know what last night would have been like without them; it was rough enough with them.
Just to clarify, I'm not disputing that painkillers have their place and many need them short term. But I don't blame PCP and ER docs for shying away from writing prescriptions, as long as they're willing to make referrals.
Really!
I would disagree with you.
While rolling around and barfing at an out of town hospital on a motorcycle trip, the kidney stone hurt so bad I couldn't get home and they would give me nothing. NOTHING for four hours. Not even an aspirin. Shame on America.
I have had two incidents in my life when pain became unbearable. In both cases I passed out from the pain. The first time I had an opioid injection every 4 hours. I had a 10 minute wait, then 15 minutes of relief and then hours of increasing pain waiting for the next injection. That went on for days. No one seemed to understand. The nurses were sympathetic but the doctors orders stood without change. Years later I had surgery followed by a morphine pump. As far as I could tell the morphine pump was a placebo, but after 4 days I was Ok. A couple of weeks later I suddenly developed intense pain due to intestinal adhesions. By the time I got to the hospital, I could only roll on the floor of the bathroom in intense pain. They did not want to give me pain killers in case I needed surgery. After hours and scans, the pain abated and then sent me home with Tylenol. May they rot!
Personally I believe when you need pain relief it should be available. I do understand that there is an opioid epidemic that has nothing to do with pain. If so why punish those who need help? That will not cure the abuse.
If someone is truly in unbearable, acute pain, narcotics are a great option. Still, they're way too prevalent. This isn't an issue contained to just retirees - one of our local radio programs did a special on local disabled veterans being denied access to narcotics.
I live in an area ravaged by opoids and other pain medications. I've lost at least half a dozen fairly close friends to opoid overdoses, and nearly 10% of my high school class (2004) is dead because of suspected or confirmed drug overdoses.
What ends up happening is most addicts usually did start out with some legitimate need for the narcotics, then it takes over their lives. A friend of mine had a rough pregnancy in her early 20s, got started on narcotics after the delivery to ease the pain, and after many years of addiction, ultimately died from an overdose. My mother fell back in 2007, breaking bones in both feet simultaneously, and had a very difficult time coming off the opoids after the injury. Being in an area with a higher than average rate of manufacturing and mining jobs (physical work), a lot of laborers get broken down at a relatively early age, getting on narcotics, SSI, and "the draw."
Most people on high, consistent narcotic doses are unemployed and unemployable. The narcotics become the focus of their lives, and many formerly decent people commit crimes to either find drugs or money with which to buy them. In some respects, the medical industry is partly to blame, but ultimately it come down to the end user to police their own usage.
No one is trying to "deny granny pain medication," but in some areas, the problem is so bad that being overly restrictive is probably the better policy. If there is a true need for narcotics, they need to be prescribed judiciously, usage monitored closely by the provider, pharmacies, and the patient, and ideally for a short duration.
For anyone interested our country is finally bringing into focus what is needed to address the misinformation about chronic pain and pain management through the use of doctor prescribed opioids:
I've had a couple of surgeries and for each one I was given Oxycontin. All I can say is that medicine was the worst. I would rather deal with the pain. Give me a couple of Tylenol or naproxen any day.
The Oxy gave me hallucinations which were worse than the pain (imho).
But it took a couple of requests from me for them to stop giving it to me.
I've had a couple of surgeries and for each one I was given Oxycontin. All I can say is that medicine was the worst. I would rather deal with the pain. Give me a couple of Tylenol or naproxen any day.
The Oxy gave me hallucinations which were worse than the pain (imho).
But it took a couple of requests from me for them to stop giving it to me.
Same here. I had a septoplasty ("bent nose" surgery) done in my early 20s. I was prescribed Dilaudid. Yes, I was pretty sore, but I had surgery that morning and was up and about that evening. I didn't take any of the narcotics and it wasn't unbearable pain. Of course, I could have taken all the Dilaudid and probably gotten more.
I'm not saying that these medicines shouldn't be prescribed at all - obviously, they are helpful in some cases and for short durations, but I've seen far, far more problems caused by them than solutions.
Just to clarify, I'm not disputing that painkillers have their place and many need them short term. But I don't blame PCP and ER docs for shying away from writing prescriptions, as long as they're willing to make referrals.
The problem is acute pain, as the OP has outlined. I agree that if a PCP is not comfortable managing chronic pain, they absolutely should refer to a pain specialist. But it's going take some time for the patient to get an appointment. In the case of acute pain, if the PCP won't prescribe even a very short course of pain meds, the patient's acute pain is untreated and a pain specialist most likely will not see them on an emergency basis. It's not a workable solution, and untreated acute pain can lead to chronic pain -- not always, of course.
Since the OP went to the ER, he or she could have been given a prescription for a few (and I mean a few) pain pills to tide them over until the personal physician could be consulted. But the pendulum has now swung very, very far in the direction opposite of where we were 10 or so years ago, when the problem was perceived as pain being undertreated.
The problem is acute pain, as the OP has outlined. I agree that if a PCP is not comfortable managing chronic pain, they absolutely should refer to a pain specialist. But it's going take some time for the patient to get an appointment. In the case of acute pain, if the PCP won't prescribe even a very short course of pain meds, the patient's acute pain is untreated and a pain specialist most likely will not see them on an emergency basis. It's not a workable solution, and untreated acute pain can lead to chronic pain -- not always, of course.
Since the OP went to the ER, he or she could have been given a prescription for a few (and I mean a few) pain pills to tide them over until the personal physician could be consulted. But the pendulum has now swung very, very far in the direction opposite of where we were 10 or so years ago, when the problem was perceived as pain being undertreated.
The problem with pain specialists is that, as far as I could find, they are all specialists in muscular or skeletal pain. I went thru a period in my life when I suffered from chronic kidney stones. This was serious crawling-into-the-ER-at-3:00am type pain, happening almost every other month, along with frequent smaller and merely painful stones. The pain specialists I visited kept referring me back to a urologist. My urologist wouldn't give me anything stronger than Tramadol. Even then, he refused to give me enough so that I could keep some handy to take when the pain started; so I wouldn't have to sit in his office in pain all day until I could be "squeezed in" for an emergency appointment. I ended up doing my own shopping for PKs online. I wasn't happy with it, but it was better than the alternative. Fortunately the stones have abated, since getting PKs online is considerably harder today than it was a few years ago.
I am sorry that so many people have trouble with addiction to opioids. But their problems are simply not a reason why I or anyone else who is capable or controlling themselves should have to endure excruciating pain. Isn't that why these medicines were developed in the first place? And whatever happened to personal freedom/responsibility? This is the same argument we often hear with respect to other potentially useful or enjoyable but hazardous things in our society -- some people can't handle it, so we shouldn't have it either.
Last edited by CapnTrips; 05-05-2017 at 10:00 AM..
The new reality......if you need pain meds it is time to look to the streets, find yourself a dealer, hope the pills you get are legit and you don't get caught. This new draconian approach to pain killers is just going to up the demand for backstreet drugs.
Exactly. Heroin deaths are already up 34% from previous rates. I don't know how many of those are young people unable to obtain the pills from their parents' med cabinets anymore but I'll bet a good percentage of them are people including retiress who live with constant pain. Advocates who decry this new policy from the FDA (which mandates 1/3 cut in manufacturing of opioids this year--and more to come, you can bet) have evidence chronic pain patients being turned away from their physicians are increasingly either turning to the streets or ending their lives. Suicides among the elderly are skyrocketing
Quote:
Suicide rates among middle-aged Americans have risen sharply in the past decade, prompting concern that a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm.
The scary thing is that there is a good likelihood these meds, if they are not made outright illegal, will have their production restricted so greatly that there will be none available for legitimate use, even to hospice patients. I am terrified if I get cancer I will die screaming in agony. Of course I'd always planned on utilizing Oregon's Death with Dignity benefit anyway the moment I got the diagnosis to offset the possibility I wouldn't be able to obtain morphine for the pain and fortunately in Oregon and Washington they use strong hypnotics instead of opioid analgesics, but several high-profile executions in Arkansas recently were called off because the same barbituate Arkansas uses for lethal injection expired and the state couldn't get more because of low supplies. That too is a worry.
The strategy for me anyway would have a plan A, a plan B and a plan C.
Plan B would be to move to Europe since I have the financial means and since they are much more practical over there about pain management and practical matters. They also don't have the religious bias against assisted suicide since they are a secular nation.
I'd flee to Mexico but believe it or not there are absolutely no painkillers made available there even for operations and dental work. If a patient has an operation he is given strong NSAIDS to deal with the pain. The statistic is that 100 million Americans live with some form of pain. Granted much of it can be dealt with by OTC but for many elderly who have age-related conditions such as rheumatoid arthritis, herniated discs, sciatica and such it's a scary new world out there.
I wonder how the FDA will react when the number of suicides among the chronic pain sufferers and overdoses of heroin quadruple against the number of kids who buy the opioids on the street.
Quote:
Originally Posted by jrkliny
I have had two incidents in my life when pain became unbearable. In both cases I passed out from the pain. The first time I had an opioid injection every 4 hours. I had a 10 minute wait, then 15 minutes of relief and then hours of increasing pain waiting for the next injection. That went on for days. No one seemed to understand. The nurses were sympathetic but the doctors orders stood without change. Years later I had surgery followed by a morphine pump. As far as I could tell the morphine pump was a placebo, but after 4 days I was Ok. A couple of weeks later I suddenly developed intense pain due to intestinal adhesions. By the time I got to the hospital, I could only roll on the floor of the bathroom in intense pain. They did not want to give me pain killers in case I needed surgery. After hours and scans, the pain abated and then sent me home with Tylenol. May they rot!
Personally I believe when you need pain relief it should be available. I do understand that there is an opioid epidemic that has nothing to do with pain. If so why punish those who need help? That will not cure the abuse.
^^^^ THIS! Why punish the people who legitimately need them. The FDA just took a one-approach solution to the problem that dragged all the legitimate pain sufferers into the net. First of all, any gray-haired person who is retired should immediately eliminate 75% of suspicion in Dr's minds because the vast majority of retirees are not addicts looking for a high. We've gotten past all that. All we want is to spend our few remaining years in comfort free from pain but the government has robbed us of even looking forward to that. I don't know how this will end. I know it will get much worse before it gets better, if it does get better. People wracked in pain cannot leave their homes to attend protests because they are bedridden and couch-ridden, therefore they have no voice in pressuring the Feds to exempt them from the rules obviously designed to stop young people from abusing opioids. But young people will always have the wherewithal to get them on the streets, whereas old people won't, That's the tragedy: the idea that an old person has to turn to a dealer to get something to make his/her life a little more bearable because of their government's heartlessness.
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