Here is an anxious report from the Journal of Academic Emergency Medicine.
You be the judge
From my perspective, I am not much into hydromorphone (Dilaudid), but it is a very effective opioid pain med.
I use fentanyl and morphine.
Note that the pattern of practice described has eschewed codeine and meperidine (Demoral)–that’s good since they have bad side effect profiles.
So 10 plus years ago the journals and public policy chatterboxes were saying docs don’t treat pain effectively, in adults and children–it’s a scandal.
Well the way to treat serious pain is opioid, hydro and oxy codone orally, fentanyl, morphine.
The treatment of chronic pain is another subject, I am just focusing on the nature of the report.
There is no satisfying the nannies. Now we’re prescribing too much.
Trust me, when you have serious pain hydrocodone (Viocodin, Lortab) work well. Oxycodone (Percocet) is stronger.
Yes there is a problem with habituation and tolerance. Sure there are people who get addicted.
I use opioids in the ED all the time, it’s the right thing to do.
I prescribe small amounts of outpatient opioid for pain for the same reason. Every had a kidney stone, or a tooth abscess–you would know why I do what I do.
As for this report, so, what are they trying to tell us, now we are too concerned about pain, prescribing too much pain med?
What are the alternatives for pain relief? Paracetamol, as it is known in Australia has its side effects, because overdosing causes liver damage.
Then there is Ibuprofen which is supposed to be an anti-inflammatory – well yes it works as an anti-inflammatory but the potential side effects are ignored and there are no warning labels to remind people that ibuprofen (a NSAID) should not be taken on an empty stomach. Overuse of NSAID medication causes bleeding stomach ulcers.
There is another class of drug but it was taken off the market. It was very effective in giving pain relief. It is sad that it is no longer available.
A combination of paracetamol and codeine comes with a warning that it can cause drowsiness… well so does amitriptyline but that also causes weird dreams and other side effects.
Then there are the other pain relievers already mentioned. The issue remains that they are very addictive. When my son smashed both his feet and ankles he found out exactly how addictive such pain relief can be.
Then there is morphine. It has its uses, especially for people who are dying. A word of caution on morphine needs to be sounded, and that is, over medication can have disastrous effects upon a patient, especially when the patient did not need something as strong as morphine in the first place.
Pain medication should not be given lightly and it should be used according to direction. As one who has had issues for a period of more than 30 years, I can speak to some of these medications and the side effects that are hidden from public scrutiny. It is difficult at times not to over-medicate, especially after going through a medical procedure or having a tooth abcess that requires root canal therapy.
As a consumer though, I want to see more caution rather than a relaxation of caution when it comes to prescribing pain medication or approving medication for OTC use. There needs to be more warnings about side effects, especially for Ibuprofen and Paracetamol.
“Where there are no alternatives no values are possible.” One would think that such common sense would easily identify and rectify the current supposed conundrums associated with opioids and other controversial therapies. I for example have never used marijuana because I prize my mind. Someone close to me has tried dozens of medications for pain and the like over the past 20 years and has just found that MJ works better than anything tried to date. This persons alternatives are considerably narrower than mine and I can find no fault in their use of MJ. Those who need opioid therapy are in this same predicament and for the government to assume that denying morphine to someone in pain lessens the impact on some anonymous addict is ridiculous.
To go full conspiracy theorist here, they’ll let you have the pills, but only if you surrender your firearms and then you’ll be entered into the NICS for “mental health” reasons to ensure you don’t purchase a new firearm while under the influence. Of course once you’re off the pills it’ll take some time to be delisted. You’ll have to pass some form of psychological testing and that’s not covered by the health care. Then there’s the fees for handling and storage of your weapons you’ll have to pay to get them back (it wouldn’t be fair to make the tax payers pay for that, now would it?)…
I stopped using codeine 20 plus years ago–patients didn’t like the side effects–mostly GI upset and it didn’t work well.
some of the stories above about what does and doesn’t work are certainly well known to me. hydrocodone is strong stuff oxycodone is stronger, but they work. pain medication for pain is not addicting if used judiciously and for a limited time. tolerance always develops.
Treating pain is what i do–and what i will always do. We sometimes admit for unctontrolled pain. I cannot predict what will happen with totalitarian healthcare on some things mentioned–troublesome.
Just adding my 2 cents worth here (even though the penny has be withdrawn as a currency in Canada!). I had a total knee replacement performed in Toronto. The first thing they put you on is a morphine pump (don’t know what the procedure in the U.S. would be) Why do they use morphine–because is works!You are out of pain for a while,but it has a timer on the release button, so you cannot overdose.
When I had excruciating pain during the hospital recovery you were still able to get an injection.
If I were an M.D. and had patients with terminal illnesses,I would not hesitate to prescribe the strongest possible pain relief medication possible. Who cares about “addiction”, they need end of life comfort.
As a dentist, I very,very rarely prescribe Percodan or Percocet to my patients with abscesses.An antibiotic and acetaminophen with 30 mg. of codeine usually suffices.The secret to get compliance is to only prescribe it for a few days, thus forcing the patient to treat the problem, My younger brother who is an emerg, physician, says that acetaminophen with 30 mg. of codeine is a shitty drug for pain relief, I have to agree: you might get a buzz for only an hour if you take two, but this is probably the way it is prescribed by most dentists.Tommorow is Spring,thank goodness.It has been a very brutal winter here.Looking forward to summer
Good point.
It does seem strange that liberals favor torture over comfort.
You are all missing the point, by writing intelligently and with good intentions.
This is just another setup for Obamacare, so that when they refuse to give you pain medication (unless you fall into certain political elite groups), they will say they are doing it because it is good for you. Go home and suffer – or die – and their statisticians will record your treatment as successful.
I file this one under minor, necessary evil. The common man’s perception of prescription drug abuse is based more on TV dramas than reality. When was the last time you saw a doctor show that didn’t have at least one character that was addicted to pain meds? Most people know that fiction exaggerates, but they often underestimate just how much it exaggerates. When you look at the number of people who abuse prescription opioids compared to the number of people prescribed them, it’s a non-problem. Controls are already in place to catch the few exceptions. Anything more drastic runs the risk of doing more harm than good.
Some people just won’t be satisfied until we live in a perfect world. They’re unwilling to accept that their fictional utopia is unattainable. As a result, they refuse to look at the bigger picture, or contemplate unintended consequences. Their use of the phrase “at all costs” is without hyperbole. They’re willing to inconvenience, or even harm the 99.5% for the sake of the 0.5% they’ve decided to “save”. They place more value on compassion and zeal than on logic and results. They feel that, as long as their heart is in the right place they can do no wrong. They honestly believe the fact that they’re at least trying to “make a difference” makes them better than people who are willing to leave well-enough alone.
Here’s some perspective. In the alarmist article linked below, the “NSDUH estimates about 1.9 million people in the U.S. meet abuse or dependence criteria for prescription opioids.” The same article notes that prescriptions “for opioid analgesics [have risen] from about 75.5 million to 209.5 million.” Even though these numbers were chosen to indicate that there is a problem, it still works out to less than one percent of prescriptions involving addiction. How much are we willing to spend to fix a system that already works more than 99% of the time?
http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse
No link to the report is provided.
Assuming the Journal of Academic Emergency Medicine is not a government operation, I have no problem with their naval gazing.
When my first wife’s cancer got into her brain, Dilaudid gave her relief, from pain beyond our comprehension. I truly hope that bureaucrats don’t force someone else to suffer in the future.
I received oxycodone for a busted ear drum. The only effect I got was pretty pictures. I am not sure that alleviated the pain, but it did give me this fascinating slide show in my head. Maybe that distracted me a little.
They gave me hydrocodone when I broke my leg. I didn’t think that helped much either. The pain subsided just enough to let me sleep. I didn’t think it was that strong.. I didn’t use much of it either and had “leftovers” in my cabinet. I got a bad headache one day. I took the hydrocodone. I will never do that again. With serious pain it didn’t have much of an effect. With not so serious pain it threw me for a loop.
PS The word factitious comes to mind. Good luck with that.
You might be addressing the risk of abuse reasonably. Other doctors are definitely not. When I worked in regulation, I would sometimes observe that it only takes big one screw up to make a set of rules and interpretations to mess it up for everyone. I would suggest that all doctors do a better job voluntarily because it’s in the interest of their patients to address all the risks and to respond when abuse becomes a part of the circumstances. It’s not in the patient’s best interest to hand the state or some other regulatory body an excuse to be the doctor by fiat. I would also say that mandated and subsidized health insurance and a national obsession over “health” will help make the problem worse in a society that has long had the 1950s housewife and her barbiturates.
Having had a ruptured appendix surgery (morphine) and a few abscessed teeth (one that went on for over a week with only Tylenol and penicillin that eventually closed my throat), I get the need to address serious pain. But I have distanced myself from my daughter-in-law and my son who adopted her approach of having a half dozen opioids and other pain pills for various occasions (neck ache here, strained knee there, migraine) on their persons at all times. They, being well employed professionals, never the less base their emotional well being on a collection of pills. After a while, like all addicts, their mind creates the need to take those pills.