Posted on 07/13/2019 5:27:23 AM PDT by GailA
Burn patients have acute pain, not chronic pain. Surgical patients have acute pain, not chronic pain. People treated appropriately with narcotics usually have no problem with addiction because they have a desire to “return to health” and don’t really notice the euphoric affects because they are temporarily living a very disturbed life, trying to sleep in the hospital, etc. I remember well a patient I helped care for who had burning pain on half of her body after a stroke. 24/7 for years. She was on 400 mg of Morphine a DAY and it did NOTHING to alleviate her pain other than provide comfort for her family because she wasn’t screaming 24/7. We did an appropriate, stereotactic destruction of a small part of her Cingulate Gyrus bilaterally. It ENDED her suffering. You could casually converse with her and she was very comfortable. (She also went from 400 mg a day to ZERO in one day). If you asked her she would admit she still had pain. It just didn’t bother her. Sure it was extreme but it accomplished every goal. Her family didn’t have to listen to her scream. She didn’t lie around like a stoned zombie on 400 mg of Morphine a day. She was actually able to get out and do things with her family.
So, knowing what I know, why would I ever advocate long term narcotics for truly chronic pain?
I am a chronic pain sufferer. So I am biased. I want a medical developed treatment with periodic test to ensure my overall health stays somewhat within bounds. The treatment and surveillance are between me and my doctor. Not between me and my senator, congressman and the neighbors down the street who self appointed control freak because their kid died from illegal drug use. My doctor knows my history, treatments (what worked and failed). It’s not like they treat chronic pain from miserable to no pain. The treat it down to manageable. I wish under treatment that all the pain is gone. Not realistic for me long term.
I agree that treating chronic pain with fast acting opiates is horrible and does cause over use and addiction moving people into illegal drugs. I don’t want to be in pain. I never asked for it. I wish it on no one. I can either treat it and function. Pay taxes, college tuition ..., provide value to society or wither and die.
I fully expect a day will come when politics will force me into untreated pain.
We offered to “wean” the lady down from 400 mg. SHE didn’t want the stuff anymore.
I am certainly not “demonizing a medication”. I am criticizing the claim that opiates have a place in treating chronic pain. Some people disagree with me. Most of them lack the experience I have so I understand that. I am trying to educate people.
[[The implication is that these people lack moral fiber or character. If they could tough it out, they could get over their pain without an opiate These people are control freaks]]
Exactly-
[[The fact is that even actual drug addicts would be better served getting opiates from a physician than on the street where it is likely to be contaminated or not pure.]]
That’s a good point- if all these docs and the gov are so worried about the opioid ‘epidemic’ then why aren’t they setting up clinics to deal with the problem instead of simply going after people in debilitating pain? Many drug deaths are due to street drugs being mixed with other drugs that increase the potency- and often mixed with lethal crap- The number of deaths could be fairly drastically reduced if they were supervised- these people are addicts- true blue addicts- and they need help- but instead- our government’s solution is to go after law abiding pain patients?
There certainly needs to be better screening for ‘drug seekers’ when prescribing opioids- but there also has to be a system that helps addicts to stop going to the streets to buy the illegal dangerous drugs that are killing them-
I know the gov has tried to help by giving out narcan- and that likely is saving a lot of lives, however, the addicts are still getting their drugs from shady dealers- I don’;t like the idea f turning the gov into a ‘clean dealer’ but something has to be done to keep the dirty deadly street drugs from addicts- I dunno what the solution is- but it surely isn’t going after people who are suffering with crippling pain-
[[I agree that treating chronic pain with fast acting opiates is horrible and does cause over use and addiction]]
Very little addiction- less than 3%
In the 2016 campaign Trump in a speech said we are governed by idiots. Something we all instinctively knew about career politicians but what could we do the system is controlled by them so we vote for the least harmful (or least idiotic!). Then Trump came along, not a career politician, he had made his mark, had shown success in the “rubber-meets-the-road” world. Started applying that experience & look what’s happened. Not only has he turned things around he has some seemingly intractable problems (e.g., North Korea) on some sort of road to solving. He puts to the lie that we need a professional political class, for that he must be destroyed!
So, if you’re dependent on a medication with a positive result, you are doing harm. Well at least you’re making progress and you didn’t say addicted this time.
Ok, let’s stop treatment for diabetics, hypertension, heart failure, cholesterol, arrhythmias, migraines, MS, Lupus. And on and on.
I know what you’ll say. The other patients need that treatment but the pain patients don’t. Or you could say that we can’t really measure pain objectively, so it doesn’t exist even if patients claim improved function on opiates.
Like I have repeatedly posted, we have had treatments for chronic pain that work very well for over a hundred years in many cases. We just allowed our government to make a massive mistake that prevent these treatments from being used.
I have repeatedly posted that there are treatments for chronic pain that do not require narcotics. Many have been known for over 100 years. They are much more successful. They don’t run the same risk. I think you beleive I am saying EVERY chronic pain patient will turn into an addict. I never posted that. But I HAVE seen hundreds and hundreds of people who were. Including my own cousin who was like a brother to me who died homeless just a couple months ago.
I have never seen anyone commit an armed robbery because they couldn’t get their diabetes medication.
What’s interesting on this, is the political rhetoric. Its stampeding the conflating of illegal acquisition & use with medially prescribed acquisition and use (a 3% addiction problem!).
There’s a reason for doing that. I guess to justify more accumulation of state power.
Always beware the politician trying to help (any politician!). Often in the long run the problem is made worse.
...and I never said people with chronic pain don’t deserve treatment.
[[I am certainly not “demonizing a medication”. I am criticizing the claim that opiates have a place in treating chronic pain.]]
With all due respect- yes you are- you claim all people need is an operation- a risk in itself- and you fail to mention which types of pain operations can help with- mostly they are with spinal pain- some other pains- however, operations do not help all chronic pain sufferers- As well, not everyone can afford $30,000, $30,000 or more operations- numerous operations etc- even with insurance paying some- and as mentioned, there are no guarantees such operations will even help- and as mentioned, there aren’t operations for many types of chronic pain- Many folks are beyond operation qualified- an these folks must somehow deal with crippling pain-
Some cases can indeed be solved with operations- noone is disputing that- but to suggest there isn’t a place for chronic pain management with opioids because some people- very few people infact, get addicted, is not a genuine argument-
My comment was maybe to harsh. Fast acting have their place. In long term pain it creates a roller coaster effect of pain, no pain, pain, .... so the pain cycle + rebound pain ... causes fast acting to be hard to manage for me. I tried it for years then went to slow release options. I only know one other chronic pain patient (VA) and he lives with a higher base pain level than I do. But that was the choice he and his doctor made. Not some politician.
“So, knowing what I know, why would I ever advocate long term narcotics for truly chronic pain?”
Really. You have one non-peer reviewed non- published anecdotal case report of your post stroke patient and you think that information can be applied to the much broader subject of chronic pain?
Because our government is run by people who don’t know. They are advised by people who claim to know but are wrong. Like I learned from my Chief Resident all those decades ago, it is a mistake to treat chronic pain with narcotics. Acute pain is the role for these drugs (and terminal illness which is also an “acute pain” when you think about it).
What is needed is for people to demand that the folks who are supposed to be trained in how to treat these conditions offer the damn treatments.
That is true- the real ‘epidemic’ is with illicit drugs- not with legally prescribed drugs- to try to make the case that legally prescribed opioids are dangerous to the point of being an epidemic by pointing to the few addicts who die when ABUSING the legally prescribed drugs is disingenuous, and harmful to those who are in need of chronic pain management-
It would be akin to claiming diabetes drugs must be halted because some diabetics continue to drink alcohol while taking their meds, and end up dying earlier than they should- The fact is the mass majority of diabetics that do the right thing, and take their m eds, make lifestyle changes etc- will be fine- they shouldn’t suffer because some people continue to abuse their bodies and fail to take their meds as prescribed-, and mix their meds with alcohol
Not the greatest analogy i know- but it gets the point across i think- The vast majority- nearly 100% infact, of chronic pain sufferers who take their meds as prescribed, will never develop an addiction- and while it’s regrettable that even a small % might, it’s not a reason to deny the nearly 98% that won’t
I referenced a book published some 60 years ago. Some roughly 400 different procedures specifically tailored to specific diagnoses. They do not all require expensive procedures. I recall helping a neurosurgeon to a “percutaneous Cervial Spinothalamic tractotomy” for an invasive tumor of the brachial plexus. It was done as an OUTPATIENT in the CT suite. It was 100% effective.
[[ it is a mistake to treat chronic pain with narcotics.]]
nonsense- there is very very low addiction rate- less than 3%-
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