tag:blogger.com,1999:blog-6329595.post1019543231415425331..comments2024-03-29T07:04:55.776-05:00Comments on Althouse: "Even When Patients Describe Pain in Vivid Detail, Doctors Have Few Tools to Determine What's Real."Ann Althousehttp://www.blogger.com/profile/01630636239933008807noreply@blogger.comBlogger47125tag:blogger.com,1999:blog-6329595.post-27519370142628099212011-07-06T14:16:25.089-05:002011-07-06T14:16:25.089-05:00I think the doctors should err on the side of beli...I think the doctors should err on the side of believing the patient.<br /><br />Why? Because it's better that 100 drug abusers O.D. than that one legitimate patient be denied adequate pain relief.<br /><br />IMHOPeterhttps://www.blogger.com/profile/16099940931064117337noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-26838489092541128372011-07-06T09:43:30.396-05:002011-07-06T09:43:30.396-05:00For those of you who don't know the blog, www....For those of you who don't know the blog, www.theangrypharmacist.com has a great rant up about a customer who picks up her [TAP tries to disguise the customer's sex, but at one point he slips] diabetes meds, but doesn't take them, because "she knows her own body." Picking them up is the price she has to pay to get her Percocet. (The only price, as apparently she's on Medicaid or something equivalent.)<br /><br />wv: adaver. What a diabetic who doesn't take meds will become: A cadaver, minus a bit.Michelle Dulak Thomsonhttps://www.blogger.com/profile/18041391162535875301noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-28883908029237887162011-07-05T19:24:52.178-05:002011-07-05T19:24:52.178-05:00Pain is not a scientific fact. Neither is conscio...Pain is not a scientific fact. Neither is consciousness for that matter. This may seem counterintuitive, which of course it is, but intuition is not science. Science is limited to phenomena that are directly observable by more than one observer.Luke Leahttps://www.blogger.com/profile/11290760894780619646noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-42632016891856370282011-07-05T18:10:15.736-05:002011-07-05T18:10:15.736-05:00But the FDA insisted on the inclusion of the aceta...<i>But the FDA insisted on the inclusion of the acetaminophen in the first place to keep people from becoming addicted to the opiods...</i><br /><br />This really irritates me. People still become addicted to opiods, it's just that they now have liver problems in addition to whatever was originally wrong.<br /><br />When you get a prescription they always give you a five page sheet with side effects and directions in five point type. Most of the side effects aren't real. They all say "don't take with alcohol", even when it doesn't matter. So people don't read them any more.<br /><br />We ought to err on the side of believing the patient. At least things have changed for the better over the years - 20 years ago in Santa Barbara there was a series of damning newspaper articles regarding the local hospice. Terminal cancer patients were spending their last days in intense pain because the DEA was putting pressure on the doctors for "over prescribing". At a hospice!Erichttps://www.blogger.com/profile/10330712047609650184noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-56256611307614236212011-07-05T17:11:51.326-05:002011-07-05T17:11:51.326-05:00"I don't care if someone wants to drug hi..."I don't care if someone wants to drug himself to death. I do care that people who are truly in pain are not denied painkillers."<br /><br />This. If we're really going to legalize pot (someday) why not make opioids available OTC? I can't see how people could be libertarian about one drug, but restrictionist on everything else. <br /><br />Hell, let us grow opium poppies, climate permitting.Carolhttps://www.blogger.com/profile/09055468613470143350noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-68886033833294516592011-07-05T16:41:12.798-05:002011-07-05T16:41:12.798-05:00I've been in chronic pain for the past 23 year...I've been in chronic pain for the past 23 years. It is a constant, achy, pain that I've learned to tolerate over the years. In fact, my pain tolerance level has risen a LOT in the past 23 years. I used to be a real wimp about pain. <br /><br />I was on NSAIDs for quite some time until I developed an ulcer. Now I can't take the NSAIDs or aspirin. I'm now on Tylenol #3's and regular acetaminophen.<br /><br />I do my best to take the meds only when the pain gets acute and the levels rise above 5 or 6 on the scale.<br /><br />Codeine is converted to morphine in the liver. I was once prescribed Tramadol (a synthetic morphine) but I couldn't tolerate it. It made me throw up.<br /><br />Now the FDA is lowering the amount of acetaminophen in combo drugs (Vicodin, Percocet, Tylenol #3 and #4) because of potential liver damamge. But the FDA insisted on the inclusion of the acetaminophen in the first place to keep people from becoming addicted to the opiods...kimschhttps://www.blogger.com/profile/15742219426291395677noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-47667579348117579102011-07-05T16:38:39.092-05:002011-07-05T16:38:39.092-05:00@Indigo Red My heart goes out to you. My grandmoth...@Indigo Red My heart goes out to you. My grandmother complained of pain and had a suitcase full of medicines, and everyone considered her a hypochondriac. (I learned that word when I was a little child.) In fact, she had a painful disease that was not diagnosed and which she died of. (Scleroderma.)<br /><br />My mother did just about the opposite, enduring a very advanced cancer while insisting that her doctor told her she did not have cancer. One day I caught a look at her when she didn't think I was looking, and, realizing that she'd been hiding what she was going through, I made her go to the doctor the next day. A real doctor. She had been seeing a homeopath as her doctor, without telling us that either. She really believed in that, she told me, and she accepted his assurance that she was going through the ordinary pains of aging.Ann Althousehttps://www.blogger.com/profile/01630636239933008807noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-18646557436953873202011-07-05T16:19:53.845-05:002011-07-05T16:19:53.845-05:00This comment has been removed by the author.jamboreehttps://www.blogger.com/profile/10072654852275348264noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-60601653320199069932011-07-05T15:52:59.093-05:002011-07-05T15:52:59.093-05:00Its also more than just "not having an object...Its also more than just "not having an objective measure of pain". People widely vary in their "tolerance" for pain.<br /><br />What a professional football player experiences daily would generate gobs of opioid scripts in the "real world"Phil 314https://www.blogger.com/profile/04133300763922742206noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-17655745525142660132011-07-05T15:49:36.425-05:002011-07-05T15:49:36.425-05:00Obviously our management of pain engenders a lot o...Obviously our management of pain engenders a lot of opinion and emotion. From the Doc's side of things, they do feel squeezed between the twin demands of adequate pain control and limiting prescription drug abuse and diversion. At any one time some states are passing new stringent laws to punish docs who "over-prescribe" opioids and other states are encouraging docs to adequately control pain in pain patients such as cancer patients.<br /><br />And as the discussion demonstrates, there are more than just medical issues here.Phil 314https://www.blogger.com/profile/04133300763922742206noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-65292997756484875272011-07-05T15:39:36.762-05:002011-07-05T15:39:36.762-05:00My mother-in-law recently retired after 53 years o...My mother-in-law recently retired after 53 years of nursing, the last twelve of which were in north Florida.<br /><br />She commented on how you see the very same people back in the ER, week after week. With black women it's always non-specific abdominal pain. Intolerable, of course.<br /><br />The men, black or white, did indeed have "kidney stones." Regular as clockwork.<br /><br />The docs knew the gig and would write 7-day scrips just to get the poseurs out of the way in what was a generally busy ER -- gunshots, drunks falling off a balcony, stabbings, and so on. <br /><br />Nice town.Bart Hall (Kansas, USA)https://www.blogger.com/profile/06060627788809034719noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-54831507797764626362011-07-05T15:27:09.546-05:002011-07-05T15:27:09.546-05:00Yes this will always be messy. but if your patient...<i>Yes this will always be messy. but if your patient:<br />-frequently "loses" his/her prescription<br />-regularly asks for refills before they should be out<br />-has multiple sources of the prescription<br />-has a continuing accelerated need<br />-has a strong history of drug/alcohol abuse</i><br /><br />Maybe some of this, but I have a friend who falls into most of the categories and has real pain, ultimately resulting from 5 or 6 bad disks from an auto accident (5 of 6 have been replaced, the other one is sketchy). <br /><br />The memory problems are a result of medical malpractice after a surgery - heart stopped as a direct result, resulting in permanent brain and vision damage. And, when you lose your pain meds, many of the rest of those naturally follow.<br /><br /><i>Some tools for use in chronic pain patients on chronic opiods:<br />-pain contract<br />-periodic drug screen (looking for substances of abuse) with the patient's consent<br />-inquiry of pharmacy</i><br /><br />One of the reasons for the drug screens, which this friend has to routinely undergo, is to make sure that the opiods are being consumed and not sold. The street value of these meds is many times the pharmacy price, even without insurance. <br /><br />The flip side is that stealing such meds is endemic. TSA people have done so more than once. Indeed, I think that this person's pain meds have been stolen maybe a half dozen times in the last 3 or 4 years - the last time maybe a month ago.Bruce Haydenhttps://www.blogger.com/profile/10815293023158025662noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-37583037085785492582011-07-05T15:14:28.701-05:002011-07-05T15:14:28.701-05:00Ann is right - pain is too subjective, no one can ...Ann is right - pain is too subjective, no one can know the pain of another person. Most folks do not believe I am in pain all my waking hours. The degree of pain varies, but it's always there and has been since birth when a serious orthopedic condition was diagnosed. My first surgery was at 3 days and my last was at 13 years. <br /><br />In the late '80s, I was in a car crash and had to see a neurosurgeon for insurance claims. He hooked me up to an electrical torture device that sent increasing amounts of electricity through my body to determine the level of pain I was in. His instruction to me was simple, "Tell me to stop when the pain gets to be too much." He had to stop because I had exceeded the capacity of the machine.<br /><br />I don't look like I'm hurting. I live with my pain as I have all my life having learned by myself to control the pain through meditation. I have used meds for pain that was more time compressed, incessant, than it was painful. A little pain all at once is harder to deal with than a lot of pain over a long time. Aspirin has been my longest lasting friend and has been more help than the morphine injections given when the talus bones were removed from left foot, but sometimes something stronger is needed.<br /><br />I know the risks of addiction to pain meds, even aspirin. And I know how to control pain to a tolerable level without medications, but that's come from a life time of experience with pain that physicians just cannot know. Doctors must simply trust me when I say the pain is too much as I trust them to treat me appropriately.Indigo Redhttps://www.blogger.com/profile/07488424336985581412noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-58610347426135723212011-07-05T15:11:54.082-05:002011-07-05T15:11:54.082-05:00Hmmm... I read "Pain" as "Palin&quo...Hmmm... I read "Pain" as "Palin" and immediately thought it was a legit headline from the MTM... :)Neallhttps://www.blogger.com/profile/08765957288931389925noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-22280953942212793022011-07-05T15:09:39.158-05:002011-07-05T15:09:39.158-05:00Chronic pain can ruin people just as surely as any...Chronic pain can ruin people just as surely as any drug addiction. And apparently today's doctors are a lot more sympathetic about helping addicts than treating "suspicious" patients who can't actually prove they're in pain.Bryan Chttps://www.blogger.com/profile/10387816413528886340noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-6686374677196055642011-07-05T15:06:57.900-05:002011-07-05T15:06:57.900-05:00A friend of mine works in pediatric hospice. A few...A friend of mine works in pediatric hospice. A few years ago, at a fundraiser for the hospice, a doctor gave a talk about that difficulties of managing pain for pediatric patients. Apparently, it's a lot more complicated subject than it appears to an outsider.Peter Hohhttps://www.blogger.com/profile/06916196998855947137noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-6646038200373854742011-07-05T14:59:06.528-05:002011-07-05T14:59:06.528-05:00Next thing we know, doctors (or the government) wi...Next thing we know, doctors (or the government) will require a lie detector test to determine the level of pain and the need for relief. Or would an addict be able to fool the box?JohnnyT1948https://www.blogger.com/profile/08189683302719109546noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-23085134692780501642011-07-05T14:36:42.229-05:002011-07-05T14:36:42.229-05:00You really don't know what pain is like for an...You really don't know what pain is like for another person. And there is a big subjective element. One of the values of having the prescription -- say after a dental procedure -- is that you know you can control it if you need to. That feeling of control may be all you need, and you don't even take the drug after the first or second dose. That's what I've found. But if I were in a situation with pain and no medication, I think I'd focus on it and worry. The fear of increasing pain would make the existing pain worse.Ann Althousehttps://www.blogger.com/profile/01630636239933008807noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-86335664824709060582011-07-05T14:04:03.450-05:002011-07-05T14:04:03.450-05:00Some time ago my wife had very painful dental work...Some time ago my wife had very painful dental work. The Dentist gave her a powerful pain killer which let her sleep very well from the first night. She took them for three days, realized that she really liked them and threw the rest away. The following week the Dentist called to follow up and offered another prescription. It ain't always the patient.glennhttps://www.blogger.com/profile/00993381999736874161noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-62098627874750493892011-07-05T14:03:06.282-05:002011-07-05T14:03:06.282-05:00Because it's better for a hundred people to di...<i>Because it's better for a hundred people to die in agony than one person to get high. </i><br /><br />This isn't the fault of the doctors. If somebody decides they have been giving out too many pain meds they risk their license. It's just the stupid drug war bleeding over into legal drugs, with predictable and dumb consequences. <br /><br />I mean, the pain score is a series of happy faces. Pretty hard to determine who is trying to get high from that, versus those acutally in pain.Shannahttps://www.blogger.com/profile/15709594638793030086noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-73984218531229916782011-07-05T13:23:07.809-05:002011-07-05T13:23:07.809-05:00Drug induced liver disease<a href="http://www.medicinenet.com/drug_induced_liver_disease/article.htm" rel="nofollow">Drug induced liver disease</a>Alexhttps://www.blogger.com/profile/11205752419540502278noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-24039415033687404072011-07-05T13:19:56.347-05:002011-07-05T13:19:56.347-05:00Doctors need to remember that they are front line ...Doctors need to remember that they are front line soldiers in the War on Drugs, and patient welfare is a secondary consideration at best. If I ever go to a hospital in a lot of pain, I know I want the doc to say, "Oh, yeah? Prove it, junkie scum!" Because it's better for a hundred people to die in agony than one person to get high.Smilin' Jackhttps://www.blogger.com/profile/01501763605001379362noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-82604106484793037072011-07-05T12:47:37.494-05:002011-07-05T12:47:37.494-05:00I know a doctor who, when faced with a suspicious ...I know a doctor who, when faced with a suspicious and difficult-to-check claim of pain (kidney stones were always popular), would deliberately first suggest a very mild pain killer, just to see if the patient protested. If no protest, the doctor would "change his mind", and write a prescription for something stronger.<br /><br />Alternatively, you can use the approach a pain medicine doc I know and his assistant use - be ex-junkies. It is very, very difficult to fool someone who used to be addicted to the stuff themselves.Kevinhttps://www.blogger.com/profile/12622466185753210550noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-50720764799168809102011-07-05T12:44:59.265-05:002011-07-05T12:44:59.265-05:00Alex said,
"Then why does my Tylenol bottle ...Alex said,<br /><br />"Then why does my Tylenol bottle say I can't take more then 3 doses in 24 hours or I risk severe liver damage?"<br /><br />Tylenol is hard on the liver. I'm pretty sure these people aren't addicted to tylenol :)<br /><br />I guess if people take a bunch of percocet (tylenol and oxycodone) they could end up with liver damage, so that is a fair point.<br /><br />Most people with significant addictions are sticking with the straight stuff (just the narcotics themselves). Rush was addicted to oxycontin right? no tylenol there.<br /><br />Here is another point though: even if some took a bunch of percocet (or another Rx with tylenol) and damaged their liver, they only need to be free from abusing it for 6 months before they are eligible for a liver transplant. Same with a liver destroyed by alcohol or with hep C contracted by shooting drugs.<br /><br />6 months clean, that is all you need.Lukedoghttps://www.blogger.com/profile/16610044975272369005noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-30794934398697683532011-07-05T12:33:46.036-05:002011-07-05T12:33:46.036-05:00And of course there's those people who, when a...And of course there's those people who, when asked to rate their level of pain on a 1 to 10 scale, will casually say, "Oh, yeah, this is like easily a 9 or a 10. It hurts a lot." When really if you're at level 9 or 10, you would barely be able to speak.<br /><br />Thankfully most hospitals have those neat little charts, with the little faces going from happy at level 1 to morose at level 5 and sweat-dripping, teeth-grinding pure anguish at level 10. I guess the doctor can pull the chart down and compare his patient's face to the chart.coketownhttps://www.blogger.com/profile/11257222645480570714noreply@blogger.com