Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds.
On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a knee. When the surgery was done and I was being discharged, a nurse came to me with a percocet script and told me to take one every xx hours. Having taken percocet in the past and being familiar with the aforementioned side-effects, I asked her if she wanted me to take it for pain management, or if there was another reason to take it (blocking the formation of blood clots for example). I'm fairly pain-tolerant, so if it was a pain management thing, I wasn't going to take it. Her response was "just take the pills." That was not helpful. If doctors and nurses are just shoving these things down patients' throats it's not surprising there is a problem out there.
Digestive problems are so common with long-term use that some doctors think that they should co-prescribed with omeprazole and other agents to head them off. (Long-term omepraloze will give you B-12 deficiency if you don't supplement; it is an unusual side effect, but I can't sleep if I take omeprazole.
Cardiovascular risk from Vioxx was enough to pull the drug from the market; risk is also seen with Celebrex and other COX-2 selective NSAIDS. The risk with non-selective NSAIDS is less understood but still present.
My doc does not want me taking acetaminophen because she thinks it causes me to get elevated liver enzymes.
Like opioids there are problems when people don't "use as directed". My grandmother used to take Bufferin by the handful and one day at the dinner table we saw her throwing up blood like something out of a horror movie and she was subsequently hospitalized..
Acetaminophen overdoses can easily destroy your liver and are one of the most common forms of fatal poisonings.
The verdict is that we don't have truly 'safe and effective' medicines for pain in 2017.
This study only looked at acute pain. Generally those medications are safe for acute pain.
(Unless by 'safe and effective' you mean NEVER have side effects, in which case we probably don't have any 'safe and effective' medications.)
Chronic pain is difficult to deal with and wasn't addressed in this study. Generally opiates are not recommended, but its tough to find other alternatives that are consistently safe. Opiates often end up being used and... epidemic. (... == long complicated story)
That's a bit like saying we don't have food that doesn't cause obesity. What is your definition of safe? what is your definition of effecitve? If a person turns up to the emergency department in severe pain from trauma, I can safely relieve their pain without endangering their life, that is both safe and effective. If an elderly person with arthritis of the knees is on 3x daily 1330mg Paracetamol SR for months and months, that is both safe and effective.
Paracetamol/Acetaminophen has an incredible safety profile - in people who use it responsibly and don't have liver disease.
It is, after all and as you are obviously well aware, responsible for the highest number of ED presentations for overdose, and it does kill a number of people each year. But that's a mental health issue, and you can overdose on Water (or food, as I indicate in opening paragraph), and die. For people who take it responsibly and without intent for suicide, it is incredibly safe and effective.
Same with ibuprofen - although with the proviso of Do not take for more than several days. But, the same could also be said of opiates - safe for short periods. it's chronic use that will cause problems in lots of cases (ie. add in benzos as well)
The topic at hand is acute pain management in the ER, you seem to be talking about chronic pain management, which is another (more complicated) topic altogether.
Cannabis has pretty awful side-effects for me. It gives me absolutely incredible nausea, to the point where I've tried it ~10 times in varying doses, thinking my dosage was an issue, and out of those I was violently ill 4 of the times. The other 6 times were simply unenjoyable.
It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high afterwards, so I've become pretty hesitant about it.
That being said, it is very likely less addictive and has far fewer side-effects for those who it helps. For that reason I am extremely positive about legalizing it and studying it further. :)
A lot of people who take cannabis for pain or anxiety take CBD [1] rather than the raw THC-containing plant. There's almost no associated high, so it sounds like you haven't tried it. The abuse of medical marijuana laws to circumvent prohibitions on recreational use has confused the issue, but people shouldn't equate the substances that get consumed recreationally with the much more processed and specific substances that get used medicinally.
Sorry to pick on you, but people should realize that if all they want to do is try cannabis for pain management, they shouldn't let a dislike for the recreational effects deter them because the two can absolutely be separated.
FWIW, I manage my pain with meditation techniques and it's the only form of pain management that I recommend whole-heartedly, so I'm not recommending anyone try CBD. But I know people who take CBD for pain and I think people should, at least, understand how cannabis is used medicinally before saying negative things about it.
I never touched the stuff, but I would end up having to take my friend to the ER. For some reason at different times it would cause an allergic reaction and he would act like he was in septic shock and have dementia.
Doctors and I were convinced he was not telling the truth or his stuff was laced. Ended up that he was telling the truth and was clean other than pot. Sad thing was he would keep using pot which ended up messing with his health.
I never see why people care to be sedated emotional. Worst thing about pot to me. They miss out on so much emotionally.
If you don't understand why people would avoid the full force of their emotional response to life then you apparently have had great fortune in your emotional experiences. I note you don't have to want it for yourself to understand why others would want it.
Cannabis enhances my emotions. I'm normally pretty flat emotionally and cannabis is one of the only things that changes that. I'm not sure what you mean by sedation here.
Who the hell would 'lace' weed? With what, water? Nearly every other dug costs more to lace it than just sell it de novo. THC as a drug is SUPER cheap with the various 'legal' states. Even at high-end stores, concentrates are $25/gram [0]. This reads like some ham-baked DEA post.
Yep! I tried edibles, joints, and vape pens from 3 different dispensaries in the bay area. The edibles and "free" joint I got from Airfield Supply Co. were the ones that effected me the least negatively.
“Respond” is an understatement. 10mg THC, with no CBD, represents a typical edible from a dispensary, but as a small person with low tolerance and a fast metabolism, I’ve found that amount of THC by itself ends with me fearfully holding onto the Earth for dear life for a couple hours.
On the bright side, at dispensaries you can know precisely what you’re getting, so at least I can say “this weed will pleasantly reduce my anxiety and pain, that weed will blast me unwillingly into space” which is an option I never had before.
Anecdotal, but I can't imagine living a normal life while regularly using though--even if regular is just a couple days a week.
It's legal where I live and the handful of times I have used during the week, I can't remember what I did the day before as well, or what my tasks for the day are. My performance at work noticeably degrades. I'm also more tired the day after, despite generally getting more sleep.
It's great for the weekend when I can just sleep it off or my only tasks are to go for a hike and get groceries though. Better than alcohol at least.
I'm curious what makes it great for the weekend for you. Not being able to remember what your goals for the day are or remember what you did the day before doesn't sound great, even if it is the weekend.
I suppose I was thinking in terms of the alternative being alcohol. If I were going to choose between a night out drinking, or a night out having smoked a bit, I'd go for the latter. I'd rather feel a bit hazy the next day than be sick to my stomach or have a headache--which I get even just from ~3 beers over a few hours. I could of course opt for neither, but social norms being what they are.. there's some pressure there but that's a separate issue.
That being said, I may have exaggerated the memory issues. It isn't like full blown amnesia. More so it just takes longer than usual to remember things. I'd compare it to a cache miss. Smoking clears my brain's cache the next day and I end up feeling like I am pulling short-term thoughts and memories from colder storage.
I'm not the person you are responding to, but I limit my cannabis use during the workweek for similar reasons. Most often my goals for the weekend are to relax and enjoy myself. Of course I'm not going to get high if I'm about to fill out paperwork to refinance my mortgage.
It may help to note that THC and CBD are two active components which can treat different symptoms. I find CBD extraordinarily effective at treating my essential tremor. CBD and THC combined provide mild help for my pain, but THC makes me anxious and spacey. The side effects don’t quite outweigh the benefits for me, personally. But I cannot recommend CBD enough, and agree both are worth trying.
So many innovations in medicine, food, exercise, pesticides, whatever, only look better than the old stuff because they haven't been around long enough for all their flaws to be discovered.
True for high-THC strains, but not high-CBD / low-THC ones. And of course opioids also famously affect perception: "do not operate heavy machinery" etc.
I have heard that CBD is extremely great as a natural anti inflammatory however the strains that get recommended are so absurdly expensive. On the order of 30ml for 150$ for charlottes web for example. Is it actually worth it? How long does that 30ml bottle last for 150$?
The bottle lasts approx 2 weeks with 'correct dosage'. And that price is the higher end product. I am familiar with the mid-range product which I used for 1.5 months (due to pain) and discontinued it because I honestly couldn't really tell the difference.
Yeah this is quite disheartening to hear. 300$ a month for something that some people can't even tell the difference with. I don't want to spend 150$ for 30ml of snake oil haha.
My wife has a number of health issues (chronic knee pain, low-level anxiety, CFS). She tried the same CBD oil for about a month and found it had no effect one way or the other.
you're referring to the LP prices, i.e the "legal" stuff. you can buy far higher quality CBD strains at dispensaries, or even black market dealers, for cheaper.
> My doc does not want me taking acetaminophen because she thinks it causes me to get elevated liver enzymes
An uncle and some other older physicians who are on long-term measured acetaminophen usage reported supplementing their regimen with n-acetyl cysteine (NAC) with no apparent diminution in analgesic effect. WebMD has a description of the chemical mechanism:
I had some bad reactions to NSAIDs (asthma attacks & bad headaches). I was never sure if I was having an attack come on and thus took aspirin, or if the aspirin was causing it. Eventually I went to a doctor and it turns out there's a allergy-like sensitivity to these things that some people have.
I agree the nurse absolutely should have answered your questions about the medication or gotten a doctor to answer them. It's just inexcusable behavior on her part.
Did the script say "P.R.N?" PRN means "as needed" in medical terms. It's an abbreviation for "pro re nata." Just for future reference.
I've also found that, for me, naproxen (Aleve) works much better than opioids. Opioids just make me feel very, very sick (from nausea). If they do help with the pain relief I can't tell over the nausea and vomiting.
There's a fairly big camp of people both online and in real life that is strongly against questioning medical authority. I've encountered it before.
For example (and I know this is purely anecdotal), after doing a few hours of extensive research and photography comparisons online I came to the conclusion that my sister had shingles. I mentioned this to the doctor when I took her and he dismissed it and said that it is unlikely since she is so old. I mentioned this on a subreddit that I frequent and a bunch of people jumped on me and told me to stop doing my own research and to let medical authorities do their job without me pestering them. However, after taking her to a different doctor, he immediately recognized it as shingles and prescribed her the appropriate medicine.
On the one hand, I get why doctors don't want the "ignorant masses" doing their own research and coming op with cockamamie theories, but on the other hand, doctors can only hold so much information in their heads whereas the internet has vastly more information available and I can become an expert in one tiny little niche fairly quickly.
After a number of years with a different diagnosis, I convinced an ultrasound technician to go beyond their exam script -- enough to discover that, in fact, I did indeed have a minor hernia.
If the doctor hadn't been so sure of his diagnosis, this would have been caught years earlier. I'd specifically asked, more than once, about the possibility.
A lot of scrambling on their part, that day, to get me a same-day appointment for consult with a well-regarded surgeon.
A useful approach is to ask "could this be shingles?", and then "why not?", and then "if i isn't shingles what else could it be, and why is it that and not shingles?"
the UK has had a campaign recently around sepsis where people are being trained to ask these questions.
It's a fine line. Most of the time, the patient is actually wrong, and that can make it pretty annoying, especially if the medical professional in question is having a stressful day (and aren't they all...).
I have a lot of medical knowledge and I try not to be a wise ass with my doctors. Sometimes though, it pays to pay attention.
I always like to come to a Dr's appointment with a "sealed envelope" ... what I think the problem is, but not to mention it until they get through with their diagnosis.
Yes doctor, no doctor, I don't think so doctor, yes doctor also my left foot. => He thinks I have a sprained ankle, I think I'm not sleeping well (or whatever) and I'll mention what my guess is at the end (not before) and ask him why my guess is (presumably) wrong.
Of course if you think there's something unusual or your symptoms are severe then of course go to the doctor without delay, but it's also helpful to get a bit of a personal education when you've got time with a specialist.
I had a slightly different experience, luckily, I guess. When I was in recovery after having a brain tumor removed, I was first being given fentanyl once every hour or two. I found that for the few minutes I was lucid (before the next dose), I really didn't have much pain and asked for something less strong. They moved me to norco, which still seemed too strong. After another request for something less, they moved me to plain tylenol.
I did get a big script for norco when I was discharged, but their instructions were to take it if the pain became distracting.
The nursing and medical staff at the hospital (CPMC Davies) overall seemed great, so it may just be the difference between staff that listens/tries and staff that doesn't.
Same here. After a LONGGG phone call cradling the receiver while trying to type, etc., I had my neck spasm severely -- so much so that the following day someone else had to drive me to urgent care (1). They prescribed a strong muscle relaxant in combination with either Percocet or Vicadin -- I forget which.
I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of those two "heavy duty" prescription drugs.
I will say, though, that doctors in the U.S. have been damned cavalier about ibuprofen. One doctor with a popular radio show would cite the nickname, "Vitamin I", and routinely tell people to use it non-stop for a month or two.
I've found that now, a few days on it will make me rather lethargic. My cardio strength and sometimes rhythm feels impaired. And lo, there are studies now coming out that indicate it may carry as much risk as Vioxx and the like.
(Incidentally, a doctor prescribed me Vioxx a month or two before it was yanked from the market. I questioned this, remarking on recent news I'd read indicating it had problems. He had no clue and told me it was perfectly safe. Sure, it was still on the market, then, but he appeared to have no clue about the looming controversy.)
With any medicine, it really seems TANSTAAFL. You have to carefully weigh the benefit against known as well as suspected risks. And the U.S. medical system completely falls down in not fully informing not just patients but also doctors to the existence and nature of these.
1) Well, that urgent care experience -- a new facility opened by the premier area hospital -- was itself a horrible experience. Deserted facility, by all appearances, yet it took about 2.5 hours to see a doctor. Who gave me no neck brace; family took me to their chiropractor, the next day, who DID give me a neck brace -- which provided the first real relief and stopped me from constantly retriggering the injury with every movement.
To be clear, I refuse to have my neck cracked. And the chiropractor wouldn't have, at that point, anyway, given my severe spasming. But at least he had the sense to immobilize my neck. (Then he provided some ongoing care to encourage the release and healing of the spasming. To whatever extent this may have helped, that initial immobilization was key. WTF was wrong with that fully credentialed MD serving the urgent care's rather extensive ER facility?)
I've found through my experience that the choice of urgent care vs a non-urgent care doctor is more important than I have always thought: An urgent care center wants to focus on the shortest path to getting you relief (your story aside). They'll err towards slightly over-prescribing. The non-urgent care doc will take a more comprehensive treatment path.
A slight distinction that might not matter sometimes, but i often wonder how many antibiotics/pain killers I've taken prescribed from urgent cares that were possibly overkill.
Yeah. Rather than your typical urgent care facility, this was the hospital's initial effort to significantly expand its effective service area. It was a quite substantial building -- since expanded to the size of some hospitals -- and they had labeled what I used an "emergency room". My family suggested going there as it was a lot closer.
That ER doctor just gave me the prescriptions and sent me off. No follow-up care. I guess you'd have had to see my level of discomfort. My family was equally surprised and disappointed.
I take your point. And much of the U.S. health care system keeps pushing patients towards urgent care and "the doctor at hand". Not that there aren't good urgent care staff; nonetheless, it doesn't exactly promote medical management.
Also, I've delayed some care because I've been uncertain of the approach and awaited more information and perhaps improved procedures and techniques. This might well be called a conservative approach -- and these days, so much of the U.S. rhetoric is about the need to be "conservative". Well, much of that is actually "Conservative", which is actually a rather different ideology.
Yet, insurance keeps worsening by the year. Patients who might otherwise be inclined to be conservative and await better knowledge as well as what would normally be lower costs (in most other industries, "product" costs decline with age and with technical improvements and growing marketshare). Well, in U.S. health care, patients can feel compelled to "act now", because while technology and standards of care may improve, next year's insurance may well not cover it or cover it enough for it to be affordable ($5000 deductible? $7500?), if one even has insurance next year.
For the ER in our town to take you seriously you would have to have visible bullet holes or severed limbs. Otherwise they dismiss you with a condescending sneer.
pasbesoin says> " They prescribed a strong muscle relaxant in combination with either Percocet or Vicadin -- I forget which.
I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of those two "heavy duty" prescription drugs."
Had you continued the muscle relaxant (the problem was an involuntary muscle spasm), you possibly could have avoided further treatment (the neck brace).
If I suffer a muscle spasm that can't be massaged out, then a muscle relaxant + ibuprofen serves well for 1-2 days and, after that, only ibuprofen.
IMO muscle relaxants + narcotics is not a useful combination, their purposes(muscle relaxation vs pain-reduction) being orthogonal, except in cases of severe injury where near-immobilization is required.
I was on the muscle relaxant for a full day, and I was no better. Any time I moved, I was retriggering the spasm.
The neck brace stopped that. I still had to be careful, but at least I could walk around and sit and such without constantly re-spasming (which I suspect was actually exacerbating the injury).
I do agree in concept with the concern about combining such an injury / muscle relaxant with strong pain killers. The pain is warning you as to damage; numbing it seems like it might well promote furthering that damage and/or hindering healing.
In my case, once I was braced and stopped retrigging -- and possibly worsening -- the spasming, the remaining pain was entirely tolerable. Of course, the limited effective activity was another aspect requiring coping. That included sleeping: Getting into bed, and keeping things immobilized in bed, was a bit of effort. I learned how to sleep with a neck brace on, and I "trained" myself quickly not to roll from side to side -- despite my allergies that promote frequent shifting.
I was going to post a similar opinion specifically of percocet: it was prescribed for me after a surgery, it gave me a weird sense of detachment, but didn't seem to do anything particularly significant for pain.
I stopped after the first one.
I have enough addictive behaviors, I don't need to add a chemical one.
God do I hate medical
professionals like that. It's as if they don't want you to steal any of their elite knowledge or that you as a patient are beneath them. How dare one of us ask a semi-intelligent question!
Agreed, I've been lucky and only required a few surgeries in my life. Every time I get handed a jug full of opiates, and end up taking ibuprofen instead. Personally the pain management I get from ibuprofen is similar (definitely less, but sufficient) to the opiates but without the side effects.
This is not the case when you suffer major 3rd degree burns. When you need morphine in the case of say regrowing nerve endings in a damanged limb advil will not cut it, not even medical cannabis will cut it, there are still cases where giving a patient morphine is appropriate.
The discussion around opiate abuse isn't about the extreme cases. Yes, if I get 3rd degree burns then I want to be as out of it as possible until the pain goes away.
The problem isn't the extreme cases, it's the every day ones. Opiates are being massively over-prescribed in cases where OTC medicine or a shot of whiskey would suffice, and this over-prescription is a driving force behind the addiction epidemic.
Not sure if you said it in jest or not but alcohol is also highly addictive, prone to abuse, and harmful to your health and IMO would really not be a step in the right direction.
edit: I almost added to my comment "It's almost taboo in our society to mention this fact" but didn't. I was almost immediately down voted so I guess maybe I'm not wrong...
I'd say it's extremely taboo to mention anything negative or even the possibility that alcohol is one of the most abused and disruptive drugs in our society.
People don't even like to call it a drug, which severely bothers me to be honest. I've tried some things and alcohol, from my perspective, is one of the more dangerous drugs around
As on expat UK-> USA said if you have a pint for lunch people start leaving AA leaflets on your desk.
A while back I was talking to a course tutor who in the UK gave the "dealing with staff with serious addiction problems" course - he commented its when you find 3 or 4 stashes of vodka hidden in the office that you know you have a problem
Took morphine for a back injury, I just got sleepy but still had the pain.
Took Percocet after a shoulder surgery, I just slept through the pain. I also understand now why people get addicted.
I get raging migraines, Excedrine is the only thing that works for that.
True story, when my daughter was in the hospital (cancer) we overheard a nurse and doctor discussing what to give a child (also with cancer) for tooth pain... "morphine". The nurse was like "for a tooth? can't we tell the mother to give him Tylenol?"
Also, true story Tylenol is not "formulaic" (I may be saying that wrong) at many hospitals. Meaning THEY DON'T KEEP IT IN THE PHARMACY (the one that fills orders for internal use). I was very surprised to learn this.
I find it very odd that a nurse would be so cavalier about that. There are a lot of people who can't/won't take prescription pain meds for a myriad of reasons. Some are concerned about addiction, but other reasons are religious/philosophical. I've always been asked if I want those kinds of pain meds, even when they are highly recommended, it was always a question.
On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a knee. When the surgery was done and I was being discharged, a nurse came to me with a percocet script and told me to take one every xx hours. Having taken percocet in the past and being familiar with the aforementioned side-effects, I asked her if she wanted me to take it for pain management, or if there was another reason to take it (blocking the formation of blood clots for example). I'm fairly pain-tolerant, so if it was a pain management thing, I wasn't going to take it. Her response was "just take the pills." That was not helpful. If doctors and nurses are just shoving these things down patients' throats it's not surprising there is a problem out there.