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After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

nytimes.com

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Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#311

Post by throwaway34241 »

eropple wrote: post #283
throwaway34241 wrote: post #269

Earlier quoted context omitted.

People talking positively about pain (and especially immediate post-surgical pain as in the article) makes me uneasy. Sure, some level of pain is useful as a warning sign. And wanting painkillers primarily to avoid resting is unreasonable. But, if there is too much pain, it will cause extreme stress during the day and they will probably be unable to sleep at night - it is hard to imagine this being beneficial for rec…

> I don't think this means that the same is true for all procedures, and suggesting that people just make peace with it or whatever without knowing what the level is seems wrong It's like I literally expressed that? Maybe I made it trickier to parse by referring primarily to chronic pain--if you want to lump extreme, trauma-induced pain into that? Sure. When lives are on the line, whatever, do what needs to be done;…

I see that makes more sense now, I think that line did throw me off somehow.

I haven't seen any close friends or family just pop a Tylenol for every day aches and pains, but it certainly seems to be a thing, so I'm open to the idea that I'm living in some kind of bubble in that regard. I've always thought of pain medication as for bringing severe pain down to a lower (but non-zero) level, so for example it might not be taken at all if you break a toe, but would be more than reasonable for the jaw surgery in the first post in the thread.

It's interesting, chronic back pain is one of the most common chronic pain causes, and a doctor was talking to me recently about it (in general, luckily I don't have it). Apparently once it gets started it can have its own self reinforcing process, and there are measurable biological changes to how nerves fire etc. that are independent of any initial underlying injury. Probably there's some people faking or overstating it, but I could easily imagine such a process getting pretty severe. Unfortunately, the outlook is pretty bad I think once you've had it for a set amount of time.

So concerning chronic pain / opioid use I can't figure out if Americans are less willing to deal with pain, or actually have more pain, or some combination of both. If back pain just needs an initial injury to set it off, then escalates from there, the unhealthy lifestyles and ever increasing obesity levels here would do a lot to explain why it is becoming an increasing problem.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#312

Post by Terr_ »

clwk wrote: post #294
jjeaff wrote: post #136

Earlier quoted context omitted.

I wonder if that doctor has ever had major surgery himself and been told not to use painkillers? Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

I have a very relevant anecdote: My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it. Later in life, he underwent a surgery requiring…

I was reading "Dr. Mutter's Marvels" a while back. The eponymous surgeon was working around the time that anesthesia was being invented in the US, and it talks a bit about how some competing traditionalists believed that pain needed to be part of the actual bone-sawing surgery itself. (Also a natural part of all childbirth, with biblical overtones.)

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#313

Post by cal5k »

justonepost wrote: post #306
cal5k wrote: post #7

I had jaw surgery recently... while I wouldn't describe it as incredibly "painful", particularly since everything was numb (they have to slice through nerves for this procedure), it was really uncomfortable and stressful for a couple of days afterwards. I wasn't at all ashamed to take percocet after the surgery. Could I have lived without them? Sure. Did they turn me into an instant addict? Of course not. This story…

You are projecting anecdotally your own situation and extrapolating in a somewhat irresponsible manner. Statistically it is shown that these prescriptions do lead to addiction in a frightfully large number of people. Being "uncomfortable" and "stressed" is a part of pain and it's an important signal that you need to take it easy. If pain is to the point where you can't sleep and heal appropriately, than I can see whe…

"Columbia University researchers found that opioid addiction had tripled over a 10-year period, with the proportion of Americans reporting abuse or dependence increasing from 0.1% of the population in 1991–92 to 0.3% in 2001–02."

It's true... in a population of 350MM (the USA), that's over a million people reporting abuse or dependence. Though I'd like to see a further breakdown of what abuse means in this context.

Of course, the question that needs to be asked: how many of those began as legitimate prescriptions and ended in dependence? Certainly not all of them, perhaps even a small fraction. But a well-to-do person become addicted after minor surgery tends to get more attention than poor people substituting fentanyl for heroin.

Finally, there's a cost/benefit analysis. Painkillers have an obvious benefit for people who need them - whether to treat chronic pain or temporarily after surgery. What is the cost to restricting access to those who have a legitimate need for these drugs?

I don't have answers to these questions. I will note that public health policy has a checkered past when it comes to unintended consequences. Our attempts at wide-scale social engineering, particularly that driven by outrage and headlines, rarely work the way we expect.

To whit, I can't help but think that the crackdown on prescription painkillers in our recent past (central registries, jailing physicians, imposing production ceilings on opioid manufacturers) has directly lead to the rise of synthetic alternatives we're seeing today.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#314

Post by roenxi »

clwk wrote: post #294
jjeaff wrote: post #136

Earlier quoted context omitted.

I wonder if that doctor has ever had major surgery himself and been told not to use painkillers? Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.

I have a very relevant anecdote: My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it. Later in life, he underwent a surgery requiring…

As human as that anecdote is, there are a long list of issues here. In particular, was the original idea that it would be a valuable part of the recovery in error?

It is easy for me to imagine a pain that I would never voluntarily experience or inflict (this isn't even a very profound level of pain, I don't like suffering even in small doses). This threshold is regularly breached and I often come out of it as an improved person.

Sometimes, and I'm thinking doctors and the military when I say this, people end up in situations where choices must be made. The situations are not emergencies and the choices affect other people in ways that the decider might not willingly accept for themselves. This is an unfortunate fact of the world not being a nice place.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#315

Post by andrewksl »

woodpanel wrote: post #232

Two words: German Romanticism. Although the article‘s premise seems reasonable (given the author‘s origin, the USA, being renown as prone to prescribe pain killers and psychotropics for the most menial things[1]) - a similar bias must be outlined when trying to understand the German perspective: That we are still romanticists. Many German doctors will send you off with „some rest“ and „tea“. Some will prescribe homeo…

Whoa, seriously? Actual medical doctors will prescribe government-paid homeopathy?

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#316

Post by telchar »

justonepost wrote: post #306
cal5k wrote: post #7

I had jaw surgery recently... while I wouldn't describe it as incredibly "painful", particularly since everything was numb (they have to slice through nerves for this procedure), it was really uncomfortable and stressful for a couple of days afterwards. I wasn't at all ashamed to take percocet after the surgery. Could I have lived without them? Sure. Did they turn me into an instant addict? Of course not. This story…

You are projecting anecdotally your own situation and extrapolating in a somewhat irresponsible manner. Statistically it is shown that these prescriptions do lead to addiction in a frightfully large number of people. Being "uncomfortable" and "stressed" is a part of pain and it's an important signal that you need to take it easy. If pain is to the point where you can't sleep and heal appropriately, than I can see whe…

Out of curiosity do have a citation for that? It's something I'd like to look into.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#317

Post by telchar »

hn_throwaway_99 wrote: post #304
refurb wrote: post #290

"Time is a flat circle. Everything we have done or will do we will do over and over and over again- forever." For those of you who were around in the late 80's early 90's. Today's moral panic about opioids will give you a chuckle. Back in the 1980's opioids were the devil and many patients, even in hospice, had undertreated pain due to fear of addiction. In the 1990's it dawned on doctors that maybe they should be a…

I think calling current thoughts around opioids a "moral panic" is ridiculous. Much of today's response to opioids is an actual panic given that there is a real, ongoing epidemic of opioid abuse that is killing tens of thousands of people. The number of deaths by opioids more than doubled in 2016 compared to 2015. I was around in the 80s, and this isn't just some "cyclical response". Take a look at any of graphs of o…

I'd say it's a moral panic. The response to this very real epidemic of deaths seems to be to moralize about opioids rather than to look for ways to reduce deaths from opioid use. Thus this is a moral panic as much as it is a health issue.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#318

Post by Lordarminius »

snotrockets wrote: post #262
btian wrote: post #222

Earlier quoted context omitted.

Huh? You don't need a prescription to get paracetamol, acetaminophen, and ibuprofen

Both of them (Acetaminophen is the US name for Paracetamol) are highly dangerous, even in small dosages. Paracetamol poisoning can kill within a day, and the lethal dosage is equivalent to about 20 pills. Ibuprofen is proven to cause heart attacks & stroke. Your suggestion is the perfect example of why over the counter drugs as so dangerous: a Dr or a pharmacist is aware of the dangers, that we (being the public) may…

I am a practicing doctor and I don't know where this is coming from.

Paracetamol and Ibuprofen while they have potentially lethal side effects are incredibly safe and effective in daily practice and consequently are very widely used. Every known drug has side effects and if you ever read a drug insert you would never pop a pill again. In the case of ibuprofen/paracetamol we are careful to avoid use in patients with ulcers, elevated blood pressure, liver or kidney disease, alcoholics or allergy to either drug.

Unlike opioids they don't cause dependence and their anti-inflammatory effect is very useful post trauma. Most patients self regulate their dosage and usually taper down within a few days. Used in combination a more nuanced effect can be achieved with lower doses.

Paracetamol toxicity in particular frequently occurs in the context of attempted suicide, alcohol abuse or mental impairment and requires a huge pill burden 20 - 24 pills ingested at once or about a 6 - 12 pills in repeated doses over multiple days. This is not as common as you would assume.

Surgery without anaesthesia is cruel and abusive. NSAIDS are not always the right call,but given a choice they are a good alternative.

Tldr: they are dangerous in theory but safe in practice.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#319

Post by kalleboo »

kurthr wrote: post #236
dpflan wrote: post #143

Earlier quoted context omitted.

I agree that there is no "one-size-fits-all" medical solution, but perhaps having this base-line allows building up when discussed with one's doctor - the article does not discuss this post-operation re-negotiation of how to manage the pain. Perhaps some HNers have experience with a similar situation that they could share.

I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself. I'm perfectly understanding the concern for long term morpohine derivatives for treating post-surgical pain (although there are plen…

> If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.

What do you mean by a filling? Just for a minor cavity? I've never received local anesthetic for a minor plastic filling, just for root canals/crowns, and the pain has never been a problem. This seems to be common practice where I've gotten dental care (Sweden and Japan)

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#320

Post by Turing_Machine »

danieltillett wrote: post #198
eropple wrote: post #165

Earlier quoted context omitted.

Is there a compelling reason for codeine to be OTC in the first place? It's an addictive opiate.

Codeine at the dose available over the counter is not very addictive. On top of this the pharmacists record your details so that anyone addicted is picked up and helped. As far as I can determine there has not been a problem with OTC codeine in Australia. As for why to not make it prescription only is we have universal healthcare in Australia. Shifting low dose codeine to prescription only will cause a massive increa…

When I was a kid you could purchase codeine cough medicine OTC in my U.S. state (it was same deal as you describe for Australia -- the patient would have to sign a register so the pharmacist could make sure you weren't buying five bottles a day or whatever).

Nothing works as well for a nagging cough as codeine and terpin hydrate. Nothing.

Unfortunately, you've got to go to a doctor to get it nowadays.

Instead, most people use OTC stuff with DXM (which doesn't work as well, is an abusable drug in its own right, and is quite likely more toxic than the codeine).

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