OT - Broken shoulder and rib

[eKretz]

A definition of irresponsible prescribing that applies patient by patient and situation by situation would be so helpful.

I guess it is tempting to think this problem of being "responsible" is easy. It is not. It must be one of the most challenging for practicing physicians. How to be compassionate and still not screw up a perfectly normal person converting them into an addict.

Folks did not come into the office with an "A" on the their forehead if they were addicts or were likely to become addicted. In fact, those addicts spent an enormous amount of time and effort attempting to deceive and defraud well-meaning docs. (I had one guy who we learned presented to my office late on a Friday afternoon with a "fresh" few-day-old surgical wound on the midline of his abdomen with a well-practiced story of travel home, significant pain, etc etc. The thing was his he kept freshening his wound with a razor blade for one doc after another). So ya, docs get gun-shy.

And we do see injured people requiring/requesting/pleading for pain meds. The trick was to convince them that try to take away their pain entirely was practically impossible and attempting to do so has significant risk. A cooperative approach with them doing their part to avoid addiction is important. When I hear folks wanting the docs to "take their pain away" I see huge red flags. That is the whole point of what I have written. Use the meds responsibly, but fear them. They are dangerous and there are untold numbers of good people who have been harmed by well-intended treatments. If the patient takes initiative to protect themselves outcomes will be better and they will be safer.

I did not think that needed explanation, but maybe it does. Machinery is dangerous and anyone using it should be clearly cautioned. Pain Medications are also just as dangerous and more insidious, and patients certainly should be cautioned.

Denis

All of these fear mongering CDC and news articles are confusing the situation by mixing long term chronic pain patients and drug seekers. There's no confusion in a situation where a patient sees a doctor long term, but a doctor is still afraid to prescribe medication because addicts have f*cked things all up. For instance, I've seen the same doctor for pain management for well over a decade. He still expresses fear of the ATF and CDC guidelines. Most people do that same mixing of addicts and legitimate patients in severe pain. I have no sympathy for drug seekers for that reason. You're barking up the wrong tree if you expect find any here. I also don't see how a patient that is regularly randomly drug tested could possibly be taking medications or dosages that they shouldn't be without getting caught. Being cautioned is one thing. To caution someone you say "be aware, be careful." Fear mongering is another. Saying"fear this! Be afraid!" Is not cautioning. The only thing to fear is irresponsible use. That isn't the fault of the medication. It's the fault of the person who doesn't have enough willpower not to abuse it to get high and the fact that they're somehow able to get away with it when they shouldn't be.

 

[dgfoster]

I am sure there are always people who get trapped in rules and definitions through no fault of their own. It is impossible to write the perfect law or machine the perfect part.

I am also certain there are a lot of people who suffer some injury or painful condition who start down the path of using (as prescribed) pain meds who could not for the life of them imagine becoming addicted. But they do end up addicted. I know for certain it happens and way too often.

In my opinion, not warning people of that clear and present danger and getting them involved from the start in avoiding pitfalls unconsionable. Opioid Pain drugs are dangerous. They should be used when necessary. Their use should be minimized (except in terminal cancer cases) to the extent that it is possible based on the tolerance and understanding of the person taking the meds. They need to use non- narcotic pain meds and other modalities as much as is safe and effective to reduce the need for narcotics. Warning is not prohibiting. Warning is not fear mongering.

Denis

 

[stephen thomas]

Richard -
wife & I were out of the country through the end of April, started to catch up in May, somehow missed this.
Really sorry to hear about it, trust you are well on your way to being back in excellent shape!

My mom used to terrorize us about her mom (who was actually her grandma) being an addict & throwing her up against the wall when she was a toddler. So it kept me from being interested. Most of my injuries and such i politely took the bottles of pills and stashed them on a shelf. Then in 2015 a motorcycle accident broke my shoulder blade and most of the ribs on the left side front and back. In the hospital i did get to where i kept turning the morphine drip up & even took the pills. They sent me home with a big bottle of ocy's and i threw them away. In the ICU i never had a bowel movement all week, and always smelled like burning plastic. Couldn't wait to eat actual vegetables and decent food. Later a PM'r friend who had had a horrific disability construction accident and i were talking about pain and a 3rd party mentioned opiods. I said they don't actually even take the pain away, but it doesn't matter anymore. My friend jumped on that and agreed: You still feel most of the pain, you just don't care. Or at least that was a big part of my experience.

Sorry for the digression - Richard hope you are pain free and healing well!
smt

 

[eKretz]

I am sure there are always people who get trapped in rules and definitions through no fault of their own. It is impossible to write the perfect law or machine the perfect part.

I am also certain there are a lot of people who suffer some injury or painful condition who start down the path of using (as prescribed) pain meds who could not for the life of them imagine becoming addicted. But they do end up addicted. I know for certain it happens and way too often.

In my opinion, not warning people of that clear and present danger and getting them involved from the start in avoiding pitfalls unconsionable. Opioid Pain drugs are dangerous. They should be used when necessary. Their use should be minimized (except in terminal cancer cases) to the extent that it is possible based on the tolerance and understanding of the person taking the meds. They need to use non- narcotic pain meds and other modalities as much as is safe and effective to reduce the need for narcotics. Warning is not prohibiting. Warning is not fear mongering.

Denis

I am sure that people getting trapped et al is true. As I noted, cautioning or warning of dangers is one thing. Telling people to be afraid is another. I do not agree with that approach. And yes there absolutely is long term severe pain that nothing but opioids will touch, just the same as cancer patients go through but without the terminal diagnosis - and I have seen it firsthand where it's thought that someone who will only endure it a short while and then die should get pain relief, while someone else that will have to endure such pain for possibly decades is told to "tough it out." And there are other types of pain that absolutely do not need opioids, and they get prescribed anyway. I have gotten plenty of prescriptions for hydrocodone and similar medications over the years at the dentist and such that were never even filled. If you don't need them, don't fill them. If you do need them, use them responsibly. I'm still not going to tell anyone else to be afraid of them. I don't have a lot of sympathy for those who don't have the willpower to make the distinction. Do I think it's a crying shame, sure. But having been on the other side of that coin and having had a lot of pain caused by doctors' unfounded fear of medications, I don't have a whole lot of sympathy for those people. I'm not the right guy to try to convince. I still suffer a great deal every day, and will for probably the next couple decades. Taking opioid medications does not automatically create addicts. Do people need to be aware that the medication can create dependence and addicts will tend to abuse it? Yes. Do they need to be afraid? No. Double the amount of people that die from opioids each year die in car crashes. I just looked that up on a whim.

 

[Richard King]

thanks Stephen and all who wished me well. i'm not seeing what dennis saying as i have had him on ignore for a longtime. i am sure he has a wealth of good info as he is retired from the medical side of things.. the new pm forum only shows the ignored folks say something when the other person hits reply. otherwise noting is shown. . i could open what he says, but i want my blood pressure to stay down. oh my reg doc lowered my bp pills down today too.

I only took 1 pain pill today because my back was killing me. Thought home healthcare i have 2 people who come in every couple of days who have me exercise. today one who i think is PT had me doing leg exercises and an OP who help move my hand, wrist, elbow and shoulder. that hurt today as my arm has'nt moved much in the sling the past weeks. i took 2 Tylenol. im saving the pain pill for the bad pains...lol... they also prescribed a sticky patch with 4 percent Lidocaine. my regular doc told me i can put them on my back if needed. they said to put on my left arm. ive only used 3 as my wife has issues taking off the wrap over the sticky side. hopefully not taking the pain pills will make it easier to go number 2. . I saw my reg. doctor today... ive lost 10 pounds, my INR is good, my hemoglobin is good, my glucose is the best it's been. so it sucks having the broken bones...lol..but its helping me in other ways..

 

[Joe Miranda]

Sorry to hear of your trouble and glad to hear you are on the mend! Sounds like you are doing as well as can be expected. Good job on losing weight, glucose numbers, and staying off the pain pills! Praying for a steady recovery for you and that you regain good use and mobility of the arm and shoulder.