Article Talk: Opioids Aren't Always the Answer for Certain Post-Op Procedures

Started by jlg1254, April 07, 2018
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jlg1254

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April 07, 2018
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jlg1254

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April 07, 2018
I really resent this article and the many others like it. I am not a cancer patient, but I did take care of my mother who had stage 4 breast cancer and is no longer with me. I had to advocate for her to obtain pain relief because she also had dementia and had difficulty verbalizing when and where she had pain, especially as her dementia progressed. She never received more than 50mg Tramadol, which is barely a drop in the bucket when it comes to serious pain relief. I suffer from chronic pain - mostly due to Fibromyalgia and Lumbar spinal stenosis. I have difficulty walking any significant distance or standing for extended periods of time. I also have recurrent right foot pain due to a recent car accident which forces me to walk with a cane due to balance issues and I'm not even 60 yrs old yet! So, yes, this gets pretty depressing for me. The people who are dying from opioid overdoses are not the ones who have been taking opioids for chronic pain for at least a year or longer. These are patients who are trying to regain some relief from the overwhelming pain they have, to restore some semblance of order to their life, to, perhaps, continue on in a PT or FT job without having to depend upon SS disability or help from others, to take care of themselves and their activities of daily living, especially if they live alone (as I do). For chronic pain patients, the class of medications called "opioids" can be life-saving medications when used properly - this is the key. If someone doesn't have chronic pain (short-term pain is typically less than 3 months duration), perhaps something like acetaminophen or NSAIDS (either OTC) or prescription will suffice; even something innocuous such as Tramadol might be helpful. A physician needs to work with his patient to determine the type of pain his patient has and medicate that pain properly so the patient can recuperate through the healing stage and not be in so much pain that physical therapy cannot be performed or simple ADLs cannot be done! Unfortunately, the way we fix things today is by going overboard! Physicians are being blamed for overprescribing in the past because PAIN was treated objectively as the "5th vital sign" - meaning we asked patients to describe their pain and how long they had it and what made it better/worse and we believed them! We then medicated them to, hopefully, help them feel better. If we don't do that, we should be getting to the root of the pain and fixing that, instead. But, we have now gone too far in the opposite direction, defining everyone who takes opioids as a potential addict. This is not true. "Addiction-prone" people are very different from someone with chronic pain who is taking opioids. Unless you suffer from pain every day, you cannot judge what a person in pain feels like and what he/she needs to be part of society & not appear totally disabled. Right now, I have to measure out the activities I can do on a daily basis so I don't "pay" for it with more pain the next day. Why? Because addicts with their penchant for opioids have made it more difficult for me to acquire the medication I need on a regular basis. I now have to go through "prior authorizations" that weren't previously required and limitations on dosages by my insurance company because of the "crisis" addicts have created for what used to be a helpful medication. Of course. the insurance companies love this because if doctors don't put through the prior authorization forms or call the insurance co. on behalf of the patient now, either the patient has to pay for the medication out of pocket or doesn't get it at all! And the insurance co. doesn't care if me or any other chronic pain patient has abruptly stopped taking our opioid medication due to their insurance rules and regs and we get sick, as a result. It's all about the money. An addict will do anything to get his/her "fix". The addict will pretend to have lost the script the physician just gave him in order to secure another one! He/she will have a physical and psychological craving for the opioid - it covers feelings he'd rather not deal with or have exposed. The chronic pain patient will also deal with physical withdrawal if caused to abruptly stop the medication - this is purely a physical reaction. Tolerance develops as one takes opioids and it is not easy to withdraw from "cold turkey". Chronic pain patients do not get "high" from their opioid meds, we just look forward to some pain relief so we can get through our day like people without pain. Addicts, on the other hand, look for the opioid even after the short-term pain is no longer a issue, they will "doctor-shop" to attempt to get scripts from a different physician, they will pharmacy shop so their prescription history looks piecemeal in any one pharmacy, they will even steal pharmaceuticals from friends medicine cabinets. A good and attentive physician will recognize these signs and will perform a thorough enough exam to realize he is dealing with an addict and should not give into the request. Someone who is truly suffering from chronic pain, for whom the opioid is helping, will be willing to sign off on an "controlled substance contract" - something that many practices make their patients do. It's a promise you, as a patient, are making with your physician not to carry on abusive type practices while on the medication. Addicts may do this, but don't keep their promise. Let's not let a few bad apples (addicts) spoil what works well when used properly, for the right reason, and for the right patient group. We're not dealing with Thalidomide here. If ED physician can easily identify "addicts" looking for a "fix" so should office-based physicians. If they can't, let's re-educate them. You don't remove the meds from the group of patients for who they help, especially cancer patients.
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