Comments on life, the universe and everything from an aging Sixties survivor.

Location: Massachusetts, United States

Ummm, isn't "about me" part of the point of the blog?

Tuesday, June 05, 2012

Pain, or...

The Harrumpher recently rearranged his musculoskeletal system in a bicycle accident. In the course of tossing chaff about this to and fro, he mentioned that he was prescribed Oxycodone, found that it didn't do much good for him, and decided to do without it: he chose wisely.

On this subject I present this information for reflection. This falls well within my professional purview. About all I can say legally is that my experience confirms this study absolutely. Too many physicians are too quick on the trigger when it comes to prescribing opiates. In justice to them, too many Americans are too eager to make the pain go away right now, regardless of the consequences. The consequences, all too often, are drug addiction. The TV character of House, with his painkiller addiction, is art imitating life. Opiates, especially the "safe" ones, such as Oxycontin and Oxycodone, are the most prescribed drugs in America.

I have both empathy and impatience for those who fall into this trap. Empathy because I have an experience of pain that will trump most people's when it comes to games of "can you top this." Impatience for the same reason. I do consider that I haven't been tempted by opiates, simply because they might as well be sugar pills for treating my nasty friend. I have my life courtesy of powerful doses of two anti-convulsants, plus a hypnotic to put out the fire when they cannot. Both the warnings of my physicians, and my own experience, lead me to treat the hypnotic about as casually as a high explosive, because it's as addictive as crack. However, does every patient have both clinical knowledge and professional warnings available when it comes to painkillers? That answer is obvious.

We used to let our paranoia run wild and imagine dark foreign conspiracies to turn us into a nation of junkies. That would be a waste of energy, because we're doing a good job without outside assistance.


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Blogger massmarrier said...

I confess that I agree and grew up thinking the take-it-away attitude toward pain is weak, understandable but weak. I was disturbed to feel the urge to double up (or more) on the opiate or or more. I won, but it wasn't easy. It's hard sometimes being human.

12:32 pm  
Blogger Uncle said...

It's no easy thing to turn away from the promise of relief, don't I know. After reading your last Harrumph, I did a little homework on some related subjects...

1) Patients are likely to lose a lot of weight after trauma, especially fractures, first because the body is set up to repair major injuries as well and as quickly as possible. You’re in metabolic warp drive. The repair functions make very high demands on your resources. Along with that, there is evidence that otherwise healthy people may suffer from malnutrition during recovery from physical trauma, because the demands for repair are so far ahead of supply.

2) Hospitals give patients (especially fracture patients) Tums or the like because the repair function is diving deeply into your Calcium resources, and Tums are a good, cheap and readily absorbable source of Calcium. Also, if you lost enough blood to require receiving blood, that too can throw your Calcium balance out of whack. One thing that can happen if your Ca is low is that you’ll sneeze a lot. Believe me, with broken ribs you so don’t want to do that.

3) Hospitals give you laxatives because opiates, even in small amounts, slow or stop the wave action (called peristalsis) that moves food and waste through the gut. This contributes to lack of appetite, but it also causes constipation, and constipation from this cause can lead to impaction and really serious, even fatal,
complications. You must remember getting tincture of Paregoric for diarrhea as a kid: same deal.

Clinicians know more than cynical, disillusioned patients may realise. Their great weakness is that they don't share information like this with anyone who isn't part of the club. The clinician-patient relationship would be better if they did.

10:38 pm  

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