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Pain Management?

 
Old 05-14-2019, 12:19 PM
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Default Pain Management?

I'm confused. What are doctors doing for pain management these days? Is there a typical "plan" now that prescription opioids are so frowned upon?

It just seems like they've taken such a 180 degree turn in the last few years from throwing pain medication at you by the bundle for anything, and now they seem to prescribe literally nothing for anything.

I'm going on Total Hip Replacement #2 now. My right hip femur head has now collapsed, and I go in for surgery the first week of June. I've also got significant back issues contributing (MRI report on that reads like a hot mess).

Almost exactly 5 years ago I went thru the same thing with my left hip. I got a Total Hip Replacement on that one too.

Back then, they thru every pain medication at me like candy. Oxy in the last stages when it got really bad, but Tramadol by the bushel before that and everything else up the pain medication ladder as well.

Now they aren't even suggesting anything. It almost feels like a taboo subject to even bring up. I am on nothing at all right now....not even Tylenol (at this pain level why bother?)

I'm dealing with it, and it will be much better in a few weeks after surgery. And I don't want their drugs anyway. I've got a better plan myself anyway.

But......I'm just wondering why such a swing in the way they treat pain? Now it seems as though pain management is "see what they can tolerate" as opposed to how it used to be "see how much we can prescribe them". This is both with my VA doctors and my private doctors.

Anybody seeing the same thing I'm seeing? Anybody know of any official policies?

This is the **** that makes me lose confidence in the medical field. It's like eggs......one year they're great for you....one year they will kill you. It just depends what study you look at.

It almost feels like there is as much politics in medicine as.........politics.
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Old 05-14-2019, 12:22 PM
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I was diagnosed with chronic acute pancreatitis 8 years ago. Standard operating procedure is for me to drive to the ER, have the entire staff call me a liar (in so many words), and then send me packing after a few hours and one shot of morphine. Pain management perfected. Insurance is all but useless at this point, unless something catastrophic comes up.
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Old 05-14-2019, 12:29 PM
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They blow sunshine up your *** and tell you that you need physical therapy.
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Old 05-14-2019, 12:34 PM
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Originally Posted by jashmore1234 View Post
They blow sunshine up your *** and tell you that you need physical therapy.


THAT IS LITERALLY THE VA!!!

That's what they've told me for the last year.....I need physical therapy. They basically said I'm old and stiff (I'm 54 )

Then I go to my private doctors. X-Rays and MRI's reveal new hip is needed and back is a total mess. Neither of which was a surprise to me at all.

I'm completely done with the VA now. I would rate them as "incompetent". And that is not a word I use lightly.

And AOC.....you can shove the VA up your ***.
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Old 05-14-2019, 12:55 PM
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Knee jerk reaction to the opioid overdose problem. I can't really blame the Doctors with all the deaths happening around the country. My last prescription for Norco came with a box of NARCAN even though I've only taken 2 half tabs of Norco in the last 6 months. Better safe than dead.
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Old 05-14-2019, 12:57 PM
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I have chronic Nerve pain from a bilateral Hernia 2 years ago. While I go through every procedure known to man (acupuncture, numerous Nerve Blocks,etc). I manage the daily pain with 6 tramadol and 2 1 mg ativan a day. Some days are okay and some are not. Without pain management, I'd have done something drastic by now.
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Old 05-14-2019, 01:04 PM
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Originally Posted by Low12s View Post
I have chronic Nerve pain from a bilateral Hernia 2 years ago. While I go through every procedure known to man (acupuncture, numerous Nerve Blocks,etc). I manage the daily pain with 6 tramadol and 2 1 mg ativan a day. Some days are okay and some are not. Without pain management, I'd have done something drastic by now.
Disc hernia's? Which ones?

I've got 4 in the L2-L5 region with L5-S1 being worst, along with moderate central canal stenosis (ie nerve pain here too). A bunch other ugly crap like facet hypertrophy, osteophytic spurring, etc.

But this isn't even the focus right now. Right now the focus is my collapsed hip and getting me a new one at the first available time slot (first week in June).

And zero pain drugs for this currently. I seriously don't know whether I'm insane or super human.

Last edited by X-ZZ4; 05-14-2019 at 01:07 PM.
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Old 05-14-2019, 01:09 PM
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Originally Posted by moose.b3 View Post
Knee jerk reaction to the opioid overdose problem. I can't really blame the Doctors with all the deaths happening around the country. My last prescription for Norco came with a box of NARCAN even though I've only taken 2 half tabs of Norco in the last 6 months. Better safe than dead.
That is my feeling.

And I don't know whether doctors are to blame or not. It just sure seems like there would be something in between this "all or nothing" thing.
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Old 05-14-2019, 01:24 PM
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Lansing — Michigan set a new record for overdose deaths last year, the state reported Thursday, but the rate of growth in the opioid-related death epidemic is slowing.

Preliminary data showed 1,941 of the 2,729 overdose deaths in 2017 were opioid-related, according to the Michigan Department of Health and Human Services. It represented an 8.7 percent increase from the 1,786 opioid-related deaths in 2016

I head on the news we are 2nd only to the District of Columbia..

That's ALMOST all traffic and firearm deaths combined

According to the National Safety Council, 962 traffic fatalities were reported statewide in 2018

Firearm Deaths1,138


https://www.detroitnews.com/story/ne...an/1520040002/
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Old 05-14-2019, 01:28 PM
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My neighbor is going through this now. He had a bad motorcycle accident and a botched surgery that gave him a bad staff infection.

Dude says they will only give him 800mg ibuprofen. Poor guy is in bad shape. I would source some on the dl if I were him.
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Old 05-14-2019, 01:34 PM
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Originally Posted by jashmore1234 View Post
They blow sunshine up your *** and tell you that you need physical therapy.
I agree through experience with my minor hand problem. With hip problems, PT was prescribed for a friend before and after surgery.

PT is their prescription for seemingly any movement discomfort or constriction. A given doctor perceives no personal liability because that's what they all do.
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Old 05-14-2019, 01:41 PM
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Originally Posted by X-ZZ4 View Post
I'm confused. What are doctors doing for pain management these days? Is there a typical "plan" now that prescription opioids are so frowned upon?

It just seems like they've taken such a 180 degree turn in the last few years from throwing pain medication at you by the bundle for anything, and now they seem to prescribe literally nothing for anything.

I'm going on Total Hip Replacement #2 now. My right hip femur head has now collapsed, and I go in for surgery the first week of June. I've also got significant back issues contributing (MRI report on that reads like a hot mess).

Almost exactly 5 years ago I went thru the same thing with my left hip. I got a Total Hip Replacement on that one too.

Back then, they thru every pain medication at me like candy. Oxy in the last stages when it got really bad, but Tramadol by the bushel before that and everything else up the pain medication ladder as well.

Now they aren't even suggesting anything. It almost feels like a taboo subject to even bring up. I am on nothing at all right now....not even Tylenol (at this pain level why bother?)

I'm dealing with it, and it will be much better in a few weeks after surgery. And I don't want their drugs anyway. I've got a better plan myself anyway.

But......I'm just wondering why such a swing in the way they treat pain? Now it seems as though pain management is "see what they can tolerate" as opposed to how it used to be "see how much we can prescribe them". This is both with my VA doctors and my private doctors.

Anybody seeing the same thing I'm seeing? Anybody know of any official policies?

This is the **** that makes me lose confidence in the medical field. It's like eggs......one year they're great for you....one year they will kill you. It just depends what study you look at.

It almost feels like there is as much politics in medicine as.........politics.
See if you can have the hip replaced by the newer anterior approach. Much faster ambulation, recovery and less pain.
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Old 05-14-2019, 01:57 PM
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The way to successful narcotic use for me was to make my own plan and stick to it.
Doc originally prescribed 4 narco 10.0 @ 24 hr period.
That is a hello lot bud.
With constipation as result, you have to get that under control right away. I call it ''God's great narcotic regulator''.
(I really don't know how addicts continue there life style.)
Only 3 was required I determined.
Cut them in half using one of these pill cutters. Take 1/2 and give it 55 mins. that's how long it takes to ramp up.
Lay down , or it's like I never took one.
After that, that's as good as that dose will get. May as well get up and do some chores .
Buy one of those ''will be back at 2'' signs they stick on the store doors and set the hands at the time you took the 1/2 pill.
Your bods going to fool you.
But that little clock doesn't lie. You have 3 more hours to tuff it out before you can take another 1/2 pill.
That's when the Tylenol/Motrin's come in.
I stuck to this... and as I improve, I am down to 1.5 narcotic pills in 24 hr.
Been that way for 3 years.
Doc laughs , say's I am the '' poster child for responsible opioid use.''....
Normally people increase the pill intake, It seems to become less effective as time go's by.
But as I got better, I was able to stay at the same intake level .
That my friends , Will help you cope with your injuries maybe for the rest of your life.
God speed boys.
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Old 05-14-2019, 01:59 PM
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My wife had a thee level cervical spinal fusion here in Los Angeles. It just changed the nature of the pain, not the intensity. We went to the Mayo Clinic in Phoenix for an consultation. Surprisingly the consulting doctor was the chairman of their neurological surgery department! He said her operation had been competently done, complete fusion, no infection. He said that because of the years before the operation, her spinal column was experiencing permanently damage. She will probably be in pain for the rest of her life. He said the good thing about the operation was that her condition should not worsen. Upon return home, our family physician sent her to a pain management specialist. To be accepted into his practice, she had to undergo a quantitative urine analysis ($$$) and a psychiatric examination. This is to help the doctor substantiate to the FDA she is not a drug addict. She has a Tramadol prescription, non-renewable, for 30 days. 3, 50 mg tabs per day plus gabapentin.. Renewing the prescription every month requires at usually two phone calls. After two years of monthly visits to the doctor for the prescription, she now goes once every three months. Life would not be tolerable without the Tramadol.

BTW, part of the reason for the psychiatric exam is that people in chronic pain often develop clinical depression, so pain management also requires treatment for depression.

Last edited by 68/70Vette; 05-14-2019 at 03:26 PM.
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Old 05-14-2019, 02:02 PM
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Originally Posted by X-ZZ4 View Post
That is my feeling.

And I don't know whether doctors are to blame or not. It just sure seems like there would be something in between this "all or nothing" thing.
In the '90's our medical societies came to their conclusion that we docs were under treating pain. So medical standards changed and more narcotics were prescribed as pain level became the 5th vital sign. More recently the political powers that be have decided that we docs have created too many addicts and related deaths. So many docs have pulled back or out of pain management.

In my own practice since I always do what is in my patients best interest, little changed with any of the above. Until recently where I've had to temporarily quit my practice in order to care for my wife, I was one of the highest primary care prescribers of narcotics in my county. For which I remain proud, not ashamed.
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Old 05-14-2019, 02:04 PM
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Originally Posted by Hoonose View Post
See if you can have the hip replaced by the newer anterior approach. Much faster ambulation, recovery and less pain.
It will be. My last one was as well. My surgeon (same one for both surgeries) is outstanding.

Last one was in-hospital. I thought that went incredibly well. I was in Monday morning, out (and walking) Tuesday night.

This one is even more accelerated, and it is outpatient. No hospital this time.....dedicated joint replacement surgery center. And no overnight stay.....in at 7am......out at 5pm!

I'm not worried at all about the surgery. I know I'll be fine after. I'm just wondering about the drastic change in how pain is managed (or not managed really) these days.
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Old 05-14-2019, 02:07 PM
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Originally Posted by 68/70Vette View Post
My wife had a thee level cervical spinal fusion here in Los Angeles. It just changed to nature of the paid, not the intensity. We went to the Mayo Clinic in Phoenix for an consultation. Surprisingly the consulting doctor was the chairman of their neurological surgery department! He said her operation had been competently done, complete fusion, no infection. He said that ibecause of the years before the operation, her spinal column was experiencing permanently damage. She will probably be in pain for the rest of her life. He said the good thing about the operation was that her condition should not worsen. Upon return home, our family physician sent her to a pain management specialist. To be accepted into his practice, she had to undergo a quantitative urine analysis ($$$) and a psychiatric examination. This is to help the doctor substantiate to the FDA she is not a drug addict. She has a Tramadol prescription, non-renewable, for 30 days. 3, 50 mg tabs per day plus gabapentin.. Renewing the prescription every month requires at usually two phone calls. After two years of monthly visits to the doctor for the prescription, she now goes once every three months. Life would not be tolerable without the Tramadol.

BTW, part of the reason for the psychiatric exam is that people in chronic pain often develop clinical depression, so pain management also requires treatment for depression.
I am definitely not "as cheery" as I am normally. I'm a bit concerned about this if my pain in my back continues after my hip surgery. But I'm hoping hip surgery alleviates much of the back pain. Emphasis on "hoping".

I find the rest of what you're saying comical. Last time around they threw the same stuff at me, including gabapentin. Somehow, without the psychiatric exam and urine tests I survived addiction free. But now they worry people magically turn into addicts overnight?

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Old 05-14-2019, 02:08 PM
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Originally Posted by Hoonose View Post
See if you can have the hip replaced by the newer anterior approach. Much faster ambulation, recovery and less pain.
Yup!!

I had a hip replaced in October via the anterior approach. That approach is more complicated and isn't for everyone, but if you are a candidate, it most definitely has less post-surgical pain and a much lower chance of dislocation which is a big deal. In my case, I had a prescription for10 oxycodone but never filled it because my pain was relatively minor and much less than what I was living with unmedicated before surgery.

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Old 05-14-2019, 02:12 PM
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Originally Posted by Hoonose View Post
In the '90's our medical societies came to their conclusion that we docs were under treating pain. So medical standards changed and more narcotics were prescribed as pain level became the 5th vital sign. More recently the political powers that be have decided that we docs have created too many addicts and related deaths. So many docs have pulled back or out of pain management.
Well......you've confirmed my suspicions. Thanks.

In my own practice since I always do what is in my patients best interest, little changed with any of the above. Until recently where I've had to temporarily quit my practice in order to care for my wife, I was one of the highest primary care prescribers of narcotics in my county. For which I remain proud, not ashamed.
Excellent work. Serious.
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Old 05-14-2019, 02:15 PM
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Originally Posted by X-ZZ4 View Post
It will be. My last one was as well. My surgeon (same one for both surgeries) is outstanding.

Last one was in-hospital. I thought that went incredibly well. I was in Monday morning, out (and walking) Tuesday night.

This one is even more accelerated, and it is outpatient. No hospital this time.....dedicated joint replacement surgery center. And no overnight stay.....in at 7am......out at 5pm!

I'm not worried at all about the surgery. I know I'll be fine after. I'm just wondering about the drastic change in how pain is managed (or not managed really) these days.
That sounds like my experience also. I had mine done in the afternoon and was home the next morning. It took me about three and half weeks until I was able to drive and I was walking without a walker or a cane at the five week point. I was doing three miles a day of walking at the 10 week mark.

But, not everyone has the same result and some require more time than others for recovery. These procedures typically have a fair amount of blood loss, in my case 1.2 liters and that can knock you a bit low for a while until your hemoglobin count starts rising.

Good luck.
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