Pain management pre and post surgery in the opiod epidemic era.

[fantastic_damage]

Just wanted to write about my recent experience and how the medical industry basically lets you suffer now due to the opioid epidemic.

About 2 weeks ago I blew up my T12 vertebre at the bike park with a nasty burst fracture, it was in pieces. Absolutely brutal pain, I also had compression fractures in my T9 and T10.
While it's to be expected that you will be in pain until you get medical help you would think with this kind of injury they will try to keep you comfortable with pain meds.
WRONG, things are nothing like they were in the 2000's.

I layed in the hospital on my back for about 50 hours as they decided what to do.
They gave me oxycodone immediate release 5 mg pills every 3 hours, the other 3 hours they would IV me (.5) dilaudid. I gotta be honest, this barely did shit for my pain, yes after the Dilaudid shot i'd get maybe 2 hours relief. The oxy 5 mg didnt do shit, they refused to up any of the doses. They gave me also a musce relaxer for the brutal back spasms I was getting.

So 50 hours of massive pain then they finally clear to operate on me. After the surgery they gave me a push pump for dilaudid, this did help to an extent bit they were quick to yank me off it at about 19 hours post op.

So they put me back to the exact prior pain doses which I got some relief for 2 hours and then another 4 hours of hell until the next shot.
5 days in the hospital and they sent me home with 8 of the 5 mg oxycodone pills and naxalone spray in case this 210 lb man OD's on 40 mg of oxycodone LOL.
This wasn't doing shit for pain, I started to take a lot more tylenol than was safe but it was my only option.

Back in the 2000's I had ACL surgery and even a femur fracture back and I was pretty comfortable pre and post surgery in both cases. Hell for my femur fracture there was a Dr on the hill with fentanyl spray for this very reason, this helped immensely for getting off the mountain to the ambulance where they made me even more comfortable in regards to pain. Fast forward 12 years and you get nada.

Bottom line in this current era try your hardest not to get injured as they will not give you anything now.
Make conservative choices in whatever sport you are doing if you don't want to suffer, they'll fix you but they will not make much of an attempt now to manage your pain, doesn't matter if you're telling them you are still at a 7 or 8+ on the pain scale.
Look I get the opioid epidemic fallout etc but they have gone full retard in the opposite direction now with regards to pain control.

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[Core Shot]

That’s some fantastic damage. Ouch.

Junkies have ruined modern pain relief.
Glad you’re taking Tylenol instead of any nsaid. They prevent bone healing.

I couldn’t wait to get off oxy and perc. Had many pills left. But when the pain was on they were the key.

[SumJongGuy]

Sent home with a bottles full of heroin pills. What could possibly go wrong? Bring back the good old days when they'd keep you in the hospital with the button for a couple weeks then ween you and send you home healed.

[schindlerpiste]

That's weird. They gave me 5mg oxy for post-surgical pain after removal of a gall bladder, and it totally floored me. I don'y like that stuff. Bring back the RORER/LEMONs

[fantastic_damage]

Sent home with a bottles full of heroin pills. What could possibly go wrong? Bring back the good old days when they'd keep you in the hospital with the button for a couple weeks then ween you and send you home healed.

We live in a capitalistic medical system, insurance says you gotta gtfo asap for the next patient, time in that bed is money. Fuck the patients comfort and pain now too, get yer suffering ass home.
Everyone is different with regards to pain, i have a high pain threshold but also have a very high resistance to pain meds, in the past I could take like a 20 to 30 mg oxy pill and be perfecly fine, not getting floored etc just being comfortable going about my day post surgery.
This was hands down the most painful experience of my life without question.

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[TahoeJ]

Dang, that sucks. I'm wondering if your experience was localized or more universal. My doc friends here in NorCal have said they're mostly more careful now about ongoing prescriptions vs. immediate post injury / op pain relief.

[detrusor]

What also sucks is that it sounds like your surgeon did not do a paravertebral block


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[fantastic_damage]

Dang, that sucks. I'm wondering if your experience was localized or more universal. My doc friends here in NorCal have said they're mostly more careful now about ongoing prescriptions vs. immediate post injury / op pain relief.

That's my biggest beef with this, why cut back on the initial traumatic injury pain management & acute pain caused by that??
Why make the victim suffer when we have the tools to make them comfortable even with them being broken in pieces?
The patient is layed out on their ass in a controlled medical environment, they think I'm going to go on a rampage looking for pain medications in the hospital after I get a dose of some actual pain relief?

I totally get them not wanting to send me home with an RX for a stack of opioids, I really do understand their position in that regard but why do they have to scale back on the most brutal days surrounding the traumic crash and that acute pain.

Makes me fear any future injuries as I know medical will be there to barely do the bare minimum on the pain management aspect.

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[m2711c]

medical bureaucracy vs. applied medicine... rules are rules and if ya want to stay insured, ya better follow the rules.



i wonder how much longer till the pendulum starts swinging back the other way on this issue.

[fastfred]

good luck with getting any pain pills these days shit is on lock down

spent five days in the icu with fentanyl on demand got me off that then regular pain pills in the regular hospital bed for a few more days
they sent me home with maybe 5-10 pills can't remember
needed half of them just for the hour plus car ride home from the hospital
called the next day asking for more and they refused to give me any literally crying in pain unable to sleep take a Tylenol is what they said

won't lie I do like oxy's

[old goat]

3 years ago I broke T3 and had a fusion. I also had 14 rib fractures, a minor acetabular fracture, and some transverse process and compression fractures. I was getting enough pain meds IV that the nurse had aj hard time waking me up. I was scared enough to cut back the dose. I don't remember what I was getting, but when I was switched to oxycodone I was on 10 mg every 3 hours for a couple of weeks, in the hospital and home. I had no trouble getting off of it. Every patient is different. Every injury is different. Every doctor is given.

They're required to give you narcan when they send you home with strong opiates. I tried to give mine away but no one would take it.

[sb]

Dont get hurt.

[XXX-er]

For the ACL they gave me hydromorphine which i didnt like and Tramadol for after the hydromorphine which I also didnt like

so I swithced to IBU soon as the hydro morphine was finished after 6 days and it was OK for me

[old goat]

Opioid pain management is a two edged sword--like everything else in medicine. On the one hand it facilitates mobilization and breathing, which prevents pneumonia and blood clots and wakes the bowels up. It also reduces the excretion of stress hormones, which is good. OTOH it depresses breathing and slows the bowels. Getting it right isn't easy. Some docs are better at it than others. It doesn't help that there's a lot of scrutiny on overprescribing these days; that shouldn't make a big difference in postop and trauma prescribing but sometimes it does. As a rule of thumb, if a person enjoys the narcotics they're probably getting too much. The pain counteracts the pleasure. This doesn't apply to premeds for a procedure, but that should be a one-time deal.

As far as addiction it helps when a patient is in a closed system, where every doc and pharmacy can see what the patient is getting and prescribing and tapering off are managed by one doc, with everyone else staying out of the way. This works, unless the doc in question is running a pill mill. The CURES registry, in California, which is a database of controlled substances prescribed to individual patients, is supposed to prevent people from getting drugs from multiple sources. I don't know how effective it is.

[rideit]

I have always been the type that could enjoy the fuck out of them for a week, dosing at my discretion, and then just stop when the scrip runs out. Over and done…type to get back to life and cycling.

[AK47bp]

I have always been the type that could enjoy the fuck out of them for a week, dosing at my discretion, and then just stop when the scrip runs out. Over and done…type to get back to life and cycling.

Quitter


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[Dantheman]

Junkies have ruined modern pain relief.

We don't often agree, but here we are. Dumb people give goods drugs a bad name.

Actually, that's unfair. Most people who become addicts are self-medicating for untreated trauma, usually from childhood. A basic pre-Rx psychological evaluation and ACE screening would identify most people who are at risk for addiction.

I have always been the type that could enjoy the fuck out of them for a week, dosing at my discretion, and then just stop when the scrip runs out. Over and done…type to get back to life and cycling.

My longest stretch ever was 7-8 days waiting for surgery and immediately after surgery on a shattered clavicle. I couldn't get off them fast enough and didn't even look at them for a few months after. I love opioids in low doses as a nice way to relax on a chill Friday evening, but in high doses and/or day after day? Ew, gross.

[XXX-er]

Opioid pain management is a two edged sword--like everything else in medicine. On the one hand it facilitates mobilization and breathing, which prevents pneumonia and blood clots and wakes the bowels up. It also reduces the excretion of stress hormones, which is good. OTOH it depresses breathing and slows the bowels. Getting it right isn't easy. Some docs are better at it than others. It doesn't help that there's a lot of scrutiny on overprescribing these days; that shouldn't make a big difference in postop and trauma prescribing but sometimes it does. As a rule of thumb, if a person enjoys the narcotics they're probably getting too much. The pain counteracts the pleasure. This doesn't apply to premeds for a procedure, but that should be a one-time deal.

As far as addiction it helps when a patient is in a closed system, where every doc and pharmacy can see what the patient is getting and prescribing and tapering off are managed by one doc, with everyone else staying out of the way. This works, unless the doc in question is running a pill mill. The CURES registry, in California, which is a database of controlled substances prescribed to individual patients, is supposed to prevent people from getting drugs from multiple sources. I don't know how effective it is.

As far as getting too much opiates I have always found hospitol opiates to be a huge dissapointment and I couldn't wait to get off them, I must have had some the pros