My take on chronic pain

[Laurel Hill Crazie]

Chronic pain, let me count the spots on my body. Radial head left arm, removed; shoulder surgery, left shoulder twice; compression fracture L1, arthritis in the neck, shoulders, and lower back, recuring sciatic right side. Prior to having the radial head removed, I had a classic tennis elbow tendon that was partially detached, surgically repaired. During the first few surgeries, I was given morphine for surgery. It made me really sick, violently tossed my cookies. I felt real nauseous to the point that I would rather be in pain. For later surgeries, a different pain med was used after the anesthesiologist reviewed medications used for previous surgeries. I detest opioids but will use them for the first 24 hours post-op.

I learned to live with pain. I mostly just ignore it but it often makes me grumpy or withdrawn. I do daily stretches. Mobic when it is bad. A hot soak with Epson salt helps too. A long session with a chiropractor does wonders for some immediate relief. Powerful weed helps. Medical marijuana is legal here so I'm still trying to find the right combination of THC and CBD but any 20% plus THCa works well. It is much like opioids, the pain is there but very much reduced or just easier to ignore. I'm not sure which. The upside is that reefer leaves me much more functional than opioids. I've had decades of practice. Also, a pleasant euphoria replaces the nausea. I smoked it for fun but it was after I decided to go without it for an extended period did I realize how much it controlled my chronic pain. The downside is the nearly uncontrollable appetite and weight gain. I'm working on the diet to reduce inflammation so the weed works against that. I'm told that there are strains of reefer that actually suppress the appetite, those with high THCv and humulene, but those are often not on the list of percentages of various THC, CBD, and terpenes.

Yeah, chronic pain is just a part of growing old especially after an active life that leads to mishaps resulting in ortho surgeries. @Andy Mink wasn't that first PT finger wall walk just plain excruciating?

Also, venting about chronic pain helps too.

 

[Tricia]

This thread has made me feel like I'm in good company.
I honestly don't recall a time in the past 10 years that I don't feel some kind of pain in my right shoulder. It has become such a norm for me that I don't register it as pain anymore.
Meanwhile I have developed some back pain over the past couple years that I manage with daily stretching excercises that our friendly PT showed me.

 

[Tom Co.]

This sounds like me. What are you doing to manage the pain? I never take opioids. I use 315 extreme relief (cbd salve) and 12.5 MG gummy at night with 2.5 MG melatonin to sleep. Aleve twice a day.

Very much the same as you are doing. I have some CBD cream, CBD sleep aid pills, prescription muscle relaxers, 3 mg melatonin, Costco sleep aid, +8 hour Tylenol as needed and occasionally ibuprofen. I also belong to a gym , have a core routine I do every time I go and do daily stretches. Once in a while I just say screw it and lay around all day.

 

[François Pugh]

Last year while recovering from broken bones and internals, I was given Oxycodone among other things in the hospital. When I came to enough to understand what I was taking I stopped taking it. Then I got lectured by a doctor and staff about need and time required before pain control from the Oxycodone could re-establish.

When I got home I was supposed to continue with the Oxy but the risks made me uncomfortable. A friend, let's call him the home grown herb doctor, persuaded me to try edibles instead. As soon as it kicked in the pain was gone. I continued for the amount of time I was supposed to be on Oxy and then was able to go on without anything.

So was it the weed products killing the pain or was it a mental/mindfulness thing? I've wondered but it worked and enabled me to avoid the risks associated with Oxycontin.

This is very interesting, especially the bolded part. On one of my injuries, a broken wrist (radius), took two percacets half an hour before bed. I thought the hospital had given me a placebo, but when I took the next dose they kicked in.

I did not have any nausea when I had my surgeury, same wrist a few years earlier (scaphoid in two places and 180 degree rotated fracture of capitate), and no nausea from post-operative morphine. I do recall the doctor being upset and saying he would have to cancel the surgery because I had a cup of coffee when I woke up that morning. I was under orders not to eat anything and he didn't want me puking during surgery. I quickly changed my story and all went well. I like to live dangerously. I also found two oxys before bed and none until the next evening before bed (not going to be drugged up at work) did not stop them from working at night.

Maybe when the hydromorphone didn't work (broken humerus at the shoulder) at the prescribed dose or double that, it was just because it takes time to establish itself. Maybe I didn't have to tripple my dose for it to have any effect and not be able to hold down my breakfast; it made me sicker than the rye I replaced it with until I could get a hold of a few expired percacets). Who knew?

I've used opiods for several injuries. Every time I've stopped using them when the severe pain ended. I have no problems with addiction, but I do like things that actually work. If you using them as a party drug, I believe you will become addicted, but if you only use them for temporary pain, I do not believe it's a problem. Chronic pain, as in every day for the rest of your life, I would be looking at other ways to deal with it.

 

[newboots]

Good point, @Tom Co.

Research has found that long-term (prescribed) opioid use leads to an experience of more pain when the individual appropriately discontinues the medication. It dissipates quickly, but the patient’s experience of rebound pain is a big problem.

Psychological pain control methods, acupuncture, massage, relaxation training, Epsom salt baths or poultices, and many alternative treatments are better in the long run for treating chronic pain.

 

[Lorenzzo]

This is very interesting, especially the bolded part. On one of my injuries, a broken wrist (radius), took two percacets half an hour before bed. I thought the hospital had given me a placebo, but when I took the next dose they kicked in.

I did not have any nausea when I had my surgeury, same wrist a few years earlier (scaphoid in two places and 180 degree rotated fracture of capitate), and no nausea from post-operative morphine. I do recall the doctor being upset and saying he would have to cancel the surgery because I had a cup of coffee when I woke up that morning. I was under orders not to eat anything and he didn't want me puking during surgery. I quickly changed my story and all went well. I like to live dangerously. I also found two oxys before bed and none until the next evening before bed (not going to be drugged up at work) did not stop them from working at night.

Maybe when the hydromorphone didn't work (broken humerus at the shoulder) at the prescribed dose or double that, it was just because it takes time to establish itself. Maybe I didn't have to tripple my dose for it to have any effect and not be able to hold down my breakfast; it made me sicker than the rye I replaced it with until I could get a hold of a few expired percacets). Who knew?

I've used opiods for several injuries. Every time I've stopped using them when the severe pain ended. I have no problems with addiction, but I do like things that actually work. If you using them as a party drug, I believe you will become addicted, but if you only use them for temporary pain, I do not believe it's a problem. Chronic pain, as in every day for the rest of your life, I would be looking at other ways to deal with it.

It's concerning if your doctor prescribed you opioids without advising you how they work and how to properly use them. In my case I'd been on them in the hospital for more than a week, which was reason enough to find an alternative. As between risk of addiction to opioids and virtually risk free edibles it isn't a hard choice.

Opioid Use Disorder

www.hopkinsmedicine.org

 

[Tricia]

Good point, @Tom Co.

Research has found that long-term (prescribed) opioid use leads to an experience of more pain when the individual appropriately discontinues the medication. It dissipates quickly, but the patient’s experience of rebound pain is a big problem.

Psychological pain control methods, acupuncture, massage, relaxation training, Epsom salt baths or poultices, and many alternative treatments are better in the long run for treating chronic pain.

In my case, having a friend who is a PT has been key. He has given me excercises to do daily that have helped immensely.
I also have a TENS device which I use on my calf muscles on a regular basis to avoid plantar fasciitis.(PF is also an issue I've had over the past few years)
All of this is from the top down.
If my shoulder hurts, my posture is bad
If my lower back hurts because of bad posture, my hips get cranky.
When my hips get cranky my calfs cramp up
When my calfs cramp, I get plantar fasciitis.

 

[Paul Lutes]

Yep; turns out my Mom was right: proper posture is good; slouching is bad!

And FP: regarding that cup pf coffee before surgery - you're surgeon was entirely justified in threatening to cancel. Aspirational pneumonia is no joke. You REALLY want to avoid this.

 

[tball]

I've used opiods for several injuries. Every time I've stopped using them when the severe pain ended. I have no problems with addiction, but I do like things that actually work. If you using them as a party drug, I believe you will become addicted, but if you only use them for temporary pain, I do not believe it's a problem.

Using opioids for temporary pain results in an addiction problem for many:

Chronic Opioid Use After Surgery: Implications for... : Anesthesia & Analgesia

atients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in...

journals.lww.com

It's best to use as few opioids and for the shortest duration possible and strongly consider non-opioid pain management. Sadly, docs often still send folks home with lots of pain pills. I think it's just easier.

 

[newboots]

I was astonished when a endodontist refused to “let” me not accept a prescription for pain meds. I explained that I didn’t need them, I didn’t particularly like them, and endodontic surgery had not in the past required more than Tylenol.

The assistant left to talk to someone, and returned with my little bag of things to take home. He insisted I have the prescription “just in case.” I was incensed, and said that this was one reason for the opioid tragedies we all knew of (but I faced continually in my work).

I mentioned this to a friend, an MD. She explained that this was referred to as the “don’t call me” prescription. So you don’t call in pain in the middle of the night. Ok, sure, but insisting I take the prescription home? What if I was an addict trying to stay clean?

We lost some addicts to overdose in the program where I was involved. Tragedy.

 

[Jerez]

An anesthesiologist friend once explained to me that it isn't just rebound pain that feels worse from opioid use. He said that people who have been on oliods for any long period of time actually develop a much lower pain threshold. And that sensitivity to pain my never go away. What may feel like an ache to you could feel like a knife stab to them. Thought that was very interesting.

 

[newboots]

An anesthesiologist friend once explained to me that it isn't just rebound pain that feels worse from opioid use. He said that people who have been on oliods for any long period of time actually develop a much lower pain threshold. And that sensitivity to pain my never go away. What may feel like an ache to you could feel like a knife stab to them. Thought that was very interesting.

Your friend explained it better than I could., and I can't argue with that!

 

[François Pugh]

It's concerning if your doctor prescribed you opioids without advising you how they work and how to properly use them. In my case I'd been on them in the hospital for more than a week, which was reason enough to find an alternative. As between risk of addiction to opioids and virtually risk free edibles it isn't a hard choice.

Opioid Use Disorder

www.hopkinsmedicine.org

Oh, the doc did ask. I told him codeine does nothing. I told him oxycodone worked well for me. He said,"I can't prescribe those." I told him oxycontin worked well for me. He said, "I can't prescribe those either." I told him Percocets worked well for me. He said,"I can't prescribe those either. How are you with hydromorphone?" I said I had never heard of it, but would try some.

I think the problem is that it's easier to just blame your doctor than take responsibility for your own actions. Always somebody else's fault!

 

[djetok]

It's concerning if your doctor prescribed you opioids without advising you how they work and how to properly use them. In my case I'd been on them in the hospital for more than a week, which was reason enough to find an alternative. As between risk of addiction to opioids and virtually risk free edibles it isn't a hard choice.

Opioid Use Disorder

www.hopkinsmedicine.org

Opiods are just too dangerous imo. They are just giving you a false sense of security. Then the addiction issues. I started out on gummies during our first trip of the season. Thc was not legal in Oklahoma at the time. In all honesty, I had no plans to ski. We had paid for the trip already and my wife likes to ski as much as I do. I thought hey I will try , yes a thc virgin in my late 40s. Glad I did, as it was to be legal that Spring. I slept for the first time for since my injury in August. Boy did I sleep, I even attempted to ski the second day. Thc was the answer for me to relax my muscles. The car ride was miserable. The next trip, I got smart and took 25 MG in Trinidad when my wife took over the drive and I didn't carry any over the border, except in my stomach of course.

Once it became legal in Oklahoma

My routine is all about strategy. I take a gummy and melatonin at 9 pm, that way it would kick I at about ten. I then added hitting a vape between 9 to 10 before. It worked so well that I would increase my dose as high as 50 MG. Now after years I am down to 12.5 MG. I would love to find a cbd that works in place of the thc, while just using the thc for horrible days.

We made so many trips to Colorado that year

 

[Jwrags]

I was astonished when a endodontist refused to “let” me not accept a prescription for pain meds. I explained that I didn’t need them, I didn’t particularly like them, and endodontic surgery had not in the past required more than Tylenol.

The assistant left to talk to someone, and returned with my little bag of things to take home. He insisted I have the prescription “just in case.” I was incensed, and said that this was one reason for the opioid tragedies we all knew of (but I faced continually in my work).

I mentioned this to a friend, an MD. She explained that this was referred to as the “don’t call me” prescription. So you don’t call in pain in the middle of the night. Ok, sure, but insisting I take the prescription home? What if I was an addict trying to stay clean?

We lost some addicts to overdose in the program where I was involved. Tragedy.

It is unclear to me if the endodontist sent you home with the actual pain pills or just the written prescription. Forcing the actual pills on you is wrong, the written prescription, not so much. You do not have to fill it and if you are a recovering addict hopefully you would express your concerns and explain why you did not want it. I will put my professional perspective in a separate post to follow.

 

[Jwrags]

I have read the recent turn of this thread with interest. As a surgeon who has been in practice for 30+ years (not counting medical school and residency) I have prescribed a lot of narcotics in my life. Here is my personal, professional perspective on the opioid crisis issue. The big problem started in the late 90's or early 2000's with the push for "pain as the 5th vital sign". Patients were told that they should be pain free and nurses/managers propagated this. I would get calls from the hospital nurse that the patient had 10/10 pain but when I went to see the patient I had to wake them up from their opioid induced slumber for them to tell me they had horrible pain. If I did not somehow address the issue either the nurse would keep calling me or they would "write me up" for not taking care of the patient. To be fair, surgeons have traditionally prescribed way more narcotic pain medicine than should have been needed but it was not well documented how much was needed for what procedure.

The second thing, for me, that contributed to increasing my outpatient prescribing habits was the ban on calling in narcotic pain medications for patients. This goes somewhat to @newboots comments about the "don't call me" prescription. It was not so much about "don't call me" as it was "if you call me because you have pain or ran out of your pain meds there is nothing I can do to help you from here". The patient needed a written prescription and at night or on the weekend there is not much I can do to help them other than send them to the ER. It has changed a little now with electronic prescribing.

Now, I think most surgeons are much more conscientious about how much narcotics we prescribe as well as using multi-modality pain management, at least for acute pain after surgery. I give a fraction of the narcotics I used to give because of better alternatives as well as better data and education. Plus, I can now tell patients that if I give them more than X that I will get in trouble. I will say I resent being blamed by people/organizations for the narcotic problem when we were pushed into it 20 years ago.

Chronic pain is a whole different animal for which I am happy I do not treat. Too often narcotics are thrown at the situation but it is also the patient who relentlessly complains about pain or doctor shops until they find a "candy man" to give them narcotics.

My unofficial advice to those who have acute/post op pain is to take as little narcotic as possible to be reasonably comfortable and to use multiple modalities of pain control like regular Tylenol or NSAID if not contra-indicated. Remember, surgery hurts and it is a completely unreasonable expectation to be "pain free". The pain should be managed to a level that is tolerable, not absent. If you have no history of drug abuse by all means take the written prescription for pain med with you so you can fill it if you need it. If you have a history of addiction and are worried then talk to your doctor before surgery about how you can best manage your pain post operative. And before anybody asks, I have no experience, personally or professionally, with CBD or THC for adjuncts to pain management.

 

[newboots]

Of course, I took the prescription home and shredded it. But I found this quite offensive. Given the crisis that continues unabated today, as well as my experience meeting 20-year-olds, sending them to treatment centers, and learning of their deaths by overdose when they are discharged, it struck me as inappropriate.

If I were a recovering addict, imagine for a moment the internal struggle that would be required not to fill that prescription. I have heard many stories of agonizing about using or not using a drug that was suddenly available, despite the individual’s heartfelt intention. Do not minimize that agonizing struggle. Addicts die from encounters like this.

I do appreciate the difficult (impossible?) position that the marketing and pressure from the larger system to prescribe these medications put physicians in. But did you ever foist a prescription to a patient who objected to taking it? I remain offended by that.

 

[Jwrags]

I would never make someone take paper prescription home but frequently talk to them about why I think it is a good idea to at least take it with them as insurance but they do not have to fill it.
There is no doubt that surgery and post op pain control can be the gateway back to the dark side for recovering addicts. There is always a balance between treating their pain and fearing addiction. It takes working with the patient.

 

[François Pugh]

What makes no sense to me is why I can't get a perscription for four nights worth of oxycontin to lessen the pain of a broken bone so I can get some sleep.

What makes no sense to me is why my grandmother spent the last 4 hours of her life repeating "I can't stand it!" due to inadequately treated pain. At least she didn't become an addict.

If you don't want to be an addict just stop taking the opiates after a week.

Patient decides what to take. I'm ok with that. Too bad the way it is here and now, patient has to buy their drugs on the street, because the doctors are afraid to prescribe pain medication that works.

 

[Jwrags]

What makes no sense to me is why I can't get a perscription for four nights worth of oxycontin to lessen the pain of a broken bone so I can get some sleep.

What makes no sense to me is why my grandmother spent the last 4 hours of her life repeating "I can't stand it!" due to inadequately treated pain. At least she didn't become an addict.

If you don't want to be an addict just stop taking the opiates after a week.

Patient decides what to take. I'm ok with that. Too bad the way it is here and now, patient has to buy their drugs on the street, because the doctors are afraid to prescribe pain medication that works.

While I do not know the specifics, you should have gotten some pain meds and usually in end of life and hospice situations comfort, no matter how much narcotics it takes, is the primary goal.
And yes, our licenses are being threatened for over prescribing where previously they were threatened for over prescribing. Like most things in life when a correction is needed the pendulum swings too far the opposite direction.