Pain (non) management trends after surgery

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Bawston

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There are a number of articles that Huffington Post has up as part of a series they’re doing on pain management, opioids, and actually even a little something from chronic pain patients. I thought I’d just post the link to one of the articles here as it pertains to some hospital trends in not treating post op pain with opioids. At least this might give people an idea of what to ask, expect, and even maybe which doctors/hospitals to stay away from. Frankly it sounds to me like one big experiment on people who are in a helpless situation stuck in a hospital bed.

https://www.huffpost.com/entry/hospitals-pain-opioids_n_5e42fa7ec5b69d496c90533e
 

Doc Rogue

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Good Lord.
First off, thanks for the post and article. I’ll try to relax my heart rate while responding.
A. Not all patients respond to pain or have like pain levels after a surgery. (I’ll only reference surgeries since this is basically what they are experimenting with on reduced pain med options).
B. Not all surgeries are similar when comparing levels of post operative pain.
C. Age has a lot to do with perceived level of pain, and the perceived ability to recover faster or slower, and deal with varying levels of pain. Example:
My 11yo at the time had major knee surgery. We only had to give him 3 total doses of a 7.5 hydro (broken in half! So half that amount, along with ibuprofen to manage his pain and get him back in his feet towards recovery). I guarantee that a 73 yo would probably deal with a higher level of pain.

My very 1st back surgery eons ago I was given qty 90 of hydro, with 2 refills. It was my first ever exposure to opioids, and didn’t have a clue about how they worked. I took as prescribed, mostly because the first time you’re on meds such as those they actually take the pain away, and work for the length of time between doses as prescribed.

But at the end of my two refills, I was in as much if not more pain then before going in for the lower back fusion. I relayed that info to my surgeon, and he said bullshit and kicked me out of his office.
It was 2 agonizing years later that I finally broke down and went back to a new doc and told him of my pain struggles the last 3 years. The rest is history, if you’ve read my many previous posts.
I guess my main point is no two patients are alike when it comes to responding to pain, or will have the same level of pain.
I guess at the very least they are prescribing meds to get the patient through to the follow up appt.
it’s what happens after that follow up that’s up in the air. Thanks again for posting this Bawston.
 
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north19

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Deep breathing for post operative pain-maybe in conjunction with proper medication is useful but I don't think as a stand-alone thing it is very helpful. I am going for hip replacement surgery Friday morning-when I met with the anesthesiologist I asked what will I get for pain after surgery and I could tell he was trying to push ketorolac and other strong NSAIDs. I told him of my kidney issues and he said oh then we will use some mild opioid medications for a few days. It is a major surgery-I am worried. I have had many surgeries during a prior job and was always kept comfortable. I sure hope they control the pain as otherwise, the physio suffers and long term stability of the joint can be affected. I know in 10 years they will be saying why did we use such a high level of anti-inflammatories when patients have stomach, heart and kidney problems.
 

jakemoe

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This is such an outrage! I would advise anyone to get a solid answer from their surgeon regarding what pain meds will be available to them post op. Another thing a person might do is to talk to their general practitioner doctor for help with a more adequate prescription. That's just an idea, but seems to me it could be doable with some good family doctors. You deserve to know the post op plan and depending on how much of a hurry it is, you can always find a more reasonable surgeon, although that's easier said than done.
 

Bawston

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@north19...you might want to make sure that your kidney issues and problems with NSAIDS is actually on your chart and when you check in for surgery & they ask about drug allergies they will usually put a brightly color wrist band as a warning for unintended mistakes in meds. See if they will put a wristband on your for that.

I think I mentioned that I had a total hip replacement 6 years ago. At the time even though there was all the hype about abuse, my surgeon and anesthesiologist were in total agreement on pain coverage. I was on a patient controlled pump for the 2-3 days in hospital, went home with 30 days of oxycodone and told to call ahead for a written refill to be mailed in time so I wouldn’t run out. I did need the refill especially for my in house PT. Without it I don’t think I’d have been able to progress as well as I did.

That was a Boston hospital and doctor who performs more anterior hip replacements than any other doctor in Boston.

Compare that to over 10 years ago at a suburban hospital when I had a lung removed by a doctor (alas, I went with him because he was one of few who did robotic surgery) who did not believe in ANY opioids. I met with the anesthesiologist at that hospital who was very much ok with whatever opioids were needed to control the pain and he prescribed an epidural which gave me very good relief. Unfortunately the surgeon came in on day 3 and told them to pull the epidural. Within minutes it felt like my chest was caving in and like it was ice cold. I couldn’t see anything except blackness and could barely talk to get a nurse. At this time I was on a regimen of OxyContin for chronic pain coverage which was my baseline so pulling the epidural not only sent the post op pain through the roof but sent me into withdrawal because I didn’t have my base line meds.

The hospitalist doctor came in and ordered a pain pump (not patient controlled) and the surgeon was furious. I will never use that hospital again because that seems to be a hospital policy.

I guess one thing I’m saying is that your doctor and anesthesiologist need to be on the same page.

I wish you the best and hope that you will speak up if your pain is not controlled.
 

north19

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@north19...you might want to make sure that your kidney issues and problems with NSAIDS is actually on your chart and when you check in for surgery & they ask about drug allergies they will usually put a brightly color wrist band as a warning for unintended mistakes in meds. See if they will put a wristband on your for that.

I think I mentioned that I had a total hip replacement 6 years ago. At the time even though there was all the hype about abuse, my surgeon and anesthesiologist were in total agreement on pain coverage. I was on a patient controlled pump for the 2-3 days in hospital, went home with 30 days of oxycodone and told to call ahead for a written refill to be mailed in time so I wouldn’t run out. I did need the refill especially for my in house PT. Without it I don’t think I’d have been able to progress as well as I did.

That was a Boston hospital and doctor who performs more anterior hip replacements than any other doctor in Boston.

Compare that to over 10 years ago at a suburban hospital when I had a lung removed by a doctor (alas, I went with him because he was one of few who did robotic surgery) who did not believe in ANY opioids. I met with the anesthesiologist at that hospital who was very much ok with whatever opioids were needed to control the pain and he prescribed an epidural which gave me very good relief. Unfortunately the surgeon came in on day 3 and told them to pull the epidural. Within minutes it felt like my chest was caving in and like it was ice cold. I couldn’t see anything except blackness and could barely talk to get a nurse. At this time I was on a regimen of OxyContin for chronic pain coverage which was my baseline so pulling the epidural not only sent the post op pain through the roof but sent me into withdrawal because I didn’t have my base line meds.

The hospitalist doctor came in and ordered a pain pump (not patient controlled) and the surgeon was furious. I will never use that hospital again because that seems to be a hospital policy.

I guess one thing I’m saying is that your doctor and anesthesiologist need to be on the same page.

I wish you the best and hope that you will speak up if your pain is not controlled.

@Bawsten. Thanks for the wise and kind words. I will definitely make sure I let them know again as I did tell the internist and anastesiologist about kidney issues but will remind the surgeon and nurses too. Thanks again for great advice.
 

Doc Rogue

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This is such an outrage! I would advise anyone to get a solid answer from their surgeon regarding what pain meds will be available to them post op. Another thing a person might do is to talk to their general practitioner doctor for help with a more adequate prescription. That's just an idea, but seems to me it could be doable with some good family doctors. You deserve to know the post op plan and depending on how much of a hurry it is, you can always find a more reasonable surgeon, although that's easier said than done.

This is sage advice. My PM doc said I should have just had him write me a backup script when I went in for my neck fusion. (I knew the neuro was only going to send me home with a 1 week supply of meds- and much less than I was already taking mg wise, so more like a 3 days worth).
If I ever decide on another surgery, I would be sure to have my own plan in place if the surgeon doesn’t provide more than a few days of meds to aid in recovery. Especially anything as invasive as a back fusion, which I’d never get another one even if they promised me 100% improvement. Reading stories like this still has me wondering if we still don’t have a LONG ways to go to get back to a more companionate approach to dealing with pain.
On a side note, I had an appointment with my Rheumy this week. At the end of my appointment, he apologized to me that I’ve had to deal with the level of pain I’ve had for all these years. He said we’ve done a massive disservice to chronic pain patients, and that there should be a affronted effort by those in the medical community to put forth the study and come up with a med that doesn’t just manage pain, but relieve it fully, without the harmful side effects.
Whether such a med will ever exist, I don’t know. But I had to appreciate the fact that he gets it, and that he truly understands that many, many of us suffer daily and unnecessarily so.
 

Bawston

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What I found interesting in reading most of the articles in the HuffPost series (there are 9) is that some “experts” said “opioids should only be used for post op pain” then there were other “experts” who said opioids should be used for chronic pain but only for short courses”. This varied depending on the hospital the doctor was associated with and their specialty. But what really struck me was if you are a chronic patient, meaning there is no cure and you’ll be living with this, then how does a short course help you - you realize you can get pain relief but then they yank it away?

Then there’s this article about Missouri’s experiment with trying to get people to use alternative, on opioid pain treatments. My takeaway on that was what I’ve been saying for years...I could take a prescription which easily manages my pain and allows me to actually live my life OR I could spend the majority of my life in physical therapy, chiropractics, acupuncture, massage, yoga, and meditation. Frankly non of the alternatives were on my bucket list!
 

jakemoe

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@Bawston, the doctors that think you should be able to take a short course of opiates and then stop are in the same group of delusional quacks that have b.s. theories and have monster egos that tell them they cannot possibly be wrong.
 

Bawston

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@jakemoe...I’d love to know where they’re getting their info from since good studies have been published in respected medical journals documenting that opioids are a very good option for all pain especially acceptable for patients over 60. If you’re over 60...which I blew past a while ago, what are the chances that I’m going to get addicted and head for the street drugs if my pain is managed? As for tolerance, I was on the same dosage for over 10 years and yes, my body had developed tolerance but I wasn’t looking to get high by taking more than my script.

It’s funny because yesterday I pushed myself too far and was in a lot of pain at bedtime. I could have dipped into my backup supply of oxy but decided, nah...I’ll see if maybe 600 mg of ibuprofen might help. Well I was out of ibuprofen and saw that I had Aleve. This is 2:30 in the morning but I had to get out the magnifying glass to first find, then read the directions. Now we’ve all talked about the problems with NSAIDS and stomach issues, kidney, and liver (including Tylenol in here) but I read “heart attack and stroke warning: NSAIDS, except aspirin increase the risk of heart attack, heart failure, and stroke. These can be fatal. The risk is higher if you take more than directed or for longer than directed. And is higher if you are over age 60.”

So how is this (or ibuprophen) appropriate for long term therapy?

And they’re worried that I might overdose on an opioid? Delusional might be one way of characterizing them but I was thinking of some other words.
 

jaders

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@jakemoe...I’d love to know where they’re getting their info from since good studies have been published in respected medical journals documenting that opioids are a very good option for all pain especially acceptable for patients over 60. If you’re over 60...which I blew past a while ago, what are the chances that I’m going to get addicted and head for the street drugs if my pain is managed? As for tolerance, I was on the same dosage for over 10 years and yes, my body had developed tolerance but I wasn’t looking to get high by taking more than my script.

It’s funny because yesterday I pushed myself too far and was in a lot of pain at bedtime. I could have dipped into my backup supply of oxy but decided, nah...I’ll see if maybe 600 mg of ibuprofen might help. Well I was out of ibuprofen and saw that I had Aleve. This is 2:30 in the morning but I had to get out the magnifying glass to first find, then read the directions. Now we’ve all talked about the problems with NSAIDS and stomach issues, kidney, and liver (including Tylenol in here) but I read “heart attack and stroke warning: NSAIDS, except aspirin increase the risk of heart attack, heart failure, and stroke. These can be fatal. The risk is higher if you take more than directed or for longer than directed. And is higher if you are over age 60.”

So how is this (or ibuprophen) appropriate for long term therapy?

And they’re worried that I might overdose on an opioid? Delusional might be one way of characterizing them but I was thinking of some other words.

It just enrages me that the medical community acts like we the public are all just a bunch of children (and too many folks buy into this model as well,) but this idea that "what we said before - just forget that. Now do this...." It's such an effin' lie. When I had a day surgery to repair a broken wrist, one of the nurses tried to tell me that they're discovering the "placebo effect." Just tell folks they've had something for pain and voila! Such a CROCK!!!

Just have to keep fighting back! :yes:
 

jakemoe

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These days it seems one's character is based on convenience. I can see right thru it and I think most people can, but how can a well educated doctor just go along with this farce without feeling like a sheep. They act and behave like such pansies.
 

Bawston

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@jaders...I have a number of family members who are physical therapists (I mentioned one before who really needs to rethink her life goals). A while ago I was talking to 2 of them over dinner and was complaining about a cream a physical therapist had told me to buy ($20) over the counter. I can’t read the fine print on this stuff but I bought it and tried it for a few days for muscle pain to no avail. So I looked it up online only to find that it was this homeopathic junk ... you know, water it down to zero and the water maintains the”memory” ...etc. Of course I was mad (mostly at myself for buying it without checking it out) and my sister in law said well the placebo effect is real. My response was - not always and not when you really have a serious problem and so WHY would you tell people to spend money without giving them the full disclosure? I don’t exactly like handing over $20 for something not even as effective as rubbing Vaporub on myself.

And by the way, this was the same sister in law who pretty much thinks PT solves all problems...except she’s got almost the same neck problems now that I have. Ahem...she’s having to consider surgery. Guess that old PT doesn’t always solve everyone’s problems.
 

karuna

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I’m having difficulty expressing myself today — but wanted to say something trying to decide how to manage my own pain. It is definitely frustrating, and can be very harmful to be given information that is inaccurate, ever- changing and WE are responsible for educating ourselves, sadly learning, from misleading drug information or from personal experience or websites.

But it struck me that this is forcing us to be our own advocates (unfortunately when we don’t have enough energy to feel unwell, much less try to seek out facts and make decisions for ourselves that are the healthiest and most effective) and maybe learning what works best and the truth is the silver cloud—- I don’t know, but I don’t want to be a follower. Healthy skepticism? But where do we find the truth and physicians to listen and respect our opinions? So glad we share and support each other.
I appreciate all you share so I can add it to my war chest.
 

GringoStarr

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Good Lord.
First off, thanks for the post and article. I’ll try to relax my heart rate while responding.
A. Not all patients respond to pain or have like pain levels after a surgery. (I’ll only reference surgeries since this is basically what they are experimenting with on reduced pain med options).
B. Not all surgeries are similar when comparing levels of post operative pain.
C. Age has a lot to do with perceived level of pain, and the perceived ability to recover faster or slower, and deal with varying levels of pain. Example:
My 11yo at the time had major knee surgery. We only had to give him 3 total doses of a 7.5 hydro (broken in half! So half that amount, along with ibuprofen to manage his pain and get him back in his feet towards recovery). I guarantee that a 73 yo would probably deal with a higher level of pain.

My very 1st back surgery eons ago I was given qty 90 of hydro, with 2 refills. It was my first ever exposure to opioids, and didn’t have a clue about how they worked. I took as prescribed, mostly because the first time you’re on meds such as those they actually take the pain away, and work for the length of time between doses as prescribed.

But at the end of my two refills, I was in as much if not more pain then before going in for the lower back fusion. I relayed that info to my surgeon, and he said bullshit and kicked me out of his office.
It was 2 agonizing years later that I finally broke down and went back to a new doc and told him of my pain struggles the last 3 years. The rest is history, if you’ve read my many previous posts.
I guess my main point is no two patients are alike when it comes to responding to pain, or will have the same level of pain.
I guess at the very least they are prescribing meds to get the patient through to the follow up appt.
it’s what happens after that follow up that’s up in the air. Thanks again for posting this Bawston.

Ive lost faith in spine fusions for the most part. I see a pain psych (have for years) and she comes up with a person that is doing well. Funny, it seems little more than a year that they are in need again of more surgery. I've had 2. What a waste of pain, time, $, and junk that I cannot undo and approach from another method now. I was a smart person. I normally researched a ton before stepping into anything but was convinced by a couple surgeons. Shame on them. I was told by my first one when I was back in pain a few months later- "I am done with you". I was truly told that word for word.
So welcome to chronic pain and opiates. What else is there that I've not tried? MJ- not a fix for me. I was disowned and the whole bit by parents as I must be faking it.

I wish people could wear others' shoes for a minute (including me) so we all understood how rough life can be.
 

Bawston

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@karuna...I am so thankful for the internet! You have to be careful because there’s a lot of crazy stuff on there but at least you can go and research pretty much anything now. I remember when I started on my own personal pain journey, the internet was just beginning to be useful (although you had to dial up and put the phone in the modem).

Once I realized that it was critical for me to be my own advocate and double check everything, I felt more empowered. I found there were doctors who absolutely mocked me if I asked about something I’d read and then I had some doctors who would listen and actually say “ok, let’s try this and see if it helps you”.

One thing that I hate to do though is be dishonest with my doctors yet I find that I do it to protect myself. If a doctor says I HAVE to try a medicine that I know I’ve reacted to badly in the past, I just pretend that I’ve given it another try and tell them I had the same reaction as in the past. I’m amazed that so many times a doctor will tell me that I HAVE to try something again. What’s that expression? Fool me once..

But I agree that this forum offers something for everyone and has been a great support system as well as information source. But always be your own advocate.
 

notcharlotte

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the article says, with no citation, that 6% of people get addicted to pks!! wow!! obviously that ignores the 94% who don't. so 94% of people suffer for the 6% who become addicted (actual number is 3-5% addicted). are we the only ones who think that statistic places the emphasis on the wrong number? well, it's the huffington post so i didn't expect better.

more than half the problem is the media focusing on medical treatment instead of the meth and heroin epidemic. i guess that 6% votes and needs to be coddled into thinking their addiction is the fault of everyone but themselves. as usual.
 

north19

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After hip replacement surgery I have been given 1mg of hydrmorp. I am in pain about a 7 or 8 out of 10 but they said I have to wait at least three more hours for next meds. I am very uncomfortable. Just nice to have some people to share it with. Hopefully when anesthesiologist comes by he can up the dose as oral 1mg isn’t cuttin it for me especially as the surgeon said it was one of the worst atghitic knee he has seen.
 

M77

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After hip replacement surgery I have been given 1mg of hydrmorp. I am in pain about a 7 or 8 out of 10 but they said I have to wait at least three more hours for next meds. I am very uncomfortable. Just nice to have some people to share it with. Hopefully when anesthesiologist comes by he can up the dose as oral 1mg isn’t cuttin it for me especially as the surgeon said it was one of the worst atghitic knee he has seen.

The non-post operative normal oral dose is 4 mg. I know they make 8 mgs. It has limited oral bioavailability, because the same dosage by IV, would be very strong. Of course everyone is different. I assumed that you meant 1 mg oral. If it is through an IV, 2 mg should be fine.

I had major surgery 3 times, and thankfully, the last was before the current BS. All 3 times, I woke up with IV morphine, and the push button controller.
 

north19

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Still in hospital as the hip was really damaged. Tried walking today with a walker-it was very hard. They have bumped me to Po 3mg hydromorph contin twice a day and 4 mg instant release 3 times a day also Po. Still a fair amount of pain. Really hope to get out of hospital tomorrow but with the pain and stiffness will have to see. Thanks for all your support
 
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