Pain (non) management trends after surgery

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Bawston

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@north19...I’ve found many (not all but many) office staff who seem to take on the elevated position of the person they work for. They know they’re the gatekeeper and some just seem to get off on this stupid power trip. They don’t have the skills to be a surgeon but they have the skills to make insecure people squirm. It’s not just admin people in the medical field but insecure people who need power.

I hope you do well with the PT. I know I never would have made it through without meds beforehand. Just do your best and don’t go overboard. I kind of thought the PT exercises were lame and not enough but I soon found out that after you’ve been in a knife fight (let’s face it that’s what surgery is) your body is not as tough as you think and slow and steady seemed to work for me.
 

north19

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@north19...I’ve found many (not all but many) office staff who seem to take on the elevated position of the person they work for. They know they’re the gatekeeper and some just seem to get off on this stupid power trip. They don’t have the skills to be a surgeon but they have the skills to make insecure people squirm. It’s not just admin people in the medical field but insecure people who need power.

I hope you do well with the PT. I know I never would have made it through without meds beforehand. Just do your best and don’t go overboard. I kind of thought the PT exercises were lame and not enough but I soon found out that after you’ve been in a knife fight (let’s face it that’s what surgery is) your body is not as tough as you think and slow and steady seemed to work for me.

Hi @Bawston you really nailed it the way this secretary acted. The doctor told me my refill after I got out of the hospital would be 50 Percocet-5mg oxy/325 Tylenol. So I call this secretary and she said she would fill the prescription. When I get to the pharmacy it was for Tylenol 3. Totally different. Luckily when I called office back the surgeon was there and said she made a mistake and he would call the Percocet in. She should just do her job. It is not like the 5 mg Percocet are very strong but why not just listen to what I told her the surgeon told me and he even said he told her. I guess I have been pretty fortunate-especially with my surgeon being very young.

Thanks for your kind words about the PT. I have done it twice and as you said I wouldn’t have been able to do it properly without the Percs. I also agree about the knife fight. For the most part my hip has been ok but a few times I twisted and once squatted to low and my body sent a great dose of pain as a reminder.
 

Bawston

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@north19...well yeah, Tylenol 3 is codeine which is NOT the same and a med that I get itchy from. I don’t break out in hives but I scratch myself raw. So that’s a mistake that can have bad consequences ... I mean it’s more than a typo. My guess might be if there are other doctors in this practice that that’s what some use as a standard order. For me 5 mg of Percocet wouldn’t even be noticed. I still don’t get this reasoning of giving such small dosages. If it doesn’t help the pain then why pretend or bother giving it at all and if someone is going to abuse it, they’re just going to toss down multiple pills.

I’m getting a new MRI for back pain and seeing a new doctor. Hopefully it’s a pinched nerve that will respond to steroid shots otherwise he mentioned possible surgery if that doesn’t work. So now we wait and see but I just don’t know about surgery these days without adequate pain control.
 

north19

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Interesting article-pretty long but has some good points

NEW YORK (Reuters Health) - Recent reductions in opioid prescribing have occurred mainly among patients with moderate or severe pain, rather than those with less severe pain, who might be managed with non-opioid alternatives, researchers say.
"We were surprised to learn that there has been a larger decrease in opioid prescribing to adults with more rather than less severe pain," Dr. Mark Olfson of Columbia University's Vagelos College of Physicians and Surgeons in New York City told Reuters Health by email.
His team analyzed data on more than 64,000 U.S. adults 18 years and older who responded to the Medical Expenditure Panel Survey: 21,213 in 2014; 21,633 in 2015; and 21,706 in 2016.
As reported in Health Affairs, approximately 6 million fewer participants were prescribed schedule II or III opioids in 2016 than in 2014: 3.75 million fewer reporting moderate or more severe pain, and 2.20 million fewer reporting less-than-moderate pain.
For those who reported moderate or more severe pain, the percentage prescribed opioids dropped from 32.8% to 25.5%; the decrease for those with less-than-moderate pain was from 8% to 6.6%.
In a sensitivity analysis, there was also a significant decline in opioid prescribing to adults who reported pain that caused quite a bit or extreme interference with their daily activities, from 41.2% in 2014 to 32.9% in 2016.
Overall, the share of adults with persistent prescribing decreased from 3.1% in 2014 to 2.3% in 2016. The decrease was 13.2% to 10.2% for those with moderate-to-severe pain, which was significantly greater than the relative decrease in persistent prescribing to adults who reported less-than-moderate pain.
Of note, in 2014-2016, approximately one in five adults (19.3% - 20.2%) reported moderate or more severe pain. Those individuals were significantly more likely to be female, older, and non-Hispanic white or African American, and to have a lower family income and less formal education than those with less severe pain.
Among adults with less-than-moderate pain, significant declines in prescription opioids were seen in men, adults ages 18-29, non-Hispanic white and Hispanic adults, and those with family incomes below the poverty level.
Dr. Olfson said, "Instead of evaluating opioid prescription control policies based on the sheer number of prescriptions dispensed, the results underscore the importance of evaluating pain management in a more clinically nuanced manner. In practice, this might involve increasing the availability of non-opioid pain management interventions, such as acetaminophen, NSAIDs, exercise, physical therapy, yoga, or other non-medication options for adults with less severe pain."
Dr. David Edwards, Pain Medicine Division Chief at Vanderbilt University Medical Center in Nashville, noted in an email to Reuters Health, "There was indeed a decline in prescribing of opioids to those with less-than-moderate pain, just not as much of a decline as in those with moderate-to-severe pain. This suggests to me that alternative pain treatments are either being used, or less-than-moderate pain is not being treated."
"What providers really want to know," he said, "is that with the decrease in the number or quantity of opioid prescriptions, patients with moderate-to-severe pain are not worse off. Are alternatives being used, or is nothing at all being provided?"
Providers also want to know which patients are doing well and the type of support they've received, he said, as well as "which patients with severe pain are not being treated in the emergency rooms because providers are afraid to treat them?"
"We know that when some patients on high-dose opioids cut back on their own, they do not have worsened pain and they do really well," he noted. "We also have reports of patients forced off opioids becoming depressed and suicidal."
"The sheer number of patients with pain requires that everyone in healthcare have some competence in basic pain care, but also have (names) of colleagues who can offer alternatives," he said. "Clinicians are horrible at detecting when opioid use has become opioid use disorder (addiction). The screening tools we have are not that great, and sometimes undermine the trust we try to build with our patients."
"There are a few types of pain - nociceptive, inflammatory, and pathological - and everyone should have a working knowledge of a few treatments for each pain type," he added. "These treatments include non-medications and non-opioids first."
SOURCE: http://bit.ly/2QAFKGY Health Affairs, online January 6, 2020.
 

north19

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@north19...well yeah, Tylenol 3 is codeine which is NOT the same and a med that I get itchy from. I don’t break out in hives but I scratch myself raw. So that’s a mistake that can have bad consequences ... I mean it’s more than a typo. My guess might be if there are other doctors in this practice that that’s what some use as a standard order. For me 5 mg of Percocet wouldn’t even be noticed. I still don’t get this reasoning of giving such small dosages. If it doesn’t help the pain then why pretend or bother giving it at all and if someone is going to abuse it, they’re just going to toss down multiple pills.

I’m getting a new MRI for back pain and seeing a new doctor. Hopefully it’s a pinched nerve that will respond to steroid shots otherwise he mentioned possible surgery if that doesn’t work. So now we wait and see but I just don’t know about surgery these days without adequate pain control.

@Bawston I agree the 5 mg of oxy does very little I have to take 2-3 of them before doing my exercises. I guess my point was in this crazy opioid crisis at least I have something as much as they down play hip replacements are still a major surgery and there is significant pain.
 

Bawston

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@north19...interesting points brought up in this article. I think this is the first mention that I’ve seen of stats based on pain level. I guess it makes sense to me to try other pain relief for minor or even moderate pain levels but when you get to the moderate to severe there’s no excuse for not using the best you’ve got.

I think the federal mandate/guideline was to reduce the number of prescriptions by 30%. Typical...pick a number any number just to say we hit a target. I used to deal with that crap when I was working and having to come up with budgets...”you have to reduce every department by 20%”.
 

jaders

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Interesting article-pretty long but has some good points

NEW YORK (Reuters Health) - Recent reductions in opioid prescribing have occurred mainly among patients with moderate or severe pain, rather than those with less severe pain, who might be managed with non-opioid alternatives, researchers say.
"We were surprised to learn that there has been a larger decrease in opioid prescribing to adults with more rather than less severe pain," Dr. Mark Olfson of Columbia University's Vagelos College of Physicians and Surgeons in New York City told Reuters Health by email.
His team analyzed data on more than 64,000 U.S. adults 18 years and older who responded to the Medical Expenditure Panel Survey: 21,213 in 2014; 21,633 in 2015; and 21,706 in 2016.
As reported in Health Affairs, approximately 6 million fewer participants were prescribed schedule II or III opioids in 2016 than in 2014: 3.75 million fewer reporting moderate or more severe pain, and 2.20 million fewer reporting less-than-moderate pain.
For those who reported moderate or more severe pain, the percentage prescribed opioids dropped from 32.8% to 25.5%; the decrease for those with less-than-moderate pain was from 8% to 6.6%.
In a sensitivity analysis, there was also a significant decline in opioid prescribing to adults who reported pain that caused quite a bit or extreme interference with their daily activities, from 41.2% in 2014 to 32.9% in 2016.
Overall, the share of adults with persistent prescribing decreased from 3.1% in 2014 to 2.3% in 2016. The decrease was 13.2% to 10.2% for those with moderate-to-severe pain, which was significantly greater than the relative decrease in persistent prescribing to adults who reported less-than-moderate pain.
Of note, in 2014-2016, approximately one in five adults (19.3% - 20.2%) reported moderate or more severe pain. Those individuals were significantly more likely to be female, older, and non-Hispanic white or African American, and to have a lower family income and less formal education than those with less severe pain.
Among adults with less-than-moderate pain, significant declines in prescription opioids were seen in men, adults ages 18-29, non-Hispanic white and Hispanic adults, and those with family incomes below the poverty level.
Dr. Olfson said, "Instead of evaluating opioid prescription control policies based on the sheer number of prescriptions dispensed, the results underscore the importance of evaluating pain management in a more clinically nuanced manner. In practice, this might involve increasing the availability of non-opioid pain management interventions, such as acetaminophen, NSAIDs, exercise, physical therapy, yoga, or other non-medication options for adults with less severe pain."
Dr. David Edwards, Pain Medicine Division Chief at Vanderbilt University Medical Center in Nashville, noted in an email to Reuters Health, "There was indeed a decline in prescribing of opioids to those with less-than-moderate pain, just not as much of a decline as in those with moderate-to-severe pain. This suggests to me that alternative pain treatments are either being used, or less-than-moderate pain is not being treated."
"What providers really want to know," he said, "is that with the decrease in the number or quantity of opioid prescriptions, patients with moderate-to-severe pain are not worse off. Are alternatives being used, or is nothing at all being provided?"
Providers also want to know which patients are doing well and the type of support they've received, he said, as well as "which patients with severe pain are not being treated in the emergency rooms because providers are afraid to treat them?"
"We know that when some patients on high-dose opioids cut back on their own, they do not have worsened pain and they do really well," he noted. "We also have reports of patients forced off opioids becoming depressed and suicidal."
"The sheer number of patients with pain requires that everyone in healthcare have some competence in basic pain care, but also have (names) of colleagues who can offer alternatives," he said. "Clinicians are horrible at detecting when opioid use has become opioid use disorder (addiction). The screening tools we have are not that great, and sometimes undermine the trust we try to build with our patients."
"There are a few types of pain - nociceptive, inflammatory, and pathological - and everyone should have a working knowledge of a few treatments for each pain type," he added. "These treatments include non-medications and non-opioids first."
SOURCE: http://bit.ly/2QAFKGY Health Affairs, online January 6, 2020.

There's one point in this article that just continues to chap me no end - that practioners are "bad" at figuring out who's taking opiates "for realz" and who's an addict. FFS! Doctors aren't SUPPOSED to be detectives, and it's a patient's responsibility to tell them if they're abusing and want help. If they meet the guidelines for use tho, let them the eff alone! That's why this whole cutting back thing started. It's just not a doctor's responsibility if someone takes a medicine and gets "hooked" as long as that information was made available to the patient before starting the med. Like I've said a hundred times, no doctor prescribes opiates in amounts that will OD someone - that's on THE PATIENT. And because we so often have to blame "someone," that doctors ARE in charge of who gets what, makes them the target. I just can't fathom how we expect doctors to figure this out, WITHOUT them becoming afraid to prescribe. All it does is make the patient not be truthful to their doctor for fear of looking like a drug seeker, and the doctor can't trust the patient any longer either. It's a sh%tshow, imho...
 

Bawston

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@jaders...I picked up on that same point about doctors being bad at figuring out who’s abusing because within one month I had 2 of my doctors give me that same “studies say ...”. You can tell when the Cliff notes for doctors come out because they seem to all repeat the same talking points. It was like when 4 doctors/pt told me that taking oxy CAUSED MORE pain. Really? I’ve been off for a year now and you can’t tell me that is true.

I also had multiple doctors tell me that the majority of people with abnormal spinal xrays do NOT have pain so you can’t go by the xrays/MRIs. No one was able to answer without stuttering when I asked them about my situation which was severe spine problems AND pain & numbness in the locations noted in my imaging studies...so you’ve got pain backed up by imaging and I’m sitting here listening to you tell me about people with bad imaging and no pain? How does that help me? Why do I care about those people?

So we’ve now got doctors who apparently don’t know how to ask the right questions to figure out who’s in pain and we have doctors who apparently don’t want to rely on imaging to help them figure out what to do about pain. Should I bring my ouija board to my appointments now?
 

jaders

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@jaders...I picked up on that same point about doctors being bad at figuring out who’s abusing because within one month I had 2 of my doctors give me that same “studies say ...”. You can tell when the Cliff notes for doctors come out because they seem to all repeat the same talking points. It was like when 4 doctors/pt told me that taking oxy CAUSED MORE pain. Really? I’ve been off for a year now and you can’t tell me that is true.

I also had multiple doctors tell me that the majority of people with abnormal spinal xrays do NOT have pain so you can’t go by the xrays/MRIs. No one was able to answer without stuttering when I asked them about my situation which was severe spine problems AND pain & numbness in the locations noted in my imaging studies...so you’ve got pain backed up by imaging and I’m sitting here listening to you tell me about people with bad imaging and no pain? How does that help me? Why do I care about those people?

So we’ve now got doctors who apparently don’t know how to ask the right questions to figure out who’s in pain and we have doctors who apparently don’t want to rely on imaging to help them figure out what to do about pain. Should I bring my ouija board to my appointments now?

Ya, the government has created this situation and it galls me that the doctors are going along with it. They just don't want to prescribe "that drug" any more, and they'll come up with any phony excuse that has been given them by their "masters." I long so much to tell my doctor that folks are flocking in droves to ordering their own meds, so just save that bullsh*t for the next fool.... :shake:
 

Bawston

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@jaders...for the life of me I can’t understand why doctors haven’t stood up to the politicians. Maybe it’s a case of just trying to stay under the radar. I know the biggest anti legislation in my state came from surgeons at some of the top hospitals in the country. Didn’t do any good because the politicians had to be able to check off that box...”fixed the opioid crisis” (created another but the news hasn’t quite picked up on it.

Meanwhile here’s another case of a doctor, Dr Kline who fights for pain patients getting his privileges pulled...can’t prescribe and he’s got patients all over who are now going cold turkey...

https://www.painnewsnetwork.org/sto...-investigated-by-north-carolina-medical-board
 
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M77

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I think that most doctors, that you don’t have a prior relationship with, assume the worst. Not that they should carefully weed out the drug seeking patients, but just the opposite. I think they all assume everyone is drug seeking, unless you can prove otherwise. This really shouldn’t be rocket science, as most states have the database, and they can look at your records. This stuff is going off the rails. If you have a chronic condition, and have responsibly used pain meds to have some semblance of quality of life, there should be no issue at all. I know I am preaching to the choir with this, but the ability of gov agencies, and politicians, to get in between us, and our medical professionals, has to stop.

I think that sadly, nobody cares, if we are collateral damage in the crisis de jour.
 

Bawston

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@M77...your point about the drug databases is exactly why there shouldn’t be a problem with prescribing. I was just prescribed 2 ... TWO! Valium to take before my steroid shots next week. The doctor had to check the database then when he electronically sent the prescription to the pharmacy, had to go get his phone because they send an authorization code that has to be entered before the script will go through. So it’s kind of hard to pass off fake scripts now.

I’m guessing it’s easier to get a couple Valium on here.
 
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M77

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@Bawston
Sad, but true. The feeling like you are a criminal, for asking for pain relief, is just the aforementioned power trip. A quick look at the database eliminates any suspicion of drug seeking behavior, or doctor shopping. So that should be it. End of story, here’s your prescription. But no, that makes too much sense.
 
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