canklecat

You were doing so well until the final ad hominem. But if we're swapping references to studies published in credible journals, perhaps it' not out of line to challenge our motivations if the goal is to refine opinions rather than to simply discourage conversation.

Yeah, I've read various studies that investigate the possibility that routinely taking analgesics may actually prolong chronic pain.

There are similar studies suggesting a rebound effect for OTC NSAIDs. Several pop culture magazines for athletes recommend we don't take ibuprofen or aspirin after a workout because it may interfere with prostaglandins. However these pop culture publications tend to oversimplify the original studies to the point of being useless and even harmful. The cautions to avoid NSAIDs regarding prostaglandins are aimed at peak condition athletes who are trying to optimize their workouts. For a competitive athlete in their 20s-early 30s in sports where victories are decided by nths of a second or degree, it's valid to look for every possible edge.

It's not at all equivalent to tell a 60something cycling enthusiast to refrain from taking ibuprofen for chronic inflammation caused by arthritis, old and new injuries and chronic pain that isn't receptive to alternatives.

My main complaint about the current anti-opiate hysteria is that it lacks context, is based on hysteria, and lacks sensible solutions.

For example, a responsible medical approach would evaluate benefits vs risks for each individual patient. If a patient complains of pain that isn't responsive to OTC analgesics after 10 days, a responsible medical approach would involve an evaluation. Ask the patients about their histories with alcohol, prescription and non-prescription drugs and recreational drugs. Weigh factors that might be contributing to pain, such as situational and emotional stress -- does the patient have a supportive or non-supportive home and work environment? Loss of income due to disabilities?

Is the patient willing to submit to the same record keeping expected of any medical professional who dispenses opiates? For example, when a nurse dispenses a prescription pain med to a hospitalized patient, every dose is carefully recorded. So it's reasonable for a doctor to reach an agreement with the patient to encourage responsible use of self-administered home prescriptions. Ask the patient to keep a pain journal and note everything taken for pain, from NSAIDs to topical analgesics to massage to prescription pain meds. Review it regularly. If the patient appears to be taking the prescription pain meds appropriately they may be granted less supervision over time.

But that isn't being done now. At every medical appointment this year (and there have been many since I was hit by a car in May), I'm asked about my pain level. I tell them honestly, without exaggeration. They note it and completely ignore it. When I specifically ask for a refill of as few as 10 pills, they say no, they aren't allowed to anymore. Take more ibuprofen. The irony is that years ago the doctors told me to take less ibuprofen because of risks to my stomach, rebound effect, aggravation of my psoriasis and psoriatic arthritis (yup, ibuprofen can actually aggravate those symptoms). Now they're telling me to take 2400-3200 mg of ibuprofen a day, a ridiculous amount that's far higher than I ever took when they used to tell me to take less.

It has nothing to do with curbing addiction and overdoses. It has nothing to do with patient care. It's strictly about preserving the licenses and certifications for doctors and health care organizations.

That part of the system is broken right now.

Only one nurse has actually responded, during my recent intake exam with the VA. She asked about my routine pain level. I tell her it's never less than 3-5 since my back and neck were broken in a 2001 car wreck. I can cope with that chronic pain without any special meds. I have for nearly 20 years. I use ibuprofen, topical analgesics (Stopain roll-on is terrific stuff), warm/cold packs, soaks in a hot bath with epsom salts, massages, etc.

So she asks about my current pain due to the shoulder and neck injury. I tell her it's a 6 at the moment, often 7-8 in the middle of the night, enough to prevent sleeping or most ordinary activities including the bike rides I used to enjoy. She looked at me and said "That's a lot. This has been going on for months and your other health care provider did nothing?" So the VA promptly referred me to another doctor and their own pain management clinic and phsical therapy clinic. That's how it should be done.

As I've said many times in these discussions, junkies spoil everything. They have their own issues that are completely different from the vast majority of patients who are dealing with pain. The current main risk is from black market fentanyl, not oxycontin which was more of a risk 10-15 years ago, and certainly not from Tramadol or even the older hydrocodone. Even heroin has paled in comparison with the risk of black market fentanyl.

But we're all being treated like junkies. That's why the system is broken.