dennis336

See the article in the link below that I thought was interesting regarding use of pain medications and the approach to pain management in various countries along with the results of a survey asking people if they experienced pain recently (a greater percentage of Americans indicated they experienced recent pain than those in other surveyed countries). It does seem odd that Americans, by some measures, consume 80 percent of the worlds opioids. There also seems to be a different view of pain management and use of prescription drugs (not just opioids) in the U.S. that has evolved over recent years (influenced by the drug companies??). I expect there's a whole host of cultural, psychological, and economic factors influencing where we're at.

https://www.theatlantic.com/health/a...ntries/548822/

Would be interested, also, in the perspective of those outside the U.S., especially with a medical background, on the approach to pain management and use of opioids.

Colnago Mixte

I would say that collectively, Americans have become a nation of Dr. Smiths.


People just aren't very tough any more compared to past generations, who endured unimaginable stuff, as recently as the past century. HTFU, mannnn. Your soft lifestyle has affected you, though ironically, I would say people's stress levels probably are far higher these days than in the past.

KraneXL

A spurious correlation. You have to keep in mind availability and the state of our medical system. American drive more cars too, but we also have bigger, wider, roads (relatively) and places to put them.

Cyclist0108

Opioids are the religion of the people.

dennis336

And I think the marketing aspect is also a contributor. I've read that the U.S. is one of only two countries in the world that allow direct to consumer marketing of prescription drugs. One of the features of a free market system is the notion of 'creating demand'. Not to say there aren't real needs, but but a steady stream of advertisements for drugs as a quick fix/Plan A has implications

KraneXL

Half the commercials on TV are pain meds. Besides that, the advertising is everywhere: on billboards, in magazines, etc. The trouble is that people expect to always be totally pain free when no such condition exists in nature.

Some level of pain is a part of human existence, and in most cases it a warning system that lets you know something is wrong and needs to be addressed.

In most case, the solution is as simple as rest: The other day I went out into the sun and got a terrible headache. Instead of going to the medicine cabinet (or the doctor), I got a good night's sleep and the next morning the headache was completely gone. No pharmaceuticals necessary.

79pmooney

A couple of somewhat random comments from my experience -

When I crashed, broke ribs and wrecked my shoulder, morphine, the neural opiate drip and the hydrocodone I was prescribed were God's gift. I was on them, tapering off for at least three weeks. Huge benefit in my recovery. They allowed me to breath deeply and sleep.

I started cutting up the tablets into quarters as I tapered down. Learned quite fast that the crumbs had a real "hit" to them. What? Why not just score the tablets deeply so those of us who want no part of addiction. (I am an addict in recovery, just a different drug though I also know I was spared the curse of addiction when my opium purchase at age 16 when I was in my deepest depression was just perfumed crap.) Deeply scored tablets would break cleanly without the powder and probably keep more than a few blissfully ignorant. Of course, marketing benefits big time from the discovery and addiction. My cynicism of the pharmaceuticals stays strong.

Ben

dennis336

Agree, whenever possible, taking the drugs shouldn't be Plan A. If there's a way to address an issue with behavioral or lifestyle changes, that would be preferable as, too often, the drugs cause side effects that, in turn, get prescribed another drug to address - and on and on.

dennis336

I'm perhaps in a somewhat similar situation in that I've had a number of family members that struggled with addiction - for the older generation, it was alcohol. My dad was an abusive alcoholic - with the anger directed at my Mom, not the kids. Couple of brothers also ... one made it out (swears by AA) and the other committed suicide at 31 but probably didn't have many years left with the condition he was in after years of excessive drinking. Younger generation was drawn to other drugs. As you noted, similar to me, I didn't seem to have that addiction gene, or whatever it is. I started drinking in high school and continued through college but gradually tapered off as I got deeper into my twenties. But, it was always social (not to say I didn't have too much on many occasions) for me ... didn't do it to escape and didn't drink alone etc etc. My wife, who I met in my later twenties, didn't drink so I ended up just stopping altogether and haven't had a drink in probably over 35 years. With weed, I experimented a bit in my college/early work days but the high, for me, was awful. Felt very paranoid and recall feeling like I just wanted the high to end. Never had an interest in trying any other drugs. But, the thing is, for some reason, I didn't have whatever that 'thing' is to fall into addiction as many of my family members have had. No great act of willpower or moral uprightness on my part ... I was just fortunate that alcohol/drugs didn't have that kind of addictive hold on me.

Biker395 

Me too. My Dad came from a family riddled with alcoholism. Among his siblings, one died in jail fight in the drunk tank, one of cirrhrosis of the liver, another from suicide ... again in the drunk tank. And their father was a raging alcoholic.

Like any red-blooded American college boy, I gave alcoholism the old college try. I flipped pizzas to earn my tuition, and ended pretty much every work session with one or more beers at closing time.

But alcoholism just didn't take. I got sick of it and just stopped. And like you, I'm really not all that fond of being intoxicated by other intoxicants either. I like having my wits about me.

Nature or nurture? Hard to say. The parts of the family that moved out of the area and away from all the alcoholism had far fewer problems. Same genes. Different circumstances. Watching my father struggle with alcoholism and thinking ...This makes no effing sense. Why does he do that?!? ... that probably had something to do with it.

In retrospect, it is no surprise. He had a family history of it. A culture of it. And he also had emotional trauma that can trigger it. We had moved away from it, so I had none of those things.

Personally, I think it is a combination of factors. Nature and nurture. Genetic predisposition + addictive personality + trauma = bad news.

Interestingly, a lot of cyclists I know are 12 steppers. I think there are some serious parallels between our obsession and other addictions.

CAT7RDR

As one Developmental Psychologist once told me, "We are a dynamic interaction between our genes and environment."

["Personally, I think it is a combination of factors. Nature and nurture. Genetic predisposition + addictive personality + trauma = bad news." -Biker395]

The only thing I would add is some addicts/alcoholics are engaging in their own drug therapy. For example, someone with severe depression might gravitate towards cocaine or amphetamines. Those prone to mania/agitation/anxiety might experiment with CNS depressants such as ETOH, benzos and barbiturates.

I am personally dealing with shoulder tendonitis from overuse and lumbar arthritis from an old football injury. I vow to never start opioids; I have witnessed the long-term effects of such drugs. I manage pain with Ibuprofen and question the long-term effects of same. I am finally getting active in my own PT through stretching, ice massage and light weightlifting and core strength exercises. It is vital to keep an internal locus of control and not rely on the medical model to treat with medications but never actually treat the underlying issues.

canklecat

I've noticed that too when I cut or broke Tramadol, hydrocodone or cyclobenzaprine tablets in half. I'm guessing there's an enteric coating that delays release. Breaking the tablet works faster but with a risk of some lightheadedness.

Ditto, the benefits of pain relief for getting adequate rest. I made my 10-day supply of 30 hydrocodone last six weeks because I took them only at night to help me sleep. After it ran out I couldn't sleep soundly because it's so difficult to get comfortable with some injuries -- shoulder, ribs, hips, etc. After a couple of sleepless weeks I was mentally exhausted and depressed.

I figured the doctor would be willing to refill since I used the initial prescription so sparingly, but nope. Our health network is extremely strict about that stuff. I even had to demand an injection of anti-inflammatory at my last ortho appointment, months after the initial injury. It shouldn't have been necessary to insist on something like that, and if they'd done it earlier I wouldn't have felt any need for prescription oral pain meds.

BTW, some topical analgesics are remarkably effective for some types of pain near the skin. Stopain roll-on is the quickest acting I've tried. It's mostly just menthol in a transdermal carrier (MSM) and works within minutes. Lasts about an hour or so. Ted's Pain Cream has similar ingredients including the MSM transdermal carrier, and resveratrol (no idea whether it really works). It's slower acting but combining the two has worked pretty well for my shoulder and neck pain. I had to attach the roll-on doodad to a stick to reach my shoulder blade comfortably, and a sponge on a bamboo back scratcher to use with the Ted's and other topical creams and gels.

I've tried dozens of other topical analgesics but without a transdermal carrier they do nothing, although salicylate creams are good for some rashes and acne, so it's not completely useless. Just useless for pain relief.

Colnago Mixte

You need to travel to a medical MJ state. My brother in law got completely off pain killers after major surgery on both feet, using that option at night to help him sleep. Far fewer side effects, and relatively inexpensive and non-addictive.

Cyclist0108

Next time, try snorting it or cooking it over a flame in a spoon.

Cyclist0108

When recovering from ankle reassembly surgery, I had those drugs for a couple of days. I was very happy to be rid of them, and by day #4 found that Ibuprofen was much more effective, probably because it was anti-inflammatory.

I proudly told this to my surgeon at a follow-up appointment, and he actually gave me a lecture about how I shouldn't have come off them so soon. WTF? This was an otherwise highly competent surgeon.

The problem is these things are over-prescribed, cheap, and frequently used as a sedative.

canklecat

I've read a ton of research papers on cannabis and it seems to be a mixed bag in terms of efficacy. It works very well on certain specific problems -- appetite, glaucoma, some seizure disorders, anxiety. But pain relief is nowhere comparable to opiates and opiate receptors.

One theory is that cannabis works on chronic pain with some people because it reduces anxiety and promotes rest. That alone is enough to reduce most people's pain level a full step. If pain level 6 of 10 is getting into the range of interfering with sleep and normal daily activities, then reducing it to 5 is significant. But it's not going to reduce pain levels of 8-10 enough to replace opiates.

I've tried half a dozen brands and types of CBD, the non-psychoactive component, since my May injury. It does nothing at all for my pain. About the only thing it seems to help with is reducing the gagging sensation caused by my swollen thyroid constricting my esophagus and trachea. And that's only with the sublingual drops, not the capsules or vape forms. With me, CBD has a mild stimulant effect, comparable to coffee. Those are the only real effects I've noticed in four months of trying various CBD products.

Friends who tried all variations for their chronic pain and other ailments say it really needs to be the full complement of THC and CBD to be effective. THC alone can be too strong and causes more anxiety, paranoia, etc. -- that sensation that another poster described as wanting to get it over with. CBD apparently balances out the effect of THC.

Reminds me, a couple of weeks ago a friend, with whom I'd discussed this stuff, handed me a vape pen that I assumed contained CBD. It was THC. I took one puff before realizing what it was. Since we were on a casual group bike ride I didn't want to be impaired and I hadn't smoked weed in more than 40 years. I'd heard the newer forms are much more potent.

Sure enough, after just one hit I felt those familiar effects I remembered from my misspent youth. Not bad at all, very pleasant and relaxing. But wouldn't be my first choice for a bike ride! I can't say it helped with my shoulder and neck pain, although I just didn't care anymore. So by reducing some of the anxiety/concern, it effectively made the pain tolerable. But it's nothing at all like the effect of an opiate.

THC isn't somethign I'd go out of my way to try again. I doubt I'll buy any more CBD either, after several tries. It's too pricey. I might try cannabis again after Texas decides to legalize or decriminalize it. For now they seem to be taking a laissez faire approach without making any official decisions. But they probably recognize the futility of regulating cannabis when a neighboring state has already turned legal cannabis into tax revenues, and there's no border search between Colorado and Texas trying to interdict people toting a little weed for personal use.

Wildwood 

I rode my bicycle so hard yesterday, that by the end of the ride - the bicycle needed opioids.
Time to visit the bicycle doc.

KraneXL

I am all of these things and have no additive proclivities whatsoever. In addiction, there are no addictive individuals in my family tree. I also follow all of the remedies you describe (and more) above. So add that to you equation however you want.

As for the pharmaceutical, the medicinal home remedies can only take you so far. So for someone like myself, who suffers from chronic neck/back/shoulder pain that can spike to level 10, there are occasions (rarely) when the pain is so excruciating that only a pharmaceutical will provide the sufficient and lasting relief.

One more thing, I've never had a desire to continue an opioid beyond the needed pain relief. Nor did I experience any sort of feeling or sensation beyond that. As far as people that crave opioids for a high is concerned, "it does not compute." That, or perhaps I'm not doing it right? I take it for the pain and that's it.

canklecat

That's the thing that's so hard to get across to doctors nowadays. They have a checklist and canned responses, none of which have anything to do with actually evaluating patients as individuals.

Except yesterday. I saw my new VA doc for the first time. She actually did a personal profile of my pain history and med usage, dating back to my 2001 accident when my neck and back were broken. It's rather refreshing to meet medical professionals who actually listen.

Based on my history and very moderate use of prescription pain meds she had no problem authorizing a refill of muscle relaxers. It's just a short supply, but after I demonstrate a continuing pattern of moderate use -- not asking for refills prematurely -- they'll authorize a larger refill. And I'm trying diclofenac rather than massive amounts of ibuprofen that were doing no good anyway.

That seems reasonable. I usually take it only at night, and not even every night, just to help me sleep. Anyone who's had a fairly serious upper body injury -- ribs, shoulder, collarbone, etc. -- understands how difficult it can be to get any rest. I've mostly been sleeping on the sofa because I can prop my back against the sofa to avoid rolling over onto the bad shoulder in m sleep. I'll bet that's very familiar to a lot of people. (And my cats keep looking at me like "Dude, you have a perfectly good bed. Why aren't we all sleeping there?")

Before this new doc, the others paid no attention to my descriptions of making a 10 day supply of pain meds last six weeks or longer.

I realize some folks do get hooked, or use it recreationally or to avoid having to deal with life. But most people don't, depsite the dire sounding news reports. You'll never hear news reports interviewing people saying "Yeah, I used or use prescription opiate pain releivers. Nope, I'm fine, didn't magically turn me into a junkie. Yeah, I'm still working at my regular job as an accountant/mechanic/doctor. Somehow I avoided suddenly transmogrifying into a pimp or cartel warlord. My co-worker left the keys in her car and somehow I didn't steal it. Go figure." Those stories are too boring and don't serve an agenda.

lesiz

The US is the only country that has a significant opioid addiction problem.
Problem here is that the for-profit medical insurance companies will not approve more expensive but effective non-drug options for dealing with pain.
One thing to try is contact a physical therapist and see if they can treat your pain, and get an estimate of cost, which would be important since you might have to pay for it 100% out of your own pocket.

KraneXL

Which brings up two potential problems: First, what do you do in the mean time? And second, what if you can't afford it? Usually when someone can't afford a treatment/specialist they're forced to seek the less expensive option even if its not very healthy. Think food -- I'd purchase only organic food if I could afford it.

canklecat

The US ranks third in the world, at worst. There are dozens of nations with significant opiate addiction problems.

Afghanistan has by far the highest prevalence of opiate addiction -- not surprising because it's the main producer of opium, often protected by US and other outside military forces as a compromise to preserve some form of order amid chaos. Opiate use is so rampant in Afghanistan that one of the most common complaints by US and European military leaders trying to help establish order there is that most of the Afghan troops and police are wasted on drugs. The second most common complaint by outside military forces is the disgusting practice of bacha bazi, the ritualized sexual exploitation and abuse of young boys by older Afghan men. Between the drug addiction and bacha bazi many outside military and political advisers leave Afghanistan feeling the entire situation and country are beyond hope.

Some estimates claim Iran has a higher percentage of opiate addiction than the U.S. but accurate data is difficult to obtain.

Also some estimates are years out of date, and don't include the much more recent proliferation of black market fentanyl from China, which has rapidly replaced prescription opiates like oxycontin, hydrocodone and even the traditionally popular illegal heroin. Because black market fentanyl is so potent it's often more deadly than any other opiate, and accurate data aren't yet available.

fietsbob

A friend, a medical professional is going in for a 2nd Biopsy on a breast tumor ,
the pain meds have their uses..

but, yes people use them to cope with a pointless miserable life of exploitation .

mud

I lost a son to oxy, 33 years old, a wife and two kids. When I got the call the emts were still there waiting for the coroner, he still layed on his couch. I don't preach about it but I myself will do without. People will do as they want and we will loose more to this drug. There used to be a website "oxykills.com" where many had posted about their experiences with loosing family and friends. Just because someone follows a doctor's advice does not mean there won't be consequences.

Stevareeno

There is a difference between being addicted and being physically dependent. Anyone that takes narcotics will most likely become physically dependent but that does not mean they are a junkie.
I fell off of my roof 10 years ago (18 feet) and landed on my feet and shattered both heels and broke both ankles. I have had 6 surgeries and have CRPS or Complex Regional Pain Syndrome. I have tried everything to relieve pain, creams with Lidocain, CBD oil, 6 weeks of acupuncture 3X a week and lately a big syringe in my back to deaden the sympathetic nerve. The last made the pain worse than the original accident. The only thing left is have a some electronics installed in my back to fool my brain about the pain.
I have been on narcotics for 10 years and have used them responsibly. Random urine and blood drops and never a fail.
The big buzz now is M.E.'s or Morphine Equivalents.How much of a drug = morphine amounts. A 15 mg oxycodone pill = 22,5 ME. A year ago I was on a 75 mcg/hr fentanyl patch and 6 oxy 30 mg for a total ME of 450. The goal or mandate now is to get everyone down to under 90 ME per day REGARDLESS OF PAIN or history of pain meds. The government demanded doctors prescribe this stuff and now they demand us to quite taking it. My ME amount today is 90 and my pain is such that daily living or sleeping is not optimal. So who ever in this post that said opioids do not lessen pain is either mistaken or ignorant of medical facts. In Arizona where I live prescriptions written for opioids is down 40% but the number of monthly deaths is the same. What does that tell you??? At the Mexican border of Nogales, AZ, an hour from my house they are finding semi's full of narcotics. Fentanyl and oxycodone in original manufacturer's packets. Those are the ones they catch out of a thousand trucks a day. The problem now is that some people that become physically dependent and addicted to prescriptions are turning to heroin because it is cheaper. I may be physically dependent but reduced my medication by not having reactions of an addict. So people that have a medical need for opioids are pretty much screwed.