I had jaw surgery recently... while I wouldn't describe it as incredibly "painful", particularly since everything was numb (they have to slice through nerves for this procedure), it was really uncomfortable and stressful for a couple of days afterwards.
I wasn't at all ashamed to take percocet after the surgery. Could I have lived without them? Sure. Did they turn me into an instant addict? Of course not.
This story isn't about the crackdown on opioids since it sounds like it's more just a cultural thing in parts of Germany, but it does strike me that people experiencing legitimate pain are becoming casualties of our crackdown on "inappropriate" prescribing.
people experiencing legitimate pain are becoming casualties of our crackdown on "inappropriate" prescribing.
Perhaps in America they are so easy with the opiates because people have a real or perceived need to get back to work. When I had to have two impacted wisdom teeth removed the pain and swelling was completely under control with ice bags, aspirin and two days off work. A low wage at-will worker in the US can't do that.
This is a rather salient point. In the Netherlands, if I needed (in consultation with my doctor, of course) to stay out of work for a year to recuperate from illness or injury, I can do that and continue to receive my full salary. The second year would be at 70% salary. My job would await my return - only after 2 years would I be separated from my employer and have access to other long-term disability benefits.
In the US, FMLA generously "guarantees" 12 UNPAID weeks of medical leave in any 12 month period while still being able to return to work (provided you've met other conditions of hours worked, and the location where you work has 50 or more employees, etc etc.) Enforcement may require lawyering up, so it's de facto useless for low-wage workers - or middle-class workers who don't want to be blacklisted from future employment, as, yes, background check databases do prominently flag people who have sued their employers.
And did I mention FMLA leave is unpaid? If you can't afford to take unpaid time off work, you're using vacation days unless you're in one of a handful of localities that require employers offer a few paid sick days per year.
If you can't afford to take unpaid time off work, you're using vacation days unless you're in one of a handful of localities that require employers offer a few paid sick days per year.
Yes, on occasion they do send mass email here asking to donate vacation time to XY, who is recuperating from surgery. It makes one reach for the bucket to throw up in every time.
For the first six weeks the employer (small employers need mandatory insurance for that), after that their health insurance (which gets some lump payments from the federal government for that).
Short and long term disability insurance is common with professionals jobs in the US. After that social security kicks in.
The only think I can think of is the abuse must be rife in the Netherlands? Shit, at full salary I certainly wouldn't be in a rush to get back to work.
I'd hardly consider taking days off from work only to sit at home in pain to be "rest". I'm lucky enough that I can afford to take days off to rest when in pain post-surgery, but I'd still want something to help with the pain.
"Did they turn me into an instant addict? Of course not."
That's the case for you but others are more prone to addiction. My girlfriend some years ago had a surgery and got opiates afterward. The pain was gone a after a few days but it took a lot of convincing and almost force to make her stop with the opiates. This stuff is really addictive for some.
It must be. I've had Vicodin a few times, and found it had had no effect other than pain relief. There was no experience of a "high" or euphoria. I have never finished a prescription, as it simply stops occurring to me to take it once the pain is gone.
I abused vicodin, taking 40-50mg of hydrocodone at a time explicitly to get high. Once I ran out, I shrugged my shoulders and that was the end of it.
Some people have addictive personalities. Some don't. I don't discount people turning into heroin addicts from the stuff. It's my favorite drug in the world.
The article seems to be behind a registration wall - are you able to provide a summary?
Also, do you know if this is a widely held position or just emerging?
I found a couple of things, but none of them are as clear cut as "it's okay to stop antibiotics early".
This [0] article says
> Health professionals are trading in the "complete the course" slogan. Instead, they recommend that patients take their medicines "exactly as prescribed."
which seems to be a quote from this [1] linked article.
Last time the doctor did not give me enough penicillin, I was required to take a disgusting roadband antibiotics, which I had to mask with taste-numbing food, to not throw up the instant it hit any muscous membrane. Due to that, we had a tablet of it on a plate in the corner of the kitchen, and were wondering in the (no door; adjacent) living room, where that horrible smell came from.
Anecdata: since then, I fear horrible broadband antibiotics being needed.
I would prefer phages, but they are soviet tech, and soviet died.
Yeah, I question the idea that it's beneficial to experience pain - why should I? Especially if it's going to cost me days of my life that I could do something with. Maybe not go out, but at least be able to catch up on some of the more passive content... seems like a needless waste of life.
The experience of pain (and I'm separating this from the dopamine-release thing for people who groove on that sort of thing) is, for my money, a useful training facility for willpower and restraint. Separate from the pain-as-warning-signs noted by 'lukeschlather, few things hurt that much and the fact that you are not the master of even yourself is a valuable reminder.
The experience of being uncomfortable is not a bad one to have, nor a bad one to make peace with. Pain and discomfort are a part of humanity: when they don't exist, we invent ways to have both. And there certainly exists a line where chronic pain makes it humane to blunt it--but most folks don't have that problem at all.
And "content" is what you are left with when the soul is leached out of creativity by people who lack it. It is a soul-suckingly awful construct in the twenty-first century and decent people should reject it. Please don't promulgate its notions.
People talking positively about pain (and especially immediate post-surgical pain as in the article) makes me uneasy. Sure, some level of pain is useful as a warning sign. And wanting painkillers primarily to avoid resting is unreasonable.
But, if there is too much pain, it will cause extreme stress during the day and they will probably be unable to sleep at night - it is hard to imagine this being beneficial for recovery.
Also, if the pain is too great, people will avoid future treatment, even if it is medically advisable.
I think there have been problems with anesthesia in the past, where people woke up during surgery (although still unable to move), and I think it led to negative outcomes even though it is only pain - although I admit, I am reluctant to look up the details.
At the very least, I think it is good to give enough pain medication so that the patient does not want to die, although I understand it may be unavoidable when the level / duration is high enough.
It looks like in the article, the level of pain and recovery for this procedure is not very bad (probably because it's laparoscopic), and the doctors know this, so their recommendations were appropriate and the patient was worried over nothing. But, I don't think this means that the same is true for all procedures, and suggesting that people just make peace with it or whatever without knowing what the level is seems wrong. Especially in the case of surgical recovery where the first day or two is usually the worst, and the risks of medication over such a short period are low.
I wouldn't wish for a more serious level of pain on my worst enemy. I do not think it is useful or possible to make peace with, unless you are Buddha himself.
> I don't think this means that the same is true for all procedures, and suggesting that people just make peace with it or whatever without knowing what the level is seems wrong
It's like I literally expressed that? Maybe I made it trickier to parse by referring primarily to chronic pain--if you want to lump extreme, trauma-induced pain into that? Sure. When lives are on the line, whatever, do what needs to be done; we have doctors to make educated decisions based on the information available.
But I will contend most Americans--and my observations are largely limited to us--mostly harm themselves in the effort to avoid what we have largely decided is pain and is in many ways merely discomfort. And I tend to think that that ramps up into greater problems along the way.
I see that makes more sense now, I think that line did throw me off somehow.
I haven't seen any close friends or family just pop a Tylenol for every day aches and pains, but it certainly seems to be a thing, so I'm open to the idea that I'm living in some kind of bubble in that regard. I've always thought of pain medication as for bringing severe pain down to a lower (but non-zero) level, so for example it might not be taken at all if you break a toe, but would be more than reasonable for the jaw surgery in the first post in the thread.
It's interesting, chronic back pain is one of the most common chronic pain causes, and a doctor was talking to me recently about it (in general, luckily I don't have it). Apparently once it gets started it can have its own self reinforcing process, and there are measurable biological changes to how nerves fire etc. that are independent of any initial underlying injury. Probably there's some people faking or overstating it, but I could easily imagine such a process getting pretty severe. Unfortunately, the outlook is pretty bad I think once you've had it for a set amount of time.
So concerning chronic pain / opioid use I can't figure out if Americans are less willing to deal with pain, or actually have more pain, or some combination of both. If back pain just needs an initial injury to set it off, then escalates from there, the unhealthy lifestyles and ever increasing obesity levels here would do a lot to explain why it is becoming an increasing problem.
I don't buy the "it's good and normal for you; suck it up" perspective. Pain is a useful signal that you're doing something wrong with your body, or that you need to rest to recover and heal. But if you're lying still on your bed recovering from a surgery and are still in pain, what purpose does that serve? It "builds character"? If that makes you happy, go for it, but don't impose that view on the rest of us.
This seems to me to be entirely backwards. If you appreciate creativity, don't you want to have as much time as possible to experience and enjoy the world around you? To learn? To create? Why would you spend the day stuck in bed feeling like shit, unable to do anything but watch TV when you could easily solve that and do more?
There is a joke about Americans (which I extend to "most people", and definitely to most technical people I know): if one is to stop being stimulated from outside, then one runs the very real risk of having to consider what is inside. I tend to consider the cavalier American use of painkillers to be in that "stimulated from outside" bucket--and I try very hard to be unafraid of considering what might be inside.
I already don't watch TV when I feel poorly (or in general). I might work--usually on something that I care about, so as to make me feel good that I have done it. Or I might read. If circumstances are uncomfortable enough that concentrating is difficult, then I know I need to sleep. If sleep is very difficult--not merely difficult--due to pain, then sure, then painkillers are on the table for me. Otherwise, why would I try to change how I feel externally?
Painkillers do not change the underlying state. If it is something you literally cannot bear, then sure, get some help. But I have learned over time that the world includes discomfort and pain and that they're really not that bad, most of the time. The world around me includes me. And it includes the need to be mindful about me, too. This is part of that.
I think you're confusing some sort of emotional pain which may deserve analysis with physical pain which analysis cannot bring any insights from - it's just pain. Nothing revolutionary.
Pain is really important. You can't properly heal from an injury without pain, because you won't know when you're worsening the injury. In the worst case you'll get into a descending spiral where you need to take more and more painkillers as you attempt to go about your day normally until you've injured yourself to the point where painkillers are no longer able to let you ignore the injury.
And in the best case (and almost 100% of the time) you'll just heal anyways, but won't give a shit about the pain and will actually be able to do stuff.
I think I'll roll that dice, thanks anyways. I'm generally able to restrict myself without the need for pain.
You are projecting anecdotally your own situation and extrapolating in a somewhat irresponsible manner. Statistically it is shown that these prescriptions do lead to addiction in a frightfully large number of people. Being "uncomfortable" and "stressed" is a part of pain and it's an important signal that you need to take it easy. If pain is to the point where you can't sleep and heal appropriately, than I can see where it might be used. Even then it's important not to confuse general insomnia with pain induced waking.
"Columbia University researchers found that opioid addiction had tripled over a 10-year period, with the proportion of Americans reporting abuse or dependence increasing from 0.1% of the population in 1991–92 to 0.3% in 2001–02."
It's true... in a population of 350MM (the USA), that's over a million people reporting abuse or dependence. Though I'd like to see a further breakdown of what abuse means in this context.
Of course, the question that needs to be asked: how many of those began as legitimate prescriptions and ended in dependence? Certainly not all of them, perhaps even a small fraction. But a well-to-do person become addicted after minor surgery tends to get more attention than poor people substituting fentanyl for heroin.
Finally, there's a cost/benefit analysis. Painkillers have an obvious benefit for people who need them - whether to treat chronic pain or temporarily after surgery. What is the cost to restricting access to those who have a legitimate need for these drugs?
I don't have answers to these questions. I will note that public health policy has a checkered past when it comes to unintended consequences. Our attempts at wide-scale social engineering, particularly that driven by outrage and headlines, rarely work the way we expect.
To whit, I can't help but think that the crackdown on prescription painkillers in our recent past (central registries, jailing physicians, imposing production ceilings on opioid manufacturers) has directly lead to the rise of synthetic alternatives we're seeing today.
I wasn't at all ashamed to take percocet after the surgery. Could I have lived without them? Sure. Did they turn me into an instant addict? Of course not.
This story isn't about the crackdown on opioids since it sounds like it's more just a cultural thing in parts of Germany, but it does strike me that people experiencing legitimate pain are becoming casualties of our crackdown on "inappropriate" prescribing.