I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?
Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.
My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it.
Later in life, he underwent a surgery requiring general anesthesia and found himself in the same position. He said, "If I had known it was like that, I would not have made them do it."
So I think the surgeon's personal experience of the situation is -- in fact -- highly relevant in practice, even if not in theory.
I'm not sure we should forgo pain management after major surgeries, but the benefit of getting up and walk even just 50m a few times a day is well documented. So no, it isn't fun, but it is a highly beneficial thing to do.
As human as that anecdote is, there are a long list of issues here. In particular, was the original idea that it would be a valuable part of the recovery in error?
It is easy for me to imagine a pain that I would never voluntarily experience or inflict (this isn't even a very profound level of pain, I don't like suffering even in small doses). This threshold is regularly breached and I often come out of it as an improved person.
Sometimes, and I'm thinking doctors and the military when I say this, people end up in situations where choices must be made. The situations are not emergencies and the choices affect other people in ways that the decider might not willingly accept for themselves. This is an unfortunate fact of the world not being a nice place.
I had my gallbladder removed a few years ago. It required a major incision and I was in the hospital for five days after surgery. I had to get up and walk a lap around the hallway a few times a day. I felt it get easier every day, but those first few times were excruciating.
It was good that they made me do it—by the last day, I was starting to develop nerve pain from so much sitting, propped up in the hospital bed. Walking was torture, but so was sitting.
I was reading "Dr. Mutter's Marvels" a while back. The eponymous surgeon was working around the time that anesthesia was being invented in the US, and it talks a bit about how some competing traditionalists believed that pain needed to be part of the actual bone-sawing surgery itself. (Also a natural part of all childbirth, with biblical overtones.)
Note that this is the exact opposite of the advice given in the article: you're told to ignore the pain and take walk, whereas the article states that the pain warns you to not disturb the healing process.
> I wonder if that doctor has ever had major surgery himself and been told not to use painkillers?
Since when is that a requirement for knowing what is best for your patients? The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.
> The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.
Medicine is unfortunately not nearly as scientific as you might wish - I worked for the British Medical Journal a while back and they are all about evidence-based medicine... unfortunately, there is still a lot of medicine that's based off of received knowledge or observational evidence, which may or may not be accurate. The situation is changing though as things get proper studies done, but it's not always easy to get decent results and so current consensus can and does change over time as research gets done.
Since the world stopped being completely black and white. (It never was.) And most definitely, medical science is not either.
With every medical decision there are trade-offs. Sure, it's best to walk soon after surgery... sometimes. Sometimes it's too early. And sometimes there are trade-offs like torturous pain that no person should have to bear. Many people might choose to forgo the day after walk knowing that their chances of a full recovery might be 0.01% lower.
It reminds me of the mantra that "breast feeding is best". Yes, according to some studies, there appears to be positive relationship. But what if continuing to breast feed causes a mother to stay clinically depressed. What if she can't handle the every 2 hours and it is driving her crazy and she wants to shake her crying baby. Maybe in this case, "formula is best".
A good medical practitioner works with their patients to communicate the risks and rewards clearly and help guide them to make the decisions that work best for them.
Anecdotally, I had a very intricate horizontal impacted wisdom tooth removal surgery done on barely any anesthesia because the thing was dangerously close to a nerve and I needed to be able to inform the dentist when he was getting too close to it (AR people: there is a market here for in-surgery diagnostic image overlays). It wasn't that bad (the healing process was more annoying), I was more focused on the ongoing procedure (but then again I was in med school before I decided to switch to computer science).
Slightly less anecdotally, I have a lot of doctor friends and while they may indulge in overwrought "look at how clever I am" medication schemes for ailments that do not really warrant it, I think that it's mostly because they feel that they don't have the time to rest like the author of the article (and this doesn't involve routine painkiller use either).
Some people argue that in my country (Italy) there is a cultural aversion to painkillers due to the historical influence of the Catholic Church, but it's hard to measure the effect.
I agree that there is no "one-size-fits-all" medical solution, but perhaps having this base-line allows building up when discussed with one's doctor - the article does not discuss this post-operation re-negotiation of how to manage the pain. Perhaps some HNers have experience with a similar situation that they could share.
I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
I'm perfectly understanding the concern for long term morpohine derivatives for treating post-surgical pain (although there are plenty of studies that show pain delays healing) so there is a bit of picking-n-choosing going on. Many nurses would recommend OTC acetaminophen in combination with ibuprofen as they work quite well and you're definitely still going to "feel it" if you're pulling out stitches with no risk of addiction. Since you aren't using a narcotic, you won't need a stool softener either.
I'm a bit concerned by the reliance on ibuprofen for pain (it's great for inflamation but prevents blood coagulation) since it can cause bleeding, although I'd note that she didn't even need that to sleep so her lapro-surgery was either extremely minor or she has high pain tolerance. Normally, combination with acetaminophen is preferred, because the dosage of each can be minimized.
Frankly, this all just sounds like German doctoring. I've also been told that you don't need decongestants (when flying) because your "nose should flow". It's normally acceptable (if inconvenient) advice, but if you're flying it could lead to eat infection and damage. It's not like your ear pain is going to get a pilot to turn a 747 around or help your cold pass faster. Suffering is not the answer to everything any more than a painless existence is.
> I have had my teeth filled by a dentist that didn't "believe" in novocaine. Luckily, he died before I had any significant issues, and I had a later dentist that did it correctly. If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
I (German) openly prefer it, if the dentist gives the option whether to get a anaesthetic injection or not for dental fillings, not to get one, since I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.
I am of course aware that there are really painful dental treatments such as dental root canal treatments - but in these cases no dentist will give you the choice whether to get a anaesthetic injection or not.
> Luckily, he died before I had any significant issues,
You're welcome to have your teeth drilled as you like. However, if you have a younger family member with more sensitive teeth you may understand that it's not for everyone. Imagine if your child jerked away for just and instant that caused the drill to cause more harm than good. The modern novacaine derivative my dentist uses lasts only about 30-60min after the appointment.
Because I was under the age of 18 and he was my parents dentist I didn't really have a choice. I didn't have any cavities as a child so my first negative dental experience was at 17 when he filled 4 molars "preventatively" (because he didn't know that epoxy capping was a thing). It didn't kill me, but it was an excruciating 30 min and an absolutely miserable day. The muscle tension pain from not moving took days to subside. Not a reasonable trade-off for me.
I had your experience at ages 6-9 in Alaska. The only available dentist had moral qualms about using novocaine.
The resulting aversion conditioning kept me away from dentists until I was 36, when my then-girlfriend coerced me to see a dentist. I needed lots of work, all of which was done using novocaine.
Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.
> Pain control is part of good professional medical practice. If a practitioner puts you through gratuitous pain, find somebody else.
I he has really "moral qualms" even when asked explicitly, I accept that you better look for another dentist. My claim is rather that it is as a dubious practise to just apply an anaesthetic injection by default.
That's interesting. My dad (half German) is the same way. After having gone to the dentist and seeing that, I though to myself, if he can do it, so can I. I now prefer it over having a numb mouth the whole day.
I've never had to to anything beyond simple fillings so I'd like to think that's the limit for me.
It depends on the procedure. I had a minor cavity filled when I was younger, and it really wasn't all that horrible. Something like a root canal would be unimaginable.
As I mentioned higher up the thread, pain thresholds vary dramatically. My father has had more than one root canal with no anesthetic because it was cheaper. He said the pain wasn't that bad. He just has a very high threshold for tooth pain, or lack of nerves there.
not all procedures are the same. my doctor also asks me if i want anaesthetics - but only if he thinks i can get away without one (i.e. minor work - he wouldn't ask if he expected the operation to last for more than a couple of minutes).
i've also skipped the anaesthetics on occasion without problems, but there were surgeries where this would have been madness where the doctor didn't ask.
> I strongly prefer 5 to 10 somewhat inconvenient minutes over having a numb jaw for a whole day.
I am not sure you'd say the same after 3-4 hours of treatment. I've done some root canal treatments here and there, which can take a long time. I'll take a numb jaw for a couple of hours afterwards over being in pain for 3 hours.
But I guess you're right, for 5-10 minutes of pain, it isn't worth it.
> If you are doubtful of the usefulness of pain management while receiving a filling, you can try it yourself.
What do you mean by a filling? Just for a minor cavity? I've never received local anesthetic for a minor plastic filling, just for root canals/crowns, and the pain has never been a problem. This seems to be common practice where I've gotten dental care (Sweden and Japan)
It varies by doctor. Usually, the more awful stuff they have to actually do, the less willing they are to issue pain pills for minor inconsequential things.
The guy who operated on my penis gave me a grab bag of pills that went right up to serious prescription pain killers and said just to call by if I needed more. I never even took the first day's pills, it barely hurt at all, but then he's a penis surgeon, it's not even essential to _have_ a penis, half the population don't have one so how important can that surgery be?
The guy who used to be my dentist before he retired was a Max Fac surgeon in his day job, dentist was how he relaxed before the weekend. So, normally he's putting back together ruined faces from car accidents and that sort of thing. Need a filling? "I can numb that, but it's in your lower jaw, and it's not touching the root, so I suggest we go without, then you won't drool for the rest of the day". "OK, but it will hurt?" "Barely at all, slight discomfort, weird sensation, no real pain". He was right, it was fine, definitely worth the small amount of discomfort to be in and out quickly and not drooling like an idiot.
On the other hand, when I was a kid I got hit by a car (my fault), they used Entonox (medical laughing gas) back then, I was high as a kite, and given the car smashed me good, that was probably the right call. So I'm not saying "I never use pain killers" but more like "I think pain killers are something to reserve for when it's really bad, not the first thing to reach for every time".
Well from experience 3 ops 2 minor 1 major in the UK last year they normally ask you to rate your pain on a 1 -10 scale and base meds partially on that.
I seem to be lucky and don't feel much pain so did not need any really strong painkillers after the first day or so and Tylenol made me nauseous so I stopped taking them.
Nationalistic swipes, which this crosses into, are not allowed on HN. They create flamewars and a nasty environment. I realize you may have meant it in good humor, but the communication channel here is much too poor for that to mitigate anything.
Even if that is the case, pain seems to vary greatly in how it affects people. I would be very hesitant to tell someone that they should just let the pain "guide" them, because I have no idea what it is like for them.