[AlwaysLurking]

I hope the situation with Rush opens a good and honest discussion in this country on how to help people in pain.

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[_Jim]

patients are afraid of becoming addicted to them, and government officials are concerned about their abuse.

SOUNDS like cigarettes ... Rush licked that habit once ...

[Grenada]

ditto.....I hope this doesn't set back the progress made in the last decade. We, as a society, need to understand chronic pain.

[Wisconsin]

I was on oxycodone after surgery. About the third day I was talking to the cat -- and he was talking back. We discussed medieval stone work.

I got off it that evening. The pain was less scary. Besides the oxycodone constipates you.

[alpowolf]

"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says. "Even where there is no arrest, no indictment, no evidence of physician or pharmacist wrongdoing, an investigation sends a strong negative ripple through the medical community."

Hi, we're from the government...we're here to help you. Pfah!

[jocon307]

"I hope the situation with Rush opens a good and honest discussion in this country on how to help people in pain."

Me too, but I have my doubts. I remember reading in the Reader's Digest (a pretty conservative mag)years ago about how our society discourages adequate amelioration of pain. It is not acceptable to tell people "you should be in pain, because drugs are bad", this is puritanism at its worst.

Remember, when the going gets tough, the tough do drugs.

[Cold Heat]

But is it all deserved?

Hell no!

All this fuss is making it even harder to be treated for chronic pain.

I have to deal with this mess on a regular basis.

I use Oxy-codone (percocet) and Oxi-Contin on a 24 hr basis for pain control.

Without them I cannot function in any normal way and my life would not be worth a 25 cent bullet to the head.

As a result of the drugs, I am addicted to them. I control my intake, but you tend to get used to the drug and the effect slowly lessens and you need more.

No body who needs these drugs takes them to get high. That would be abuse.

People who take them for chronic pain on a 24 hr basis get addicted. You cannot prevent it and the alternative is to vegitate and get a case of severe depression.

Rush has apparently let things get out of control and has admitted this. However, it is so easy to have this happen and with his resources, he has gotten the dose so high that he cannot get through the with drawls on his own. (with drawls are very uncomfortable and last for days)

He has made an error in judgement, but his addiction came as a normal side effect. His bank account and desire to keep his show going and on the air has caused him to use more than he should, but not to get high.

He did it to function normally and pain free.

It happened because there is no other option for pain relief.

If Rush has to retire because of this, it will not be because of the drugs.

It will be because of the lack of them and the resulting pain that he will have to endure.

I will say and few words in my prayer tonight for him. I want him to understand that he did not do anything wrong by taking a needed drug so that he could live as normal a life as he could. His mistake was to self medicate to such a degree.

[MissL]

I have cronic back pain and have for almost 20 years....there are just times when my back does not hurt as much as some other times....but it always hurts. I have not taken any medication, I am afraid to get started. It is not easy and I still am very active, just have made "friends" with the pain.
My Grandmother, and this was 30 or so years ago when Drs. did not consult each other about meds that they prescribed, she tookk pills to wake up, to go sleep and for pain and for more pain. I saw what it did to her and I just as soon endure.
But I can excuse and understand why Rush took the meds. Just for that sweet relief and a full nights sleep.
I can't fault him for wanting to be free from the constant pain.

L.

[Cold Heat]

"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says.

This is absolutely true and on target.

The Veterans Admin, for example, will not provide Oxy-Contin, but they will provide morphine.

Talk about medical correctness.

[alloysteel]

There are those who say that Rush should not be out swinging a golf club, if his back is as bad as claimed. That the medication is only for feel-good, not for therapy.

Be aware that a really debilitating back injury is sharply acute and seriously limits range of motion, not because the muscles are unable to make the motions, but because it hurts so DAMNED much. The difference between this constant pain and near-total relief is akin to releasing a grip on a high-voltage electrical source. When the pain is at its peak intensity, a person is not thinking about much else, and who wants to be at the mercy of such seemingly unending torture? Unceasing pain can be a major contributing factor in stress-induced depression, and depression leads to the downward spiral to self-immolation. At a certain point, a person may not WANT to live any more. Almost anything that causes the pain to recede is welcomed, and some of the narcotics available seem to do a reasonable efficient job, with a minimal reduction in judgment and limited hangover effects.

Make no mistake. Under the influence, the patient is still impaired, but the pain causes even more impairment.

[Plutarch]

It appears in the latest issue of the journal Pain Medicine.

Wow, the journal Pain Medicine. Real impressive. The medical world little notes nor long remembers what is printed in the pages of Pain Medicine. Pain Medicine is an organ of the American Academy of Pain Medicine, which derives much of its funding from the Purdue-Fredrick, the makers of Oxycontin. Pain Medicine is the equivalent of the Journal of the Tobacco Institute.

[ChicagoHebrew]

It's actually a general problem with America. Most Americans fall into two camps on narcotics-- they either snort massive quantities up their nose for pleasure, or want to arrest people who do. They ignore the massive middle ground.

This summer I was in Peru and enjoyed many cups of coca tea-- made from the same coca leaves we get cocaine from. But in their natural tea-leaf form (it takes 2-3 leaves to make a cup of tea, about 3000 to create cocaine), they are totally 100% non-addictive, while still serving as a wonderful stimulant/mood enhancer/pain reliever. There are so many healthy, beneficial uses to these substances-- when used in the right doses and for the right situations.

[dix]

I had surgery to remove a cancerous tumor, and one quarter of my left lung on April 18, 2003. BTW I was a former smoker when all of this came up . I finished my chemotherapy about a month ago, had my three month CAT scan, and at the moment I am cancer free. There is just one lingering side effect, and that is the pain from my surgery. I take two and a half 750 mg. Vicodan a day.

My job requires me to do a lot of walking, and stair climbing, because I am a realtor who is working at an onsite condo development where I have to show the prospects the various units. If people want to call me a drug addict go right ahead.

When all of this started I researched all of the meds that I would be taking, and I learned about the possibility of addiction. I also learned about developing a tolerance, and I watch my dosage very closely. I have developed a bit of a tolerance, and I just opt for a little more pain instead of increasing the dosage. I think that is where Rush went wrong.

Hydrocodone gives you an incredible sense of well-being. You have to be aware of this, and keep in mind the object is to stop, or mute the pain. Not to go to la la land.


10 posted on 10/11/2003 7:30 PM PDT by dix

[goody2shooz]

Oh boy. With my opinions I'll probably get flamed, but what the Hell! You see I have a defect in my spine, a third of all discs having now obliterated and I control pain successfully with excercise - NO PAINKILLERS.

On the other hand my sister and brother-in-law, ex-rock n' roll musicians, are addicts. Heroin first, then methadone. My sister had to go through rehab just to get off of three year's use of methadone, supposed non-addictive. The brother-in-law has been on methadone now for fifteen years, 200 milligrams a day dosage. Both started with tobacco and neither have been able to quit that habit either. Brain scans indicate whole areas of their brains as inactive.

The worst part is that both have developed hyper-sensitivity to pain. Yep. It appears that the more one uses painkillers, the lower drops one's threshold to pain.

I have tried to get to do what I do: aqua aerobics. Not swimming but walking and slow jogging through chest-high water works for me. It takes the trauma off the lower back.

[MattAMiller]

I was once presribed a cough medicine with condein, also an opoid, in it. It made me sleep so much I wasn't able to take the number of doses I supposed to take for a day. Not terribly useful for recreational purposes, not for me anyway.

[Sally'sConcerns]

I wish I could say I knew nothing about chronic pain but unfortunately, I do. Currently I take Panlor SS, fioronal, elavil and soma. I've been on one type of pain medication or another for 9 years. For 6 of those years I was able to continue working thanks to the meds. I worked even in the face of a pain phsycologist telling me I needed to accept I couldn't work.

In July, 2000 I could no longer work even though I'd try. I applied for long term disability insurance and was devastated when they approved my claim. During the approval process I kept hoping someone would tell me about a magic bullet. When the insurance company approved me, it was final confirmation that I was truly disabled and there was no cure for my pain.

Even after I moved to Oklahoma, I kept the same primary care physician because he knew my history. Together we had explored every option he could think of. I was referred at different times to 3 different neurosurgeons,an orthopoedic surgeon who specialized in spinal chord injuries, numerous physical therapists, 3 pain clinics and a partridge in a pear tree. Not one of the specialists recommended further surgery so that wasn't an option.

I've had MRI's, X-rays, dye injections and shots in the joints in my neck. They all agree my neck is a mess and they all agree there's nothing that can be done physically to relieve the pain.

I mentioned I had kept the same physician once I moved to Oklahoma because it has a bearing on how chronic pain is regarded by the medical community. Once I decided to find local doctors I ran into the following problem. I'd call a doctor and ask if they were accepting new patients and if they were, whether they accepted Medicaire and my supplemental insurance. Once that was answered in the affirmative they'd ask me if I had any diseases or ongoing problems. I'd answer, yes, I have chronic pain and have been under the same PCP's care for 9 years. The answer I'd get is.....We don't accept patients who have chronic pain problems.

So, that's all I am. Just a chronic pain patient. I'm not someone who gets a physical every year, I'm not someone who occasionally gets bronchitis, I'm not someone who gets sick or ever needs a doctor for any reason other than I AM A CHRONIC PAIN PATIENT.

My whole identity to the medical community is I'm a chronic pain patient and they don't want anything to do with me.

Fortunately, my dog had been hit by a car on mother's day and he'd bit me so I'd gone into get a tetanus shot and antibiotics. I was able to utilize this back door to establish myself as a patient with a local doctor. Of course, once I made the decision to have my records transferred,the doctor's office tried to discourage me by telling me they don't prescribe pain medication. I reminded them I hadn't gone to them initially as a chronic pain patient so they finally agreed to become my PCP. I scheduled an office visit and was referred to a pain management specialist who is willing to help me manage my pain.

Is this not ridiculous? Nine years with the same Primary Care Physician managing my case and I'm treated as if I am an untouchable. Not only do I have to deal with the pain but my identity has been stolen. According to the medical community, I'm no longer Sally, I'm a CHRONIC PAIN problem.

[Ursus arctos horribilis]

Three back surgeries, four fused lumbar vertebrate, two 9 mm rods and eight large screws later. I wish I had taken pain relief meds long ago. To the tough guys and gals who say they manage just fine without pain medication. Stick both hands over an open flame until you get that sudden urge to pull them out. Now tell me why you couldn't handle that little gambit.There is pain, then there is PAIN. When you get the PAIN, believe me, you won't confuse it with pain.

[not_apathetic_anymore]

only about 60 percent of the oncologists reported being certified to prescribe opioids,"

I don't understand that statement. When applying for a DEA certificate don't all MD's check all the boxes. If one checks all the boxes you can prescribe all the opioids. (There are some opioids that can't be applied for - like heroin. Though some argue that it's a far more effective pain killer than other available opioids - maybe the euphoric side effect, and should be available to those who are terminal and don't have pain control with other drugs.)

So who are these 40 percent who aren't certified?

Other thoughts from someone who has spent some time awhile back learning about pain medicine from a pain clinic. Pain Medicine is a relatively new field where docs can become board certified, and it's a booming field. They can essentially write their own ticket. But it's also a field with relatively high liability. Patients by the time they get to a pain doc are hurting, frustrated and angry at having to endure pain. They see the pain doc as a last resort and often sue when they aren't cured.

• pain is what the patient says it is and it has the intensity they report. It's very subjective and everyone experiences pain differently. There are physical components with emotional/psychological overlay. Some people report a hangnail as 10/10 intensity. Others give post op abdominal surgery 5/10.
• JACHO - the hospital accreditation group is pushing pain as a 5th vital sign. There will be more effort(certainly more documentation) within the hospital to try and evaluate and treat pain
• people with chronic pain do develop a tolerance and can take and function while taking incredible numbers of meds. When this starts to happen most docs do get uncomfortable. Unless they can find a pain doc/pain clinic to take the patient and manage the meds everyone starts to get unhappy. The patient becasue they hurt and are frustrated, and the doc because of concerns about prescribing and addiction.
• Things may have changed, but years back when the pain docs were teaching me they tried VERY hard to avoid opioids. They'd use other drugs and coping mechanisms, and treatment modalities (TENS units etc) and use narcs only as a last resort and under 'blinded' conditions like using a 'pain cocktail' for the patient, with agreements from all docs involved in caring for the patient that only ONE of them would prescribe sedative/opioid/hypnotics.
• medical care in the US is very fragmented. The exception is if a patient gets all care from a multi-specialty clinic type set up. If a patient doesn't disclose that they go to another doc and get prescriptions - pain meds or other - the 'current' doc likely won't have any idea what the patient is taking. Occasionally with really blatant cases a phamacist will raise red flags. But saavy patients doctor shop and use multiple pharmacies.

enough flight of ideas for now!

[kenth]

Last summer I had some dental work done, which included having to have a molar cut out. In addition to it feeling like the dentist had busted my jaw getting the tooth out, I ended up with a dry socket.

I was originally prescribed large dose ibuprofen that didn't even begin to touch the pain. When I asked the dentist for something stronger, he looked at me like I was a junkie and told me he didn't like to prescribe narcotics. I spent a few sleepless nights trying to ignore the vice-grips attached to my jaw (what it felt like).

[capocchio]

a better alternative than back surgery and other pain medications

good and honest discussion in this country on how to help people in pain

"Fewer than half of all back surgeries are successful in relieving chronic back pain"

Chiropractors are a solution rarely suggested by doctors. That's too bad, because often they are completely effective in relieving back pain without surgery or medication. Let me illustrate.

My wife first had lower back pain from two herniated discs over 25 years ago. Like many, she first went to see her doctor. He checked her into a hospital and prescribed an endless stream of painkillers (valium back then). The only other treatment he tried was physical therapy, which was not effective at all.

After putting up with his mindless efforts for a week yet still hurting as badly as when she came in, she finally tired of being doped up. She screwed up her courage, convinced him she was cured and got herself checked out of the hospital.

Then we directly to a chiropractor. Thirty minutes later she walked out of his office completely free of pain. Got that? 30 minutes and no pain She's never looked back. Sure, she returned for a gradually diminishing program of treatments over several weeks to get her spine back into alignment. He then prescribed a simple regime of walking and stretching exercises which kept her out of pain and not needing to come back to his office.

Over the years, she's occasionally had new episodes which required another visit to the chiropractor, but nothing as extensive as originally. Nearly every one she talks to about their similar problems express an unwillingness to go to see a chiropractor. Often it is for as idiotic a reason as that their insurance doesn't cover the visit! Others claim horror stories of permanent damage or being milked for all of what their insurance will pay.

Whatever, she has never had such things happen to her or to anyone whom she knows who has actually gone in. All report relief. Not just relief, but RELIEF. Immediate, complete, walk out of the office free of pain relief. No doctor has ever, ever, EVER been able to provide the same.

Chiropractors may not be the solution that works in every instance, but aren't they worth the try before going under the knife or becoming addicted to drugs? They are usually absolutely, positively effective. My dad was a doctor and he always said that for what they do, chiropractors should be consulted, that medicines don't address the problem, just the symptoms. Maybe if ER included an example people would be less blind.

We don't argue much any more with those who complain of back pain but won't go see a chiropractor. We have no patience with them if they refuse to try that option and they know it, so they just don't mention their back pain around us.