To elaborate from the title, my mum was in a car accident two decades ago which resulted in her left foot being severed and re-attached, her left leg is shorter and pelvis tilted resulting in back pain that has increased over the years. On top of that, she’s got fibromyalgia and ME. Her pain is so severe every day that she is bed bound, she will go for days without sleep because it’s so bad. She has been prescribed 20mg oxycodone, which she can take 3x a week for “breakthrough pain” and has over the counter strength codeine that she takes 3x a day every day, she’s also on 75mg amatriptalyne every night for sleep, and she’s on Prozac 60mg daily for mental health. It is only when she takes her oxy that she is pain free for 6 hours and able to do simple things like take the dog for a walk, tidy up around the house, chuck in a load of laundry or get a good night’s sleep.
She used to be on 20mg oxy 3x a day, and was on that dose for 5 years without going up. Back then, she was able to work, and live her life very happily.
She went to the pain clinic to ask for an increase of 3x to 5x a week, and they basically told her that she’s imagining her pain so she needs to change her mindset, and gave her some book to read about it being all in her head. The person said she can’t prescribe more pain medication than that due to guidelines, and even if she could then she wouldn’t because of the effects of opiates on the body. But my mum feels like she would rather be pain free and be able to live her life.
We are at a bit of an impasse now because she doesn’t want to be labled as a drug seeker, but she can’t continue living the way she does. Her mental health is so bad because she is living in constant pain, she is basically being imprisoned and tortured in her own body with no escape. Where do we go from here? We are based in the U.K.
And guess what? MDMA use was discouraged and labeled as unsafe/deadly too and now it's actually being researched after demonstrated evidence that it HELPS in some cases. Yep, I know it can be harmful but we would have never cared to delve further into its healing, life changing aspects if not for some baseline research from recreational users that showed the value of looking more closely.
That, along with the knowledge that people are rotting in prison for distribution while "entrepreneurs" open a dispensary in every town, a should be enough to piss us all off. If there was anything tangible I could do with a steady job attached (because I'd most certainly be fired for speaking publicly on it), I'd fight full time for federal legalization and patient rights as a social worker. But what can we even do? We're so powerless and it pisses me off. Not my most relaxing highdea..
I am not, never have been, an addict. But I’ve been prescribed opioids after surgery and I could see how someone would become addicted. I still think about it, to be honest, the way I would take one and I felt so good all day, not even a headache (which is my normal everyday baseline). I still kinda joke about how I wish I had some. But it’s scary to think that if I had another months supply, I would be teetering the edge of being addicted to them.
My main concern going forward are my kids. This show has made me think about how I’m going to address pain management in the future with my children. I have addiction in my family, and their dad died from his. I’m terrified that one wrong move will ruin their life. This will definitely be something I am more vigilant about should we ever be in the situation where they need to be prescribed meds.
I’m presumed 60 7.5 Hydrocodone a month. I’m having a surgery to have some metal removed from my leg. Will I still be prescribed pain meds for after the surgery by the doctor doing the surgery or do I need to let my pain management know so they can prescribe me something for after surgery?
Thanks
It would probably make kangaroos too popular but like... Sylvia, you've been living on my island for a year and a half, maybe introduce me to the small child you always have the blinks in unison with you? I'm sure it would kinda complicate why there aren't other animal children... But completely ignoring it yet still including it is bizarre to me. Like have them chime in with something every ten times you talk to her and no one would think twice. Pipe dreams I guess.
I'm looking for a physician or other help who has some idea of what to do with long term (since early 2000's) chronic pain from not necessarily explicable causes. Some of it is neuropathic, some of it is physical, some of it is "throw your hands in the air because who knows."
I've been seeing Graham Reimer, MD at Sansum Clinic for Pain and I'm just not really satisfied with his approach of "let's just switch otc's and things that have that level of pain reduction. No go? Why don't I refer you to someone who has already seen you." He seems like he knows what he is doing generally but not like he knows what to do with me. I think I need a slightly more wholistic (if that's the right word) approach without hitting the opposite extreme of woo-woo.
A doctor would be great but I'd also just take a support group at this point. Or pretty much anything. I'm not picky about anything except quality. I've given up on cheap. I've nearly given up on quick. I'm beginning to wonder if I need to give up on near.
I've been looking at the websites for
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Pacific Pain Physicians: Interventional Pain Management Specialists
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Michael Kenly, MD at ALTA ORTHOPAEDICS
But they and the couple of others that I'm looking at generally look like they're the same as Dr. Reimer and that's what I don't want more of. And my google fu just isn't giving me much else or what I feel like are helpful reviews of them.
So, yeah, I'm just trying to find someone before I have more major surgeries. If anyone has any recommendations or suggestions. I'd appreciate them.
Sorry if I've posted this contrary to the rules. It looks ok to me but I'm not as quick on my mental feet as I used to be.
Thank you in advance.
Grown screw Robin. She can provide for her own kids.
I accidently left my pen at my boyfriends house and i was going to pick it up today but i find out his MOTHER smoked a vast majority of it. This makes me be beyond pissed since its hard for me to get carts due to an unreliable plug and especially since i use it for pain management and it helps with my ups and downs during my period (painkillers and other things dont work). So im not sure what to do since i can't just go out and buy my own, and she won't reimburse me since she doesn't have any money ;-;
Most people are so fucking blind to the maleficence they spread in this world. They are monsters of a lesser kind, but it makes me fucking hate this human race, I fucking can't stand it. I see it everywhere. The cycle of hatred which consumes the human race almost every single day, progressing its self from America to China to fucking Switzerland, who cares, it doesn't matter.
When you wake up each day- based on your way you treat others, your significant others, whatever group you belong to, you are progressing so much pain in this world if you are a dick.
The WORST example of this, and really want gets me pissed off, is having children. Do you realize based on how you treat your child, you are literally creating a vessel which will either traumatize other people (if you traumatize them, half the time this creates a rationalization which makes them think traumatizing others is okay, and it progresses the cycle of pain I am talking about) or help others in some fairy tale world I don't know.
Because of how fucking traumatized I am, and being a misanthropist, I think 90% of the time the cycle which is progressed is just more pain. This is where my post is going to go into antinatalism. I opt to just not having children, since this stops the cycle of pain.
How many other people think like this? Fucking none in my life experience, it's so disgusting.
My own mother who I do love refutes how marriage and children are awful, even though my father abused us for decades and my brother talks about killing himself weekly, my mother can't even barely function, and I am some edge lord on this site who complains how I want to die daily. YOU GUYS DID A GREAT FUCKING JOB, YOU ARE SO RIGHT!
What the fuck is up with our society?! I know women, I just was talking to an old ex-girlfriend where the couple is having abusive fights on the weekly and there are three children around. Do you not realize what you are doing to this world?!
We leave an imprint on the human race as we raise the next generation, and it seems like traumatizing them is almost inevitable due to how evil the human race is. So just don't fucking have children! I've done my part up to the age of 30 and not had any, why are people so selfish and just creating more and more hurt in this world and rationalizing it through the mindsets of "Well I want a cute thing which likes me, yolo :P"
Fuck people. There's no hope for the human race. People are so ignorant to the pain they progress, fuck everyone,
... keep reading on reddit ➡I have been in pain for almost a decade yet doctors won’t prescribe anything. I’m so tired of this pain. What is something to look for in pain management doctors and something to stay away from?
4 days after the initial diagnosis (still don’t know if his brain tumor is cancerous or not) and we are overnighting it at the hospital. His pain was consistently 9/10 or 10/10 today. I thought bringing him here for the night would better help manage his pain. Instead he is now solidly at 10/10 for the past 6 hours - can’t even fall asleep in any capacity. Whatever painkiller they’re giving him isn’t doing shit. Is this normal?? Do brain tumors just hurt 10/10 and there’s nothing you can do???
After the poll, I'll describe the situation that got me to ask this question here.
This is a no-nuance style poll. Pick whichever drug you want, I like fentanyl but you do you. Throw out patients you pick up weekly that are clearly pulling your leg for drugs. There's no specific injury necessarily, so think of generic pain calls for extremity injury or severe abdominal pain or whatever. Edit #1 addition: Pain is the reason they called the ambulance, and they're requesting something to take the edge off.
Likely, all of the options below will have some weight in your decision, but which one has the most weight?
Feel free to discuss the options below. I'm looking to actually look into this data, so if there's ways to improve the question, I'd love to hear them.
Additionally, if you're a service director or you know the data, throw in the comments what percent of your patients get pain management. Is it 10% of the total call volume? More, less?
We'll be lucky if a quarter of that money trickle down to the actual orphans that need care.
I've heard too much about how donations to orphanage homes are being used as souvenirs for the workers there and they all take home their share of it and leave the kids to the little remaining.
That's the same system that made the government hoard palliatives from people dying of hunger, it's a mad world out here for real
Hi, PGY1 in family medicine here with a tough question for all of you experienced family docs!
It is well known that women's pain is often not acknowledged or managed to the extent that it really should be (e.g. in ED settings, where multiple studies have demonstrated a propensity to under-treat pain in women in acute distress, an observation seemingly attributable to subconscious bias). Having recently completed my obstetrics/gynecology rotation, I cannot help but feel that this applies to the context of family medicine as well. Procedures like endometrial biopsies, cervix checks, speculum exams (in the context of vaginismus), and IUD insertions are commonly performed without analgesia or just an NSAID, with the expectation that women "grin and bear it" (to quote an attending) for a period of time. Speaking from personal experience, my own IUD insertion was the most pain I have ever experienced (including acute pancreatitis, ice pick headaches, and severe acute inflammatory progression to arthritis mutilans). I cannot help but feel that the sort of subconscious bias observed in EDs extends to what is seen in family clinic.
So I am wondering: what have you seen applied (or have applied yourself) to mitigate discomfort during these procedures/exams? Are you aware of any relevant developments for pain control in this context? Or in mitigating pre-procedure anxiety in an acute setting for predisposed patients (knowing this demographic is disproportionately affected)? Because in my opinion, we are often asking women to endure an unacceptable amount of pain, and it seems like there are a lack of accessible options for us to apply. A month's worth of eliciting significant pain with cervix checks and IUD insertions has left me feeling deeply discouraged.
Thanks in advance for your insights!
EDIT: Thanks so much everyone - this has been the start of a very, very helpful discussion! I was also wondering if anyone wanted to weigh in on:
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The use of intravaginal misoprostol in advance of IUD placement/endometrial biopsy. Anyone have any experience with this? Is there any evidence to support it? I know timing IUD insertion around menses has been proposed as a means to reduce insertion pain with whatever small amount of dilation/softening it confers, so it makes sense on some level but I don't know!
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The use of a short-acting, one-time dose of benzos (e.g. 1 mg lorazepam SL) in advance of IUD insertion in women with a history of anxiety. I have heard OF it,
I probably could have gone about this whole thing differently, but well... it's too late now so I'm here begging for a little advise. I've read the rules (if I break any, please let me know and I'll gladly make changes) and the wiki that pertains to getting off my meds, but I have about 3.5 million questions. I figure I'll start with just a few :)
So, I've been in pain management for seven years. I have a failed double fusion in my back and fibromyalgia. I'm sick of the meds and self sabotaged so I couldn't just go to the appointment again. I'm here with no way to refill my meds to get off these damn things that frankly aren't working anymore. I'm currently taking 4 10/325 hydrocodone and 3 20 oxycontin ERs per day. I wish I could say I'm great otherwise, but again, they've not been working well for a while and I have refused to go up in dosage so I've got enough meds to get me through a quick 2 week taper. Yes, I know this is going to be miserable. Yes, I still have to work and go to school. So, that's where Kratom comes in. I've used the capsules over the counter before when my meds were going to be a day late and it worked really well. But there's no way I can do that many capsules daily for more than a day or so. Keeping them down was a major issue.
I see the guy's wiki about this but I cannot stand the powder or tea, I cannot keep it down. I usually use tinctures of stuff like this. I've looked around online, but there's so many different strains and dosages that I'm a bit overwhelmed. And then there's the question of how much to use that isn't a powder. If I can find something that's not powder/capsules that will work ok.
What strain/colors should I start with here? I keep seeing greens mentioned. What is the difference between an extract and a tincture? I just can't do the powder and the capsules were a LOT to swallow at once, I cannot imagine taking enough each day and keeping it down.
Yes, in hindsight I probably should have handled this differently, but well... I knew if I didn't do it this way, I'd totally wimp out and I really need to figure out another way to deal with my pain because the pharmaceutical way wasn't working anymore.
I do take an SSRI for depression, although I went down on those several months ago because I didn't need as much. I also take a few other things, including cymbalta for fibromyalgia.
These aren’t to say it’s all fixed or it’s only a matter of time. But it can be encouraging to know people outside the community have noticed issues with the guidelines and have reported on them.
Recent court case
https://reason.com/2021/11/02/a-scathing-rejection-of-the-case-against-four-drug-companies-highlights-misconceptions-about-the-opioid-crisis/?amp&fbclid=IwAR3Hzlp0nGg1ts2S609tUq3_M-UaFmr5uBM9zdExsL_3on8HcIfdUDwcqz
Report by scientific review board regarding the new recommendations for the revised guidelines
https://github.com/chronic-pain-defense/public_docs/blob/master/pdfs/OWG-Report-of-Recs-1-12-06.30.21-FINAL-508.pdf
The AMAs letter to the CDC regarding issues with the guidelines. I believe this was instrumental in the decision to produce a new revision of the guidelines
https://searchlf.ama-assn.org/undefined/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2020-6-16-Letter-to-Dowell-re-Opioid-Rx-Guideline.pdf
This ones old but good and shows that the events surrounding the creation of the guidelines draw it’s credibility into question.
https://pdfs.semanticscholar.org/ae5f/20b84fac92a9858f35268ee896554beb54b6.pdf?_ga=2.72559891.1627630601.1616037419-799007051.1616037419
For any pain specialists or anyone who stays up to date on research in analgesics and pain management, PLEASE tell me there are some decent medications and/or treatments on the horizon. I just hit the ripe old age of 27, rolled the dice and tried a cervical epidrual steroid injection yesterday, and have felt like utter garbage since. Pounding headache, bad nausea, and continued back pain. It seems like whenever I finally give in to try some kind of treatment, it backfires or just doesn't work. I hope it will over the next few weeks, but right now I'm just hoping I don't have a small CSF leak or something. Next week I'm scheduled for carpal tunnel surgery as well. I just hate havubg chronic pain and health issues. It's stolen so much from me this past decade, and I can't help but think of all the things it will continue to steal from me and how it will just keep worsening.
I have hypermobility spectrum disorder, degenerative disc disease, failed back surgery syndrome after a failed L5-S1 fusion for spondylolisthesis which then had to be redone plus a third surgery to remove loteral garbage they left in my back during the revision surgery, medical PTSD from all that and the continuing pain and surgeries, torn ligaments, central sensitization and allodynia, trigeminal neuralgia, arthritis in my neck as well as complete loss of curvature, etc.
I can't help but dwell on the fact that these issues have done nothing but escalate over the past decade. I went from totally healthy and athletic to crippled with pain wearing a forced smile, altering my career path, and just causing so much change throughout my life.
I just want to know if there are advances being made in pain management research or SOMETHING. Anything. Just some kind of hope that I won't be laying in bed at 35 mentally begging the pain to stop like I am now. Yes, I see pain management and receive hydrocodone. Obviously, it is pain MANAGEMENT and not elimination, but even with the management there are so many times where it's just completely overwhelming, particularly as a young person who sees the future as something to be loathed instead of excited for because of this pain.
This is a bit of a rant, I really need to get it off my chest.
My doctor finally said it was time to see a pain management specialist because I have more bad days than good days now, and they no longer feel they can manage my chronic pain and try to solve what is causing it. About 2 months ago I was diagnosed with degenerative disc disease, but my doctor does not think this is the only thing contributing to my chronic pain - which I've had for 4 years now.
I could have pulled a tooth easier than it was getting an appointment scheduled with them, but I finally got one. I had my first appointment with them yesterday and the doctor *flat out* said to me that they think I am exaggerating the pain and that they will not be treating me, because I am too young to be experiencing pain that can cause me to lay in bed all day. I feel so defeated, so... deflated. I feel unheard and I just don't know what to do anymore.
My GP said he will send me to see a different specialist, because he believes me, but right now I feel like I just need to give up and accept the fact that my life is going to be pain day after day anymore.
My knee and back pain get so bad when I’m laying down. I try to put a pillow under my knees but it’s hard to stay in that position all the time and any time I move it just hurts. This often wakes up in the middle of the night.
Anyone else experience this?
Most people are so fucking blind to the maleficence they spread in this world. They are monsters of a lesser kind, but it makes me fucking hate this human race, I fucking can't stand it. I see it everywhere. The cycle of hatred which consumes the human race almost every single day, progressing its self from America to China to fucking Switzerland, who cares, it doesn't matter.
When you wake up each day- based on your way you treat others, your significant others, whatever group you belong to, you are progressing so much pain in this world if you are a dick.
The WORST example of this, and really want gets me pissed off, is having children. Do you realize based on how you treat your child, you are literally creating a vessel which will either traumatize other people (if you traumatize them, half the time this creates a rationalization which makes them think traumatizing others is okay, and it progresses the cycle of pain I am talking about) or help others in some fairy tale world I know.
Because of how fucking traumatized I am, and being a misanthropist, I think 90% of the time the cycle which is progressed is just more pain. This is where my post is going to go into antinatalism. I opt to just not having children, since this stops the cycle of pain.
How many other people think like this? Fucking none in my life experience, it's so disgusting.
My own mother who I do love refutes how marriage and children are awful, even though my father abused us for decades and my brother talks about killing himself weekly, my mother can't even barely function, and I am some edge lord on this site who complains how I want to die daily. YOU GUYS DID A GREAT FUCKING JOB, YOU ARE SO RIGHT!
What the fuck is up with our society?! I know women, I just was talking to an old ex-girlfriend where the couple is having abusive fights on the weekly and there are three children around. Do you not realize what you are doing to this world?!
Not to mention her child got diagnosed with cancer and she is making another life suffer because some suffering is out of our control. Just don't have children!!!
We leave an imprint on the human race as we raise the next generation, and it seems like traumatizing them is almost inevitable due to how evil the human race is. So just don't fucking have children! I've done my part up to the age of 30 and not had any, why are people so selfish and just creating more and more hurt in this world and rationalizing it through the mindsets of "Well I wan
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