Avoid opioids for chronic back/knee/hip pain

[Pluripotent]

For back pain, is it worthwhile to take ibuprofen for its effects on the inflammation, irrespective of the pain benefit?

In as much as inflammation is causing the pain, then yes.

PS: Alcohol lowers the dose at which Tylenol becomes toxic. /psa

[m_sporkboy]

This is a very interesting debate, I've had fun reading it, and for that thank you!

I've enjoyed it too, but I don't know if you can call it a debate when it's one random person who knows nothing against five medical professionals who know everything .

[David Clark]

Off the top of your head, how many times have you heard something to the effect of, "Vicodin is basically just baby aspirin to me" or "I can take 6 Percocet and it doesn't even touch my pain"?

My wife's health care provider told her to not worry about Tramadol, it's not addictive, it's like aspirin but it won't upset your stomach.

[Mark Rippetoe]

Tramadol is pretty damned benign, as far as psychoactive opiate analgesics go. It's not for sale on the street -- yet.

[ExpertOrBust]

Tramadol is pretty damned benign, as far as psychoactive opiate analgesics go. It's not for sale on the street -- yet.

Tramadol worked well for my dogs when they got up in years.

[Pluripotent]

Tramadol is pretty damned benign, as far as psychoactive opiate analgesics go. It's not for sale on the street -- yet.

Doesn't really get you high and you can't really OD on it (I suppose you could if you're really dedicated), so street users don't want it (when they come to the hospital, they are all "allergic" to it). It's a good tweener drug for chronic stuff (like a LoL with RA and a GI bleed who can't take NSAIDs, for instance). But in their wisdom, the FDA now lists it as a schedule 2 controlled substance, just like narcotics (did that about 4 years ago). So you have to jump through the same hoops to get it. Stupid.

[aurelius]

Are most opioids used in overdose deaths sourced from pharmacy burglaries/robberies?

I have known several opioid addicts. The more powerful painkillers are better than heroin. And they never stole or robbed. They found 'smurfs'. Which is a term for older people that sell their prescribed drugs to subsidize their social security.

[Alchemist]

In as much as inflammation is causing the pain, then yes.

PS: Alcohol lowers the dose at which Tylenol becomes toxic. /psa

Not from a place of disagreeing, but wanting to know more. Documentation? I'd not heard that.

Sully, can you expand on it?

[Pluripotent]

I really miss Vioxx, I'm sure you Docs at least remember it if not used it personally. That was the best stuff ever. Had shin splints in college from soccer, was taking 12 Ibuprofen a day that was barely touching it. Standard dose Vioxx knocked it out like 20 year old Mike Tyson.

A lot of mistakes were made with vioxx, but it should not have been removed from the market. Under the criteria that it was removed, for consistency sake, we should also remove Tylenol and all NSAIDS, since they can cause and have caused more harm than vioxx ever did.

I find this entire discussion fascinating. A special thanks to everyone who has participated--especially the docs. Again, I am quite sympathetic to anyone who is in chronic, serious pain. It just plain sucks. It takes over your life. It's horrible.

I'll just throw this in. I have a customer who is the head of a very large ER department in a major city. We got into this whole opioid discussion one day and I commented, "I was very surprised in the hospital when, right after the birth of one of our children, the hospital gave my wife 800 mg pills of ibuprofen for pain. Why not an opiate?" My customer replied, "There is very little pain I can't control with an appropriate dose of ibuprofen and I see a lot of bad stuff. It is my main, go-to medicine of choice. It is cheap, safe, and incredibly effective."

We did discuss the terrible problem of addiction and he said, "You have to really be obviously hurting--like a bone sticking out--before I reach for the opioids." (I don't know if that was just his frustration speaking--but clearly there is a major problem). He says patients get mad and give him bad reviews, but the hospital can't really do much about it because he is the Department Head, about to retire, and the hospital is ground zero in a very bad neighborhood where no one else wants the job. He says people ask him "all day, every day" for pain pills.

Contrast that to another customer who is the head of the ER in another major hospital, "The stupid legislature has mandated that we control pain. Patients come in here and threaten to give us a bad review if we don't pass out pills...so we pass them out. We are creating addicts right and left to not get written up and have our jobs threatened. It makes me sick. This isn't why I went into medicine."

Clearly we have a problem. One of the reasons I am so interested in this is I have the ear of many legislators in our state. We discuss this very topic ALL THE TIME. It is taking up a disproportionate amount of their time, money, and energy.

Clearly there are multiple causes that have lead to a perfect storm for a narcotic crisis. The bit about the Smurfs is interesting, so not only are young people getting raped by their elders to pay for their Medicare and Social Security (which in all likelihood they won't get themselves) but then these elders are actively participating in the annihilation of the young by having their Medicare pay for the opioids that they turn around and sell to them for a profit. Sick.

I think we can't talk about this problem without talking about what compassion means. We are being sold a particular definition of compassion which is killing us. Med schools try to only admit students that are "compassionate" and they are even changing the MCAT to try to screen for compassion. But this is the wrong kind of compassion. It is the compassion of the Oedipal Mother, who never wants anything bad to happen to anyone, who doesn't want anyone to ever experience pain (and therefore, never experience anything). We give people opioids so that they won't have pain now. But we ignore the whole rest of their lives. Compassion does not work on a short time frame. Starting Strength is a good example of a long time frame compassion. When you're under the bar, it's uncomfortable, but you don't tell your lifter to stop. You push through, because you are thinking about who they will be in the long term if they can conquer this now.. This is the same "compassion" that makes doctors tell old people not to lift. Take it easy, do some light stretching, walk around the block. Not only does it not work, it kills people. The opioid epidemic is a crisis of compassion. It's focus is on the now, and by preventing pain now it is literally killing the targets of this compassion. It is the smother mother, who won't let her kids do anything dangerous. We talk a lot about toxic masculinity in our culture, but the opioid crisis is a manifestation of the pathological feminine. It is the Gorgon - the Medusa. We don't solve this problem by stopping people from being in pain. We teach them that pain is part of life, and that you are strong enough to handle it. We look at the long term, not the now. We learn what compassion actually means.

[Karl Schudt]

Pluripotent,

I think that's very good. Flannery O'Connor talked about this, saying "Tenderness leads to the gas chamber". Compassion without a firm conviction in the nature of the good life leads to the prioritization of eliminating pain, and drugging them can seem to be the best course.

It's a completely different thing to think that people ought to be useful and harder to kill. Being useful requires doing painful things.