I was contacted by a chronic painer in S Florida and apparently this reporter just regurgitated this article from what she was told by a ER doc… Apparently, after talking to a local chronic painer she has been “enlightened” to the plight of those in the chronic pain community and perhaps some more positive stories might get generated if those in S Florida reached out to her… Here is her email pborns@news-press.com
Doctors are rethinking pain management – should you?
A uterine cancer diagnosis changed Lyla Whitson’s world several years ago, but the oxycontin prescription that helped manage her pain shattered it.
“When the prescription stopped after my hysterectomy, I went to the doctor thinking I had a bad case of the flu,” said the Cape Coral woman who turned to heroin. “My doctor said, ‘You don’t have the flu. You’ve been taking pain pills for three years.”
But it doesn’t take nearly that long for opioid withdrawal symptoms to set in from pain pill use, said Lee Health Emergency Room Dr. Aron Wohl.
Some hospital patients report the most common signs – nausea, diarrhea and chills – after three or four days’ use.
“What they are becoming is physically dependent,” Wohl said. “That can lead to addiction if you continue use.”
An alarming number of people do continue. The Centers for Disease Control found 24 percent of people who were given a 12-day supply of opioid pills were still taking the medication a year later. Six percent were still taking them having only been given a one-day supply.
At the Lee Health ER and across the country, a growing practitioners’ movement wants to prevent dependency before it begins.
“For the last 15 to 20 years we wanted you to be at pain level 0,” Wohl said. “The pharmaceutical industry promoted and lobbied for that. We do not need to be at 0 pain.”
The overprescription of opioids is leveling off, but deaths continue rising, says Dr. Marc Fishman of the Maryland Treatment Centers. He talks about addiction, treatment and bootleg fentanyl with USA TODAY Editorial Page Editor Bill Sternberg. USA TODAY
The pendulum of pain management is swinging back to techniques like elevation, compression, ice and heat that fell by the wayside decades ago.
Say you broke an arm or sprained a tendon and it’s acutely painful. Doctors who in the past might have prescribed hydromorphone or oxycodone now say that aspirin or non-steroidal anti-inflammatories like Ibuprofen are best, Wohl said.
Following recommendations of the CDC, a consensus is growing to treat episodes of acute pain with opioids for three days at most.
“After just five days of prescription opioid use, the likelihood that you’ll develop long-term dependence on these drugs rises steeply,” Mayo Clinic’s new guidelines say.
Florida healthcare providers adopted three-day limits for opioid prescriptions based on a new definition of acute pain signed into law by Gov. Rick Scott in March. (Pain from cancer or a terminal condition is excluded from that rule.)
Providers are also expected to come up with recommended pill counts for specific medical procedures that would reduce pill counts dramatically.
A pioneering group, the Michigan Opioid Prescribing Engagement Network has already published a model prescribing guide.
For a hysterectomy like Whitson had, its recommended dose of hydrocodone is 20 to 35 tablets at 5 mg strength, for example.
For a breast biopsy, 10 tablets.
Until recently there was no definitive recommended guide for pill counts at all.
“The answer today is Tylenol and Motrin in many cases,” Wohl said. “For a severe injury – a tibial lower leg fracture, for example – an opioid used sparingly would probably be recommended. The key is sparingly and with understanding of the risk.”
While doctors are becoming more vigilant, consumers have the most to gain by being their own advocates. The good feelings you have on opioid medications are tempting to continue, but they won’t last, Wohl said.
Just ask Whitson, who lost her home and family and is still on the street seeking drugs to feed her addiction.
Southwest Florida’s Ramona Miller gives opioid users the overdose antidote Narcan for free. “The best person to help an addict is an addict,” she says. Patricia Borns, pborns@news-press.com
What you can do
- If your doctor prescribes one of the common opioid medications for your pain (below), ask if it’s OK to take Tylenol, Motrin or Advil instead.
- Don’t keep using opioids when your pain subsides. Wait longer between doses and stop as soon as the pain does.
- If you stop taking opioids after three to five days, you may feel body aches, nausea, vomiting, diarrhea or constipation. Recognize them as withdrawal symptoms that will pass in one to a few days. Don’t take more opioids to try to feel better.
Pain-free is a pharma myth, Wohl said; an idea seeded by a marketing campaign called Pain is the 5th vital sign, complete with pain scales, that spread through groups such as the Joint Commission and American Pain Society.
An entire generation was led to believe they should be pain-free.
The re-learning process is just beginning, Wohl said.
Follow this reporter on Twitter @PatriciaBorns.
Filed under: General Problems
Steve, the opioid hysteria is killing chronic Iain patients at an alarming new rate. The large threatening fear they have intentionally or into the heart of every CPP is intentional, malicious, and deadly. That fear releases cortisol and increases pain sensitivity. God forbid you have an “invisible illness” because then they add contempt and condescension when you are in the worst pain of your life and selling legal help. We all know that illegal methods of pain control are available (albeit extremely dangerous & unregulated) yet we show up at an emergency department and are treated like scum of the earth! We have to willingly subject ourselves to discrimination and vicious disgust because we have enough respect for our families and our lives to NOT seek illegal street drugs…but does it matter to health professionals who are inundated with CDC lies and threats of losing their license just for maintaining their Hippocratic oath to do no harm.
✔Do you know that regardless of a suicide note being left if Opiods are in a person’s system It’s ruled an opioid death?
✔ Do you know that the average number of contributing chemicals in an “opioid overdose” is 6?! No doctor prescribed that…
✔Do you know that over 99% of overdoses aren’t legally obtained prescriptions…yet that is who is maligned in the media and legislative bodies?
✔Do you know that the vast majority of opioid suicides are from low dose pills mixed with other substances?
✔ Do you know that regardless of the actual cause of death (gunshot, hanging, severe fall…anything) If the person even had a legallow dose opioid rx it gets counted as an opioid death?!
✔ Did you realize anyone can buy a pill stamper online for less than$20 and street dealers often use this to convince nervous buyers that they are getting a ‘safe’ dose even though a large% have illegal fentynal laced in it?
✔Can you even imagine searing pain and no one willing to help you much less talk to you with any decency?
✔ When will the stats be announced correctly? Less that 0.3% of deaths from opioids are legitimate patients who obtained their medicine legally!
PAIN PATIENTS AREN’T THE PROBLEM THEY ARE THE VICTIMS!
There are multiple doctors who have testified to Congress regarding this and I seems to fall on deaf ears; far too worried about looking was so they prosecute CPPs for votes. They can’t seem to handle illegal dealers and don’t want the border to be brought up despite massive busts of cocaine, heroine & illegal fentynal coming through! I could go on & on with these truths…
THIS IS THE GREATEST HUMAN RIGHTS CRISIS IN AMERICA TODAY!
Awesome comments, way better then i ever could of done, Now this is what we need to be seeing the MSM talking about not the Overhyped Numbers the CDC themselves admitted were incorrect by at least 50% (which means they claim 2X as many as actual)
You know what pisses me off here is what about those people (millions) whom are not looking for this ridiculous 0 pain result.(Matter of fact I have never heard such a Steamy Pile of BS as people expect a 0 pain rating) I mean when your day can have a 7-8 pain rate getting to a 5 is AWESOME. but without any pain meds or using Aspirin or tylenol or ibuprofen would have your scale at 10 easily. These people are the ones who are being tortured and commiting suicide due to this entire Opioid Lie.Not to mention what are you supposed to take if with your Prescription medication you are already taking 2400 Mg of Ibuprofen and Tylenol or Acetaminophen? Any info being shared by MSM or anyone the Long term side effects of Ibuprofen or Acetaminophen?
It is just Absurd that a Patient that has a condition with no options medically to solve problem causing pain, has followed all the Doctors orders , done timely UDS’s Sees doctor on regular basis, has no side effects is all of a sudden told (Due to Some abusing medications you are no longer allowed to have a semi normal life, spend quality time with family, grandkids etc. or be able to go out to dinner, a movie etc.
From now on you can expect pain, Misery and be incapacitated daily)
BTW those same Clowns that Abuse Pain meds will Abuse other items also, Like Alcohol (Which should never be used when on Opioids) and I bet Abuse much more .
It has became a sad situation in our supposedly civilized society when innocent law abiding people are the ones punished for criminals activity.
Yes if you are taking medications that were not prescribed to you are not the way the instructions say to take them you are partaking in criminal activity plain and simple. Sadly I get to and have watched someone very close to me go from having multiple back surgeries and dealing with the pain well on medication, enjoying her grandson, being able to at least plant a small flower bed and enjoy some shopping, dinners outside of house to being in misery, left in such pain as any flower bed work is out of question and it is torture not only living day to day but to do anything other then sit in house praying the pain won’t be a 10 all day long.
SO my compassion for those who are abusers or take medications just for the hell of it is Gone, I have 0.
I only wish our society was not so dam stupid as to not see how Discriminating and nothing less then torture this has became to people who need and deserve proper pain medications and amounts.
Truth! CPPs aren’t addicts or criminals! We are in fact the sacrificial lambs. We NEVER chose to be sick or in pain; we NEVER had a choice but we are the villains somehow.