Organic/acute pain— dilaudid

Nothing on scans/labs— dolobid

What Pythonista says:  I say the same.

Yeah the junkies have made it worse for everyone. I had to go to the ER a couple of times for a kidney stone. Got treated like a junkie till I told them all I wanted was Toradol, Allopurinol and IV Fluids to help flush the stone out. Then, I got the red carpet treatment. I got asked several times if I needed something stronger than Toradol. My ER nurse and doc told me they got a lot of people claiming they had a kidney stone asking for dilauded. I was one of the very few asking for stuff that actually works for kidney stones.

I've been prescribed pain pills a handful of times at the local primecare. Pretty much any time I needed them. I asked them once about the "We Do Not Write Narcotic Prescriptions" signs hanging on the walls. They said "Oh, they're just there for the pill seekers." Guess I got them because I never asked for them. Sucks that it works that way these days.

Because I am talking about people who go to the ER saying they are having chest pain, kidney stones, gall bladder pain, migraines, cancer,  etc. when they do not in an attempt to obtain narcotics.

There is a whole subculture of recreational narcotic users that have become addicts making up shit they don’t have in order to be given narcotics in emergency departments.
To the point they catch people injuring their urethra in the bathroom to make their urine show a bunch of blood in it, then finding out they have been to seven ERs with negative CT scans in the past month.  Or the patient saying they are having a sickle cell crisis don’t have sickle cell anemia.  Or the guy with cancer with Mets to the bone ends up having totally normal labs and no cancer.
If I am talking about people lying about shit they don’t have to score narcotics.

I am talking about people going to the ER lying about shit they don’t have to get narcotics.
Saying every pain medicine but the ones they want don’t work or that they are allergic to them.
They are not in pain.
They want a fix of narcotics.

I am not talking about the guy with 27 rods and screws in their leg, hip, and back,
Or the poor bastard with cancer that has spread to the bone.
Or the guy that just landed after a parachute jump and has a broken femur sticking out of his thigh.

I thought this thread was about drug seekers lying about shit trying to get narcotics.
There is a huge percentage of ER visits for that.

As for your messed up spine, there are likely people with the exact same findings on X-ray or MRI getting through life just fine without being on narcotics every day.  What is different about you versus them?

Same for my state. Had some health issues a few years back (Crohns disease). Multiple surgeries. Drains placed long term. Made sleeping a real bitch. The NP at the Surgeon’s office would regularly write me scripts for Vicodin. Heck, a few times she called it in.

Not crazy doses. IIRC, they were 5mgs each. Normally 30-60 pills for the month. That part was always kind of odd. I never asked for a specific quantity. And each time I’d call for a refill, she’d write it for a different quantity. Like a box of chocolates, I never knew what I was going to get

Do the world a favor and hand them extra.

Narcan? I know I have the key for that cabinet around here somewhere. May take a while to find it though.

There is a ton of fear about the legality of that sort of stuff among older people these days.

When my mom was on home hospice care they left a veritable supermarket of pain meds for her. After she passed my dad was so freaked out about having any of her stuff around he called the hospice people who told him to just toss them. He was so worried about them "falling into the wrong hands" that he gathered them up and took them to the police station.

I've looked under chairs
I've looked under tables
I've tried to find the key
To fifty million fables

They call me The Seeker
I've been searching low and high
I won't get to get what I'm after
Till the day I die

I asked Bobby Dylan
I asked The Beatles
I asked Timothy Leary
But he couldn't help me either

They call me The Seeker
I've been searching low and high
I won't get to get what I'm after
Till the day I die

People tend to hate me
Cause I never smile
As I ransack their homes
They want to shake my hand

Focusing on nowhere
Investigating miles
I'm a seeker
I'm a really desperate man

I won't get to get what I'm after
Till the day I die

I learned how to raise my voice in anger
Yeah, but look at my face, ain't this a smile?
I'm happy when life's good
And when it's bad I cry
I've got values but I don't know how or why

I'm looking for me
You're looking for you
We're looking in at other
And we don't know what to do

They call me The Seeker
I've been searching low and high
I won't get to get what I'm after
Till the day I die

You tell me, you seem to be the expert. When you've had the same surgeries I've had and lived in my bones for the past decade, then you can enter that conversation. Until then, your opinion means jack shit. Actually, it'd still be jack shit to me.

I hurt my back and coukd barely walk, sitting was painful, walking was tolerable. But I knew my doctor would just call me a bitch, and tell me to focus on my core, before he ever gave me pills. So I sucked it up, took 800mg of vitamin I and focused on my core. 3 days later, the pain is almost gone and I'm ready to go picking up the wife again

I just tell the ER docs/nurses that I'm allergic to ALL pain meds EXCEPT Dilaudid.

People having to play "mother may I" with the medical industry to get pain relief is ridiculous.  Just legalize it already.

Sucking it up works... until it doesn't. Worked for me [mostly] from my mid-20s into my mid-40s. Then shit got broke beyond the suck-it-up level. Keep that core strong, because once your spine gets truly broken... it may or may not be fixable. Keeping that core strong can help it stay unbroken. In my case... my dad, my brother,  and myself have all had multiple lumbar surgeries. I'm the only one fortunate enough to have added a cervical surgery as well.

You know you're right. One of the other docs on this board mentioned a model that would work great. Patients can get what ever they want from the pharmacy, no restrictions. Docs just recommend what they think is appropriate, no scripts and thus no responsibility from the docs.

This actually makes a lot of sense from the doc's point of view. Just make a recommendation, you're free to go with it or decide you know better. If you think you know better, but upon your death it's clear you did not know better, well there's no responsibility in the form of a prescription from a doc.

Docs don't have to deal with state dea's, federal dea's etc. No more worry about having the prescription pad with all the safety checks, no more worry about people trying to steal prescription pads. No more worry about drug seekers, no more worry about expensive malpractice insurance, no more worry about losing your license for trying to treat your patients in a complete lose/lose situation.

No soup for you!!!

I’m not offering an opinion.
I’m asking what your opinion is regarding people with the exact same diagnosis/findings on objective studies-
With one being in chronic pain spending the rest of their life on narcotics, and the other doing okay without them, or only needing them once in a while.

I know people that have sprinted with a casualty, fall and blow out their knee, get up and keep carrying them.
I have seen people finish long infils on a broken foot, or exfil on their broken fibula.  With chronic injuries and problems and not on narcotics.
People that finished decades long careers out shooting savages with men half their ages retire, and found to have severe spinal and joint injuries with problems and not on narcotics.  What is your opinion on why they are not going to spend decades of their life on narcotics everyday and still work, have demanding jobs, etc.?

Becareful @wildearp.  Once that prescription expires you are on the hook for illegal narcotics... even if the script was in your name.  No shit

What I take from this, is that I will wear safety glasses 24/7.

You do know that people tolerate and experience pain, hunger, etc very differently, no? There is a lady that is being studied right now who feels no pain. She could have broken bones, lay her hand on hot coals, etc and have no reaction. I believe that the experts have found that she's got a fraction of the pain/nerve receptors of an average person. Human beings are different. Who knew?

Muh WoD! Muh War on Liberty! Muh War on the RKBA! Muh War on Climate Change. All different sides of the same statist bullshit.

It depends on the injury. When I first blew out my acl it sucked but I wrestled for another month and finished the season before surgery. My second acl blow out my knee was locked up and would only move a inch either way. That second one hurt like a Motherfucker, i was laying face down in the dirt ripping out clumps of grass. Walking was not a option untill another acl reconstruction.

I had two out at once and they gave me a prescription for 30 10mg oxycodones a week before the procedure, in addition to the antibiotics I'd need and a benzo for before the procedure.

Or they've perfected the art of being an absolute pain in the balls so you'll give them something to shut them the fuck up.

The one time I was offered high strength pain meds for back pain, and refused them, the doctor looked at me like I was nuts. My rationale is simple - I've taken them before and I'm well aware that my brain likes them very much, so I choose not to use them. I'll take OTC meds if I need pain relief.

I honestly have to wonder how many patients say no.

Both of my kids had wisdom teeth pulled the same year. Dentist gave them both oxycontin (IIRC) prescriptions for pain without asking. We filled them, but they never used them. Still rattling around the house somewhere.

Back in 2013 my Dad had a valve replacement and single bypass done. They sent him home a few days later with a low end pain killer, and a huge mass growing above his incision. They said it was a hematoma and normal. Fast forward several weeks, and he was feeling sickly and ached all over.

This spurned a morning trip to the ER, a second trip to the ER in the afternoon, and finally a third trip to the ER later that night. The ER doc all but accused him of looking for opioids, and in the course of checking him over, made sure to run a finger up his ass.

My Sister made a phone call to his actual doctor, who happened to be on the hospital board. The man showed up in the exam room after midnight and started raising hell about mistreatment of patients. My Dad as it turned out had a huge fucking infection above his incision, and not a hematoma.

He was sent by ambulance to a large trauma 1 level hospital. It cost him 47 days in the hospital, a second surgery, and 6 weeks of IV antibiotics to get well again. Dr Ass Reamer got his shit pushed in by my family's doctor. There was an official complaint filed and  DAR was pretty much let go.

My best friend is an ER doc. Says he spends 1/3rd of every shift outing these people. He doesn’t fall for it and works hard to keep it that way.

Does it matter, when hospital administrators are so focused on patient satisfaction metrics that they pressure staff to make the patients "happy"?

The one time they were bad enough to get me to the ER, I didn't ask for anything.  They gave me Dilaudid, and my wife (at the time, fiance and nursing student) was astounded that all it did was take the pain away, and I was completely lucid.  I'm not the type to med seek, because my whole family is pretty resistant to such effects.

Corneal melting has a lot more going on than a simple corneal abrasion. A corneal perforation, or a post cataract extraction patient and a corneal abrasion are different animals.

Science Has Repeatedly Debunked this Stubborn Ophthalmology Myth

SGEM#83: IN YOUR EYES (TOPICAL TETRACAINE FOR CORNEAL ABRASIONS)

This one is behind a login wall, but the conclusion is there.
Short-Term Tetracaine Does Not Impair Healing of Corneal Abrasions

I had four wisdom teeth pulled on the same day, wide awake, only local anesthetic. I think I got two Tylenol #3 (tylenol with codeine). I didn't take them.

If that dentist keeps giving out #30 Oxycodone 10 mgs, he's gonna have plenty of business...of the wrong kind. Druggies are like raccoons. Feed one and the next morning, there will be 10 waiting at your front door.

And they go hit every new doctor in town to see if he's a Dr. Feelgood type or not. My maximum script I write in clinic is #12 Hydrocodone 5/325 or #12 Percocet 5/325. And that usually requires a confirmed kidney stone or a significant long bone fracture. In the ER, it's a maximum of #8.

Maybe the docs are tired of dealing with seekers and figure if they give them all the opioids they want they'll all eventually die. Do heroin addicts reproduce at replacement levels? If not then maybe it's not a bad strategy.

Lol this is why I just go straight to shooting heroin.

JK

Not funny because that is what is happening.

My medical director insists that we medicate anyone with a pain scale 6/10 or greater. Fuck that.

If you don't show physical vital sign manifestations of pain, or actually have an obvious reason for me to give you anything. You're not getting opioids from me. Period.

Had one asshole last week call us for chest pain. Met us on a street corner. Allergies to toradol, tramadol, and fentanyl. Yeah, right. No seeking behavior here. Walks to our stretcher and sits comfortably, no nausea, no abnormal skin signs, normal vitals, normal EKG. Pain scale 10/10. Half way to the hospital asks if I'm going to give her pain medications. I said no, she became an indignant, pissy twat. Get her to the ER, tell old doc what her deal was, immediately became crushing pain, to jaw, neck, and back. I tell doc shes spoon feeding him horse shit. He looks up her records, 17 visits this year so far for various abdominal or chest pain related issues, all with a normal diagnosis. She had been CT scanned 15 times in 5 months just in this one hospital system alone. If the narcs don't kill her the cancer from the radiation will.

Well yes, but corneal melting is not exclusive to corneal perforation or post cat. How simple of a corneal abrasion are we talking about? central? size? Again though, is it worth the risk?

Just scanning these studies does bring up an interesting variable. In the first article it notes the first study of n=116 (which drops to 70), but over a 24 hour period, the next study was a meta analysis and systemic review but doesn't note the time period, the last study n=1,576 but with no time period again. I think one of the biggest risk here is going to be losing patients to follow up. In the second link it actually addresses this as only 80% of patients returned to the clinic.

In the first link the second article mentions: So no complications, but possibly delayed healing. Is this worth the risk?

In the first link the final article mentions: Ok so there's different outcomes for simple as opposed to complicated. It seems like an awful lot of risk for again minimal gain.

The second link is the same study that the first link uses as it's first article. It also mentions:
So it's safe, but what's the point as there was no significant difference in the VAS pain rating, only that in patient surveys patient perceived tetracaine to better? Even this is skewed as tetracaine will BURN on instillation unmasking the treatment arm versus the placebo.

The presence of the rust ring in 23 patients complicates things for this study. The presence of a rust ring indicates that at some point you had an embedded metallic foreign body. That's not just a corneal abrasion. In additional the patients with the rust rings are removed from the study. why? because the remains of a rust ring will continue to irritate the cornea surface invalidating the participation of the study because it was not just a corneal abrasion to begin with.

Third link is behind a pay wall that I do not have access to now, but I'd like to read it rather than relying only on the title. But if we take the title at face value, fine we suppose we accept tetracaine doesn't impair healing, but the links above point out side effects with the dosage of tetracaine. Why put a patient at risk for those side effects for such a minimal gain?

In a peer review situation are your peers likely to know? Is that ER physician that wrote the article in the second link going to be on a "peer" review committee? Has the standard of care changed? I'm not taking the stance that it should or shouldn't. I'm asking the question if it's well known enough that you aren't going to be exposed.

The medical industry is built on treating symptoms, not curing causes.

I don’t think this attitude is limited to when they think people are drug seeking.  My experience has been they don’t take anything seriously until they see it on an xray, mri, vitals, bloodwork, etc.  My wife had to convince them she was having trouble breathing, she wasn’t even saying she was in pain.  You would think respiratory distress would be something they would take seriously but unless oxygen sat is low or they are turning blue then oh well, they were going to release her. She persisted and they did an mri or something, then it was oh fuck, she was admitted for 4 or 5 days IIRC.

"bad review" is the key word.
Some hospitals don't get paid unless the patient is satisfied with the care they received.

Disposable human beings. They’d be better off in the dumpster, with the used catheters and uneaten applesauce.

My sister had it figured out for a while. She'd just show up at the ER, tell them she's addicted and proceed to create a huge scene till they gave her candy to leave.

Good! Screw that jackass. If he's incapable of looking at ACTUAL symptoms, patient history charts, etc... then he should be a school nurse, or maybe just flipping burgers. The ER doc who examined me during a gall bladder attack had no idea what was wrong with me (nor did I at the time). My primary care (internal medicine) doc found the issue within literally 10 seconds of having me lie on a table (probably knew what it was the moment I told him about the symptoms). You'd think that an ER doc would be pretty good at being able to diagnose simple/common abdominal issues like gall stones, kidney stones, and appendicitis... and send for tests to confirm.

The previous time I was in the ER was after two straight days of the worst headache I've ever had (only time I've ever gone to the ER for a headache, in a very long history of severe headaches caused by a crushed C6 disk). The ER doc sits down, doesn't say 'hi', doesn't ask me what's going-on, just blurts-out "I'm not giving you narcotics". I looked at him like and said "you're the doc, do whatever you can". He let me sit there for 45 minutes with an IV drip in with Benadryl, until the tech who was administering the IV finally went to him and said "you gotta do better than that" (the tech was obviously disgusted with the doc), after which I was given a small dose morphine or fentanyl in the IV, which took the edge off enough for me to go home and sleep (which is all I wanted). My regular doc and his nurse were like "they didn't even look at your charts". That's when I decided no more ER visits unless I'm unconscious and on a stretcher. The only reason I ended-up there for the gallbladder attack was because the walk-in clinic automatically transfers you to the ER when you have abdominal pain. Fuck the ER. I understand that ER docs and nurses have to sort through those with legitimate issues and those just seeking pain meds. But you'd think that they'd bother to actually listen to a patient (or even introduce themselves) and bring up your medical history before they treat you all the same. The ER seems to make a MASH unit look like the Mayo Clinic.

I’m the same way.  Have a fairly high pain tolerance and so I try to save any pain meds I get from stuff for when I really need it.  Has come in handy a few times where I didn’t need medical intervention other than something for pain and saved me a trip to the ER.

The drug seekers are flocking to the latest boom industry around these parts.  "Drug Rehab" clinics.  From what I get from most addicts it's mostly suboxone treatment with no real plan for ever getting them off the stuff.  They just medicate them as long as someone is willing to pay.  So when suboxone gets the hammer like oxycontin did from the "pain clinics" what are all those addicts going to do?  The World really doesn't want to see them in recovery, they just want to take as much of that money from them as they can get while it lasts.

What the hell is suboxone? And what's the point of using one narcotic drug instead of another?

Why would you not get that filled and just keep on hand?  Having them doesn’t mean you have to take them