rb@cci632.UUCP (Rex Ballard) (10/16/86)
In article <1823@bu-cs.bu-cs.BU.EDU> bzs@bu-cs.BU.EDU (Barry Shein) writes: >A few years ago I had surgery. I was in a fair amount of pain afterwards >(I was basically bed-ridden for several days.) The doctor had given me >codeine pills which kind of wiped me out but did little to reduce the >pain (I sort of laid there and complained more slowly.) > >Well, I was pretty bored and still in pain so I took a few >aspirin. > >Moral: Just because a painkiller has been given a mystique due to it's >unavailability, don't underestimate good old aspirin*. In several interviews with officials of the F.D.A., there was a clear indication that if aspirin had to be cleared today, that the F.D.A. would make aspirin a controlled substance. There is a more "effective" form of the active ingredient in aspirin which is made from boiling birch or aspen bark. Before "modern medicine", this "tea" was often given to patients for fever and pain. The instability and impurities however made the practice very dangerous. It was not uncommon to get the equivelant of 2000 mg. (4 extra strength tablets) in a single cup. Two or three cups of this "tea" could be quite interesting. In China, and several other areas of the world, it is still possible to get certain herbal "teas" whose main ingredient can be hallucenogenic or narcotic, even though the active ingredient itself is controlled. Rex B.
ray@rochester.ARPA (Ray Frank) (10/17/86)
> In article <1823@bu-cs.bu-cs.BU.EDU> bzs@bu-cs.BU.EDU (Barry Shein) writes: > >A few years ago I had surgery. I was in a fair amount of pain afterwards > >(I was basically bed-ridden for several days.) The doctor had given me > >codeine pills which kind of wiped me out but did little to reduce the > >pain (I sort of laid there and complained more slowly.) > > Often I've heard first hand experience of people experiencing post operative pain with little or no relief from their prescribed pain medication. This is frightening to know that you can be in a great deal of pain, letting the nurses and doctors in on this and yet you still get no relief. In one instance, a person who was in a great deal of pain received a pain pill every four hours. But within an hour or so after the pill, the pain was back to its' full intensity with no relief in sight for the next 3 hours no matter how much complaining was voiced. My question is this, does a person confined to a hospital bed in a modern hospital have any rights? Do patients have to endure pain while their crys go unheard. Don't doctors realize that everyone is not the same and that one pill every four hours is fine for one but inadequate for another? I realize that nurses cannot increase medication without a doctors orders, but they certainly must have the training necessary to assess the situation on a patient by patient basis and relay this information to the doctor. A good rule of thumb is to have someone on your side such as a spouse or relative who can scream and yell at the nurses and doctors until you get some relief. This may sound like interference in the duties of the medical profession, and you are right, it is, and in certain instances is exactly what must be done to get proper and adequate relief from suffering. Too often, hospital care is not unlike an assembly line, and individual personalized care is impossible with so many patients and not enough staff. Anyone who has ever been in the hospital knows that the likelyhood of seeing your doctor more than once a day is rare but he or she is never more than a phone call away to prescribe more medication to reduce suffering. I don't believe it is necessary or correct to have to wait until the next day to have your doctor prescribe more relief. ray
cetron@utah-cs.UUCP (Edward J Cetron) (10/17/86)
Lately, several studies have been performed at numerous hospitals to alleviate the 'subjectiveness' of pain medication 'orders'.. The idea is to provide an infusion pump full of pain killer with the controller under the patient's control.... limits are imposed on the maximum dosage allowed total as well as the max dosage/unit time..... At least one of the studies has been performed here at the Univ of Utah Med Center with the following (generalized) results: 1. Patients (especially repeaters) indicated that they had less discomfort from post-op pain (and lets face it, its the PERCEPTION of pain which is the real measure of drug efficacy...) 2. There were few problems from a technical standpoint. 3. There were little/no instances of substance abuse. 4. There appeared to be a lowered dependence on the particular drug leading to what might become less chance of addiction. 5. And MOST suprisingly, the total amount and rate of drug delivery was down VERY significantly (I think someone even mentioned some numbers like 50-60% but I'm not real sure....) I think the real issue is not WHAT medication to use, but HOW.... -ed cetron center for biomedical design Univ. of Utah
anderson@uwmacc.UUCP (Jess Anderson) (10/18/86)
> > In article <1823@bu-cs.bu-cs.BU.EDU> bzs@bu-cs.BU.EDU (Barry Shein) writes: > > >A few years ago I had surgery. I was in a fair amount of pain afterwards > > >(I was basically bed-ridden for several days.) The doctor had given me > > >codeine pills which kind of wiped me out but did little to reduce the > > >pain (I sort of laid there and complained more slowly.) > > > > > Often I've heard first hand experience of people experiencing post operative > pain with little or no relief from their prescribed pain medication. > This is frightening to know that you can be in a great deal of pain, letting > the nurses and doctors in on this and yet you still get no relief. In one > instance, a person who was in a great deal of pain received a pain pill every > four hours. But within an hour or so after the pill, the pain was back to > its' full intensity with no relief in sight for the next 3 hours no matter > how much complaining was voiced. > My question is this, does a person confined to a hospital bed in a modern > hospital have any rights? Do patients have to endure pain while their crys > go unheard. [...rest edited out; similar in tone and thrust.] While there may be cases in which indifference exists on the part of the caregivers, you should give them a bit more credit than you're doing here. Quite often there really isn't anything for pain, and sometimes the drugs have *very* unpleasant side effects. Would you rather have *just* the pain, or have the pain *and* wilder hallucinations than you can imagine and total sleeplessness? The graphic unpleasantness of this situation came home to me a while ago while reading accounts of Vietnam vets, one of whom had been hit by a "bouncing betty" mine, lost an arm and a leg, and was *besides that* (if you can imagine!) badly wounded. He had three dozen surgeries. Needless to say, analgesics were not up to the circumstances he faced. There was nothing for him to do but go on living *in spite of* the suffering. I'm not hog-wild about some aspects of the medical profession, and I've known some practitioners I thought were *monstrously* insensitive, but I think most people who have to care for people in terrible pain *do* care and try to do what can be done to alleviate suffering. Let me say this, too: it costs them in stress and a thousand other ways to be highly trained and yet unable to help. There is a dangerous tendency, and it seems to me to be a growing one, to feel that doctors (really, all "experts") have some kind of magic powers. Mostly, they're just like you and me, except they have different work. For myself, I wouldn't want their responsibilities for the world... -- ==ARPA:====================anderson@unix.macc.wisc.edu===Jess Anderson====== | (Please use ARPA if you can.) MACC | | UUCP: {harvard,seismo,topaz, 1210 W. Dayton | | akgua,allegra,ihnp4,usbvax}!uwvax!uwmacc!anderson Madison, WI 53706 | | BITNET: anderson@wiscmacc 608/263-6988 | ==Words are not just blown air. They have a meaning.=====(Chuang Tsu)=======
geb@cadre.UUCP (10/18/86)
In article <21708@rochester.ARPA> ray@rochester.ARPA (Ray Frank) writes: > My question is this, does a person confined to a hospital bed in a modern >hospital have any rights? Do patients have to endure pain while their crys >go unheard. Don't doctors realize that everyone is not the same and that >one pill every four hours is fine for one but inadequate for another? I >realize that nurses cannot increase medication without a doctors orders, but >they certainly must have the training necessary to assess the situation >on a patient by patient basis and relay this information to the doctor. There are some doctors, and more nurses that worry too much about the patient becoming an addict. Most surgeons will do whatever they can (barring safety considerations---you must realize that in larger doses narcotics can be very dangerous in patients with compromised respiration, or in those in which the mental status must be followed closely) to keep the patient pain free. Addiction is rarely a problem with acute conditions such as injuries and operations. Chronic pain (which may be excruciating also) is another matter entirely, and in these cases there are too many doctors who don't worry enough about addiction. The amount of pain medication the patient requires is a complex function of physiology and psychology. Each patient must be titrated.
dyer@spdcc.UUCP (Steve Dyer) (10/18/86)
Ray Frank is, for once, absolutely right-on here, although it's interesting
that he's advocating higher doses of the same drugs that he so adamantly
condemned earlier!
--
Steve Dyer
dyer@harvard.HARVARD.EDU
{linus,wanginst,bbnccv,harvard,ima,ihnp4}!spdcc!dyerwerner@aecom.UUCP (Craig Werner) (10/18/86)
>>In several interviews with officials of the F.D.A., there was a clear >>indication that if aspirin had to be cleared today, that the F.D.A. >>would make aspirin a controlled substance. > Prescription, maybe. Controlled, you've got your definitions wrong. >>There is a more "effective" form of the active ingredient in aspirin >>which is made from boiling birch or aspen bark. Before "modern >>medicine", this "tea" was often given to patients for fever and >>pain. The instability and impurities however made the practice >>very dangerous. It was not uncommon to get the equivelant of >>2000 mg. (4 extra strength tablets) in a single cup. Two or three >>cups of this "tea" could be quite interesting. > Ahhhh, modern myths again. Actually, the purification of Asprin and the introduction of "Salicylate Tea" happened approximately contemporalily in Europe. The practicing of chewing Salicylate bark by Indians was centuries old, however. Secondly, Salicylate Acid (the natural form) is in fact less effective than Acetosalicylic Acid and has more GI side effects. Besides, in the body within 15 minutes, all the Aspirin is deacetylated to Salicylic Acid anyway (and that deacetylation step is very important for its therapeutic effect.) So much for the more "effective" natural version. Thirdly, the toxic threshold of Aspirin is 7-10 grams, so one would need 4-5 cups of this tea, but that's just being picky. -- Craig Werner (MD/PhD '91) !philabs!aecom!werner (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517) I'll also entertain gifts,knick-knacks,offers of money, & proposals of marriage
dyer@spdcc.UUCP (Steve Dyer) (10/19/86)
All well and good, Jess, but there *is* a record of doctors underprescribing
opiate analgesics when they would be most effective for pain, because of an
inappropriate fear of addiction. This is true not only for terminal cancer
patients (where the whole idea of addiction as something to be avoided is
meaningless if not outright malicious), but also for acute pain in
postoperative and ambulatory patients. The fact is that physical
addiction and psychological habituation practically never occurs when
opiates are used for short periods of time for acute pain, especially
with a drug like codeine which is rarely a primary drug of abuse.
This is not to say that aspirin or other non-narcotic analgesics aren't
the drug of first choice for many conditions, but giving a 200 lb. man
15 mg. of codeine 4 times a day after having his wisdom teeth out is
just plain stupid; the dose is much too low.
Chronic pain, such as lower back pain, or chronic conditions, such as
migraine, are a different matter and the risk of habituation needs to
be weighed against the patient's ability to receive relief from other
conventional therapies.
--
Steve Dyer
dyer@harvard.HARVARD.EDU
{linus,wanginst,bbnccv,harvard,ima,ihnp4}!spdcc!dyertenney@well.UUCP (Glenn S. Tenney) (10/19/86)
Along the lines of this topic: Quite a while ago, with an ingrown
toenail that was very red and huge (ie. infected), I was given
Tylenol-3 (w/codeine) only to find that it had NO affect. Since I had
used Empirin-3's before, I was amazed. I later, during that episode,
switched to Empirin-3's and had immediate relief. My unscientific
conclusion is that Tylenol w/codeine are contraindicated for me.
Perhaps I'm not alone.
-- Glenn Tenney
UUCP: {hplabs,glacier,lll-crg,ihnp4!ptsfa}!well!tenney
ARPA: well!tenney@LLL-CRG.ARPA Delphi and MCI Mail: TENNEY
As Alphonso Bodoya would say... (tnx boulton)
Disclaimers? DISCLAIMERS!? I don' gotta show you no stinking DISCLAIMERS!rb@cci632.UUCP (Rex Ballard) (10/20/86)
In article <21708@rochester.ARPA> ray@rochester.ARPA (Ray Frank) writes: >> In article <1823@bu-cs.bu-cs.BU.EDU> bzs@bu-cs.BU.EDU (Barry Shein) writes: >> >codeine pills which kind of wiped me out but did little to reduce the >> >pain (I sort of laid there and complained more slowly.) > > My question is this, does a person confined to a hospital bed in a modern >hospital have any rights? Many doctors to allow a patient to self-reduce their pain medication, or go without if they wish, but PRN prescriptions have to be limited externally by the doctor to prevent overuse. > Don't doctors realize that everyone is not the same and that >one pill every four hours is fine for one but inadequate for another? Yes, they do. The problem here is three fold. The patient may have an "anti-depressant metabolism", in which case the body tries to detoxify itself more quickly. Often this occurs in people with previous drug use history, or when patients are anxious. Another problem is the "threshold" which the patient can tolerate. Some people can handle a root-canal with no anesthisia, others can't handle a splinter or a bee sting. Finally, the safest, and most effective form of pain relief comes from within the body itself, in the form of something called endorphines. Unfortunately, in order for this substance to be produced, the nerves in the area have to be able to sense the pain. Too much medication prevents the production of this natural form of pain relief. >I realize that nurses cannot increase medication without a doctors orders, but >they certainly must have the training necessary to assess the situation >on a patient by patient basis and relay this information to the doctor. Unfortunately, nurses often have little input with some "egotistical" doctors. They have the training to know what is needed, but can do nothing unless the attending physician requests their input. >I don't >believe it is necessary or correct to have to wait until the next day to >have your doctor prescribe more relief. If there are medical complications, such as infections, you can bet something will happen. Pain on the other hand, is something that often cannot be controlled. One thing that I have seen/experienced, is the use of "Lamaze" type techniques for pain control. I first saw this used on my father, who for a number of reasons could not use normal pain control medications when he had his appendix removed. The irony was that, even though he was recieving no medications, he was up and on his feet much sooner than similar patients who were given pain medication. I have also used it for a situation where I got some second degree burns over 3/4 of my hand (flaming oil). In one study, originally conducted to test the effectiveness of acupuncture as a means of pain control, both the patients recieving placebo methods and the group using acupuncture recovered more quickly than those recieving chemical relief. Various meditation techniques have also proven more effective in pain relief than chemicals. Doctors realize that no medication will leave a patient "pain free". The patient might get enough relief to get some sleep, or at least relax, but not enough to "feel nothing". It is possible to do this, such as during the operation itself, but the risks are very high. More OR fatalities occurr due to anesthesia than due to the operation itself. >ray rex
cetron@utah-cs.UUCP (Edward J Cetron) (10/21/86)
In article <543@cci632.UUCP> rb@ccird2.UUCP (Rex Ballard) writes: > >Unfortunately, nurses often have little input with some "egotistical" doctors. >They have the training to know what is needed, but can do nothing unless the >attending physician requests their input. > Invariably the nurse knows much more about 'paitient care' than the Doc but usually the Doc refuses to admit it... > >One thing that I have seen/experienced, is the use of "Lamaze" type techniques >for pain control. I first saw this used on my father, who for a number of >reasons could not use normal pain control medications when he had his >appendix removed. ... The best case of this that I have heard about (from at least 2 of the attending er doc's though I didn't actually see it) was the ob/gyn from this area (Salt Lake) who was also a lamaze coach/trainer.... He apparently broke his leg (three places, all in the femur) and was concious and unmedicated all the way down the slope and down into the hospital - while all the while doing the lamaze breathing exercises!!! My wife (who; a - has had 1 child, b - works in the hospital and ER, and c - has broken her leg skiing and is therefore d - quite capable of judging the pain levels) was totally astounded as well as being highly impressed. -ed cetron Univ. of Utah Center for Biomedical Design
cramer@kontron.UUCP (10/23/86)
> Ray Frank is, for once, absolutely right-on here, although it's interesting > that he's advocating higher doses of the same drugs that he so adamantly > condemned earlier! > -- > Steve Dyer The purpose of taking the drug is everything. Clayton E. Cramer