dyer@endor.harvard.edu (Steve Dyer) (10/19/86)
Empirin Compound used to be APC (aspirin, phenacetin and caffeine), but when the association of chronic phenacetin use with kidney damage was noted, it was reformulated to contain only aspirin. Tylenol is a tradename for acetaminophen. Both drugs named "XXX w/codeine #3" contain 325mg of either aspirin or acetaminophen combined with 30mg of codeine. It's not hard to imagine patients responding better to one or the other, although they are generally thought to be equally effective when prescribed for acute pain. /Steve Dyer dyer@harvard.harvard.edu harvard!dyer
anderson@uwmacc.UUCP (Jess Anderson) (10/20/86)
> 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. [...] > 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. [...] > 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 Thanks for reminding me of the need for *some* precision. I should have made the acute/chronic distinction myself at the time. Interestingly, the Vietnam War vet case would fall into both categories, because he had a lot of opiate in the field hospital for the battle injuries, then several surgeries in the next few days in his next hospital, then came a really long period of surgeries/recoveries/more surgeries. He doesn't talk about his drug reactions except in the first mind-boggling period, presumably the most acute phase, but it's hardly conceivable that he would not have developed a dependency on his analgesics as the chronic phase followed. You're probably right, too, that people in the acute circumstance may be undermedicated. My only first-hand experience (glad to say) was a skiing accident (four fractures in the foot, ouch), and I got off the codeine in about 3 days, switching to aspirin, because I wanted my gut to work better (self likes food :-). -- ==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)=======
chris@umcp-cs.UUCP (Chris Torek) (10/21/86)
In article <435@spdcc.UUCP> dyer@spdcc.UUCP (Steve Dyer) writes: >... 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. Be careful with those sweeping generalisations. I am not a 200 pound man (will you settle for a muscular 74 kilograms of Elf? :-)), but I recently had a wisdom tooth extracted. The dentist prescribed acetaminophen #3 in case of pain, yet I never had to use it. In my case, any dose would have been too high. -- In-Real-Life: Chris Torek, Univ of MD Comp Sci Dept (+1 301 454 7690) UUCP: seismo!umcp-cs!chris CSNet: chris@umcp-cs ARPA: chris@mimsy.umd.edu
dyer@spdcc.UUCP (Steve Dyer) (10/22/86)
In article <435@spdcc.UUCP> dyer@spdcc.UUCP (Steve Dyer) writes: >... 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. >>Be careful with those sweeping generalisations. I am not a 200 >>pound man (will you settle for a muscular 74 kilograms of Elf? :-)), >>but I recently had a wisdom tooth extracted. The dentist prescribed >>acetaminophen #3 in case of pain, yet I never had to use it. In >>my case, any dose would have been too high. Strictly speaking, which I usually manage to do in sci.med, I should have been more rigorous, although the context should have been clear. The average 200lb man with moderate to severe pain after wisdom tooth extraction would probably find 15mg of codeine hardly better than a placebo. Obviously if a person's not in pain, an analgesic isn't indicated. -- Steve Dyer dyer@harvard.HARVARD.EDU {linus,wanginst,bbnccv,harvard,ima,ihnp4}!spdcc!dyer