The author is eloquent but I have to point out that he had a kidney removed without complications. A friend of my sister donated a kidney to a stranger and didn’t complain. The author didn’t lose an essential body part (like @intercst) or have his bones cut (like @VeeEnn ) or have partial lung collapse and months of weakness from blood damage from a heart-lung machine (like I did after my open-heart surgery). Not to mention the pain from my splenectomy and hysterectomy and double mastectomy.
It’s a good description of pain from a man who obviously got to adulthood without ever experiencing severe pain before. Maybe the friend who donated the kidney didn’t complain about the pain because she was already the mother of five children.
1 - frequently told the joke to patients about the difference between minor and major surgery. Minor surgery happens on someone else but major surgery happens to you.
2 - shocked at the size of the incision and doing a major midline incision at that. I frequently saw nephrectomies done laparoscopically and I’m sure now being done robotically. So something is either missing from the story or someone hasn’t updated their skills.
3 - their post-op pain control was severely lacking. With that big of an incision planned, should’ve had an epidural for post-op pain control. At minimum a couple of regional blocks to provide 24 hour pain relief. So I question how much “team approach” is done at that hospital. I’ve seen surgeons poo-poo post-op pain control interventions and then wonder why they can’t control it with IV meds. And I’ve had some surgeons that prepare their patients for my intervention suggestions that I didn’t have to do much talking.
4 - pain control is highly individualistic and variable. My paper cut is your traumatic amputation. I always took the approach of a little bit of everything to cover all pathways plus it reduces the amount of narcotics needed.
The unanswered question is how will AI impact surgery. If a robot can butcher a chicken can robotic surgery be far away? Microsurgery with surgeon operating using precision instruments already exists.
It can’t. Butcher a chicken, that is. Poultry processing is still incredibly labor intensive, simply because breaking down and deboning a chicken is deceptively complicated stuff. And robots can’t do it close enough to as well as humans to get the humans out of the process. There has been progress towards trying to automate it, and at some point AI may get to the level where it can handle chicken butchering. But it isn’t quite there yet.
Pain is not well-understood. Add to that, the current opioid crisis which was exacerbated by pharmaceutical marketing in the mid-2000s has caused physicians to pull back on prescribing various opioid medications post-operative. I understand the risks of opioid addiction, but the pendulum has gone too far in my opinion.
Fortunately for dh and me, we’ve experienced our pain inducing care from practitioners that have well understood the assignment for post op pain management. It’s coming up to the 7 year anniversary of husband’s emergency bio-Bentall procedure…..from his perspective the most painful event in his life. Dislocated shoulders (reduced without anesthesia….a definite eye watered as I can attest) and ruptured Achilles tendon notwithstanding. The hospital had an “express” elevator from cardiac ICU to the ground floor that utilized the inside of the doors to market the rampant anti opioid sentiments sloshing around at the time …… advising anyone reading the message to “ask their doctor” if there was an alternative. I was traveling back to my husband’s room from a break in the cafeteria on one occasion with his cardiothoracic surgeon. A slightly awkward moment after the initial greeting…..until I pointed out this piece of unnecessary fear mongering and asked if, like me, he thought this was just about the most redundant messaging that the hospital decision makers could come up with. He agreed heartily.
Even without @WendyBG‘s post op complications….and even with adequate pain control (yes…..there really is a good reason why nursing staff wake patients in the middle of the night to receive pain meds!)….this surgery was unbelievably debilitating. And use of copious amounts of oxycodone during that period was remarkably nonaddictive…..if you know, you know
@VeeEnn@TucsonBones my post-op experience shows that opioids are not addictive as long as they don’t make you feel good – i.e. the pain is still active and still a certain level of pain even with the opioids. I always back off the pain killers ASAP which usually leaves part of the prescription untouched.
All feel-good drugs are playing with fire. That includes benzos and other mood-altering drugs as well as pain-killers. The point is – feeling extreme pain is bad but feeling a little pain (instead of pleasure) is just part of life and will prevent addiction.
The pendulum definitely swung too far in the anti-opioid direction.
Mine, too. Some of us also have a different experience: many years ago, after surgery and a great deal of pain, the oxy dosage didn’t do anything so the recommendation was simply to double it. That made me nauseous, dizzy, and very unwell feeling. The best course turned out to be in between: solved the pain only, but no more loopy feeling. Drugs are miracles, but they have to be tweaked oftentimes and many have adverse effects if taken recreationally apart from those who may become addicted.
But getting addicted to prescribed opioids was only [a small] part of the problem. The bigger part of the problem was that drug dealers would have large groups of people go out and get prescriptions, then collect all the medication from those people and sell it all on the streets. And it’s VERY difficult for doctors to filter those out. If 100 people come complaining about pain, it’s almost impossible to filter out the 90 that are selling the stuff from the 10 that need the stuff. And even if they catch half of them, and deny them the prescription, that’s still 45 bottles of pills that got out there to be sold on the street.
Even in emergency rooms, they are constantly being scammed out of “pain pills”. A few years ago, I had a kidney stone and ended up in the emergency room. I was waiting my turn and periodically almost writhing on the floor in pain. But they refused to dispense any pain medication until they were sure I wasn’t one of those scammers (apparently the scammers come in all types, even upper middle aged males like I was at the time). Eventually I was checked in, and only after the scan revealed the stone (a nasty and large-ish one) did they put me on pain medication. I ended up admitted to the hospital for nearly a full work week. First for a day and a half on IV dilaudid for the pain until the stone passed, then went home, and the next morning was again admitted to the hospital with some sort of intestinal issue for 2 nights. I generally do NOT like medications of any sort, I take nothing unless absolutely necessary, I don’t take tylenol or advil or aspirin unless I have no choice (usually once every two or three years). Instead, if I don’t feel well, I take a nap. If I still don’t feel well after a nap … I take another nap. And by then I’m almost always fine. If I have a cold and a runny nose, I blow my nose for a few days until it goes away. And the only time I take antibiotics is when the doctor assures me that it is necessary - like before/during surgery to preemptively avoid infections, or if I have an actual infection that can be healed with the antibiotic.
Once on a long business trip (France, Italy, Germany, and Japan) when I arrived on Friday morning to Japan I had a terrible case of bronchitis and could barely breathe. Our representative in Japan took me to a doctor recommended by the US embassy. The guy was SUPER old school, he had served in Japan during WWII, and then stayed on after the war to help and ended up living there for the rest of his life. He still used one of those old style metal devices to look at my throat (no wooden sticks for him). Anyway he prescribed 3 things, an antibiotic, a bottle codeine solution for pain (I didn’t touch it and left it in Japan to avoid issues while traveling home), and an anti-inflammatory. And as a huge convenience, all 3 medications were dispensed right there in his office! Anyway, I took the antibiotic, and by Saturday night I was feeling MUCH better, and by Sunday I was nearly back to normal and ready to be driven a few hours north for our meetings the next day.
One of my BILs just had an ankle replacement. He took one pill the first day. That was it. He has had no pills since. He has had close to no pain.
The balancing act for laymen is between their usual highs on beer and pot vs. a new high if abused. Huge numbers of people abuse substances. But even non abusers will blame a doctor if they become hooked.
Like most folk who’ve had cause to need opioids for pain management, I find it very hard to fathom the motivation of recreational users/abusers. One tale I’ve told very frequently comes from my days in practice. A question on “allergies “ featured on my patient medical history questionnaire and, after antibiotics, allergy to codeine/opioids was in #2 spot. Since it’s important to get these issues sorted, I always asked how this allergy manifested itself. “Makes me nauseous/constipated/feel spacey” were pretty much the usual answers. Obviously not allergies but rather predictable side effects (sometimes useful) When I explained this….sometimes venturing into the realms of discussing mu receptors and whatnot…the near universal response was disbelief that anyone would tolerate these features just to feel good.
My response was that there’s a difference between the likes of druggies and us. Unfortunately, as far as the lay public goes…..and general support for unnecessarily restrictive use of effective pain management strategies..….it’s the druggies who control the narrative.
My guess is that humans have an enormous range of differently evolved strategies regarding addictive substances, and a far larger range of “off-expectation” reactions than have been studied. The main reactions have formed strong expectations and so lacunae in recorded reactions. Like in me. I have always been weird. E.g. I have been an unsweetened strong coffee fan from age 4.
“I” (or shoud I write “my body”? [a topic for a different OT conversation]), is completely indifferernt to cocaine type substances. Dentists have freaked but cooperated with some amazement when I tell them novocaine has no noticeable effect for me, and that to get through painful procedures I want them to rig a camera with small screen mounted above my eyes so that I can distract myself from sensation by studying the mechanics of the procedure (or in the old days I would have them mount a mirror — much more cumbersome). Laughing gas perversely/weirdly makes me nastily obstreperous.
I experimented with tons of drugs in my tweens, enjoyed most of them, but not enough to want to repeat once my curiosity was sated….except crystal methamphetamine. About a minute after my first rapturous intake my inner brain (soul?) screamed out Danger Danger Danger Instant TOTAL SLAVERY threatens and I threw the gorgeous but quickly terrorized purveyor out of my house.
The universe is far more complicated than we want to admit.
Both, because liking at the level i had meant following a short blissful path to horrible death, and I have the good luck to be an extremely obstreperous independent sort. Only love is allowed to enslave me without provoking (as it did this time) enraged revolt.
All opioids are highly addictive, there is no doubt. That’s why patients have to be warned and followed by their provider. Humans are susceptible to opioid addiction,
First of all, I was talking about post-op pain medication. Physicians have been warned that they are libel for over-prescribing opioids. This cause a big momentum in the years following 2011 to withhold prescribing opioids at all for post-op patients. The pendulum has come down a bit, but many physicians still try to allow a large amount of pain following surgery using drugs like Tramadol which often doesn’t ameliorate significant pain.
Second, Physicians don’t have a problem ordering pain meds in even large amounts in hospital. Obviously, you’re being monitored and nurses are required to address pain in house. A nurse wants pain meds for her patient you’re not going to want to get lots of calls about it. I’ve had patients get 5versed and 200fentanyl. Once upon a time, patients were kept for weeks after surgery. Hospitals were reimbursed for length of stay (LOS). LOS was an incentive to keep patients, and that was addressed long ago. So, now patients go home (much much sooner) and the followup pain has to be address. That is the issue I was addressing.
Third, I have to disagree completely that doctors don’t know. You think “it’s VERY difficult for doctors to know”? I say , No it is not. dealing with patients for chronic pain is a whole different ballgame. Doctors are not stupid about “seekers”. I disagree with your opinion, and you don’t need to give me anecdotal stories. You can have your opinion. I respect your opinion. Chronic pain is a whole different discussion. Often not well-understood, often related to causes hard to fathom like PTSD. There are pain specialties that get referred those patients.
Thanks for the update. Yes they have been working on robots butchering chickens for years. Chickens are easiest because companies like Tyson control every aspect. Breed, food, weight, etc. Making them all likely to be similar. Yield lower and slower. But this is the sort of thing AI can help with.
The labor shortage continues. Automation is an obvious solution. Not there yet but one day.
Yeah…people (male and female) often have no clue. I had my pain scale refined when I broke my back. Now “10” is passing out. “9” is screaming and not being able to think about anything but pain (and then they knock you out). Etc. In retrospect, my broken ankle rated at 5 or 6. I won’t comment on labor, except to say that forcing a 6” head through a 4” hole (dilation of 10cm is common, I understand) has to be extremely painful.
I mentioned that (i.e. my rating) to a doctor when he was asking about some pain I had. So he knew my relative scale, and why. He said he had patients claiming it was a “10” when he touched a sensitive spot, but they weren’t incoherently screaming. They were otherwise lucid. They simply hadn’t experience real pain ever in their lives.
Read a few studies dealing with opioid addiction after surgery. The main take home, opioids can be used and as long as the patient isn’t in control of the timing and usage, i.e. hospital setting, the chance for addiction is low. Not zero, but low.
Agree. That pendulum has been oscillating drastically for. years and is one of the main reasons I didn’t go into chronic pain management. I could see it back in residency (early 90s) one side berating you for not enough pain medication and the other side threatening your license for too much pain medication.