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Pain: Pills versus no-Pill
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Yes Virginia, there are two ways of treating pain in this world. Pill versus no pill. And where do I stand on this?
Obviously I am partial to no-pain-pill approach or I’d be out of a job as a Physical Therapist if pain management rely on drugs alone. It’s undeniable, however, there are conditions when pain pill is necessary. Surgery is one. Or Cancer. Or toothache. Or hospice care. Or palliative care. These are conditions that will make someone suffer immensely without some form of medication. I will be dealing with very angry, screaming, crying, uncooperative patients who are deprived of legitimate pain meds. It can be human abuse and cruelty in fact, if that is the case.
Pain pills depend on the stage of the condition. Acute pain is that period immediately after an injury or malady onward to its resolution. Usually administration of pain should be tapered off as the full recovery is approached. Chronic pain lingers beyond 90 days and the sufferer begins to ask for more doses. Weaning is a hellish nightmare for them. We are talking of addiction. And addiction can have devastating consequences. Let us review some actions and side effects of most common pain meds:
NSAIDS such as ibuprofen (Advil, Motrin) can lead to heart problems in prolonged use. It is worse with Diclofenac (Voltaren). These medications block cyclo-oxiganase(COX2) enzymes that cause pain and inflammation due to overproduction of prostaglandins. Problem is, the inhibition of COX2 is known also to cause stomach problems, indigestion and heart conditions. They also have the ‘ceiling effect’. That means no matter how much dosage you increase the medication, the pain relief will stay the same but the side effects increase. To those who take these mostly over the counter pain pills, please start weaning as soon as possible and try other pain relieving approaches: movement is the best approach. Yoga, meditation, music, heat packs, massage, psychotherapy, PT (of course) are very useful. Better yet, keep moving, nothing can beat movement in the prevention and relief of pain.
Opioids, i.e. Morphine, Oxycodone, Methadone, Codeine are narcotics that can become addictive. Overdosage can lead to respiratory distress, hypotension, dreaded constipation, bowel obstruction, ileus. Opioids work by targeting the root cause of pain in the brain and they don’t have ‘ceiling effect’ which means the higher the dosage, the lesser the pain symptoms (improved analgesic effects). In other words, people can develop high tolerance to these meds which may require higher dosages in future. And that can lead to addiction. It becomes more dangerous when withdrawn - leading to drug withdrawal symptoms. The side-effects alone are enough to frighten anyone using these meds. And though some people legitimately need them at least during the acute phase of their painful conditions, it is imperative to be very vigilant in dosages and time-frame of use. I have had patients who became instant ‘drug-addict suspects’ when they knew more about pain meds than pharmacists :) or when the intensity of their pain is a 10 while laughing or having a pleasant conversation over the phone. Yup - I have no right to treat them differently from my other patients but one should be careful in over-prescribing with inconsistent or non-reliable symptoms. And these are not only limited to patients. They could also be friends and family members. Prescribing pain pills is outside the scope of my practice but these patients should immediately be referred to Pain Management professionals before it’s too late.
Finally, there are drugs that can ‘harness’ the impact of a pain pill. They are antidepressants, anticonvulsants, local anesthetics and corticosteroids. Together with opioids, they provide a maximum analgesic effect. These ‘harnessing’ drugs have side-effects of their own combined with pain meds. Mostly drowsiness, irritability, slow movements and in case of corticosteroids - kidney and liver side-effects.
There are always legitimate conditions that require pain pills. Unfortunately, the current trend points to their overuse and the victims mostly likely did not intend to become drug dependent in the first place. Someone does not wake up in the morning with that goal in mind. The most likely scenario is that he had a pain he needed to address. Temporarily. But the pain becomes chronic (about 90 days) and only the prescription with increased dosage (ceiling effect) would help him make it through each day. When he tries to wean himself off it, he goes through withdrawal. In no time, he would revert back to it to avoid the withdrawal symptoms. The cycle continues. That is addiction.
That prescription pill addict could be me or you or someone we both know, or a parent, sibling, friend co-worker. Pain does not discriminate and there are situations and environments that render one person more susceptible to pain than another.
[The following is copied from PT in Motion] Here are some statistics via The Centers for Disease Control and Prevention (CDC), which released guidelines in March 2016 encouraging health care providers to try safer alternatives like physical therapy for most pain management:
1. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills.
2. As many as 1 in 4 people who receive prescription opioids long term for noncancer pain in primary care settings struggles with addiction.
3. Sales of prescription opioids have nearly quadrupled since 1999.
4. Deaths related to prescription opioids have quadrupled.
5. Heroin-related overdose deaths more than quadrupled between 2002 and 2014, and people addicted to prescription opioids are 40 times more likely to be addicted to heroin.
6. More than 165,000 persons in the United States have died from opioid pain-medication-related overdoses since 1999.
7. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
Wearing Many Hats
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Here I am again wearing my PT/health-thinking hat. It had been months since I last wrote anything on my healthysport website. One reason was a visit to the ER due to abscess after my dental work by a Dentist whom I picked out of my HMO insurance catalogue (a stupid move on my part). Told her I was diabetic and isn’t it prudent to err on the side of caution and prescribe me antibiotics as protection? Oh no she said, you look very healthy. No need for meds. Just go to any drug store for any over-the-counter pain meds.
Yeah.
Main lesson here: if you are diabetic, choose your Dentist carefully. I got swollen. I needed IV antibiotics. I lost at least 8 pounds due to inability to eat solid foods. I was not able to run for at least a month.
Thankfully I am now gradually returning to my running routine. I am regaining my old weight bit by bit. I am fully recovered.
I am back to busily wearing different hats - as a programmer, blogger, reader of fantasy novels and PT. I can get overwhelmed sometimes especially when I study a new language and trying to do a complex web app using it. Seriously, if you are new to a computer language, KISS is the first rule. But do I follow this rule? Of course not.
But I feel an update on this site is desperately needed so I’d start with things that I read from PT journals I subscribe to.
Since election is in 4 days, my main area of interest is health care (politically). Clinton’s main thrust is a continuation and tweaking of Obamacare PLUS a public option for insurance which I’d like to see as a preparation for universal healthcare. ALSO, she is floating the idea of dropping Medicare coverage to 55+ which can be awesome for me since I will turn that age next year. If Trump has a better option, and right now all I am hearing is repeal and replace with something ‘better’, I’d go with him. Some of Trump’s health care ideas, like treating premiums as tax deductibles and health care savings and being able to subscribe to insurance across state lines and mandatory transparency on the fees charged by hospitals and clinics (which will stimulate competition and market-driven pricing) are good. But he is also encouraging a ‘pick and choose’ approach for insurance coverage which, in the past had encouraged insurance companies to drop or at least deny some services to people with pre-existing conditions.
That is how I understand the two candidates’ positions on healthcare. Obviously I also take issue with other aspects of their platforms but I’d rather have other websites deal with that. I would like to keep my site health-oriented.
Let me present you some facts(From PT in Motion).
Did you know that :
-- healthcare costs increased an annual average of 2.4 percent from 2003 to 2008 then slowed to 0.7 percent between 2008 to 2012? Is that due to Obamacare, efficient care, electronic record keeping, better negotiations between hospitals and insurance, less sick people, people who would rather die than be hospitalized? What do you think?
--15,781 is the average number of injuries that occur in amusement parks every year for people under 20 that prompt visits to ER, and 8.0 percent of them involve traumatic brain injuries? So parents watch out!
--9.8 percent is the prevalence of diagnosed diabetes in the US in 2014 for adults above 18 years old. 23.1 percent (which was the highest prevalence) was among women 65 and over?
--3.7 days was the number of physically inactive days reported by Americans in a 30 day period?
--563 calories was number of calories burned by 180 pound person playing beach volleyball?
--The lowest rate of hospitalization per 1000 Medicare patients in the US was recorded in Hawaii at 28.2, followed by Utah at 34.0, followed by Idaho at 36.4. National average is 62.9. Something must be doing some people good in some states?
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