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Medicine Science

Chronic Pain is an Impossible Problem (theatlantic.com) 180

A "safe" alternative to opioid painkillers turns out to be not so safe. From a report: Gabapentin was supposed to be the answer. Chronic pain afflicts about a fifth of American adults, and for years, doctors thought it could be treated with prescription painkillers like Oxycontin. But as the drugs began killing the equivalent of three planeloads of Americans every week, opioid prescriptions fell off precipitously. Many doctors embraced gabapentin, an anticonvulsant drug traditionally used to prevent seizures, as a way to treat neuropathic pain while avoiding triggering life-threatening addiction. From 2012 to 2016, prescriptions for gabapentin increased 64 percent. It's now the 10th-most-commonly-prescribed medication in the United States. Baclofen, a muscle relaxant, has become another popular opioid replacement. Though gabapentin and baclofen can cause a boozelike "high" for some people, they're far less addictive and less likely to be fatal when taken in large quantities than opioids are.

But now their own pitfalls are becoming clear. Though gabapentin and baclofen are much safer alternatives to opioids, recent research suggests that they're not as safe as some doctors might have hoped, especially in combination with other sedating medications. The findings are a frustrating turn that suggests there's still no silver bullet for chronic pain. By examining the National Poison Data System, which collects reports of poisonings around the United States, Kimberly Reynolds, a researcher at the University of Pittsburgh, and her co-authors recently found that people are increasingly using both gabapentin and baclofen to either get high or attempt suicide. From 2013 to 2017, people tried to commit suicide using gabapentin nearly 42,000 times, and thousands more abused or misused the substance. In most cases -- nearly 70 percent -- the poisoned individuals took a combination of gabapentin and other drugs. Meanwhile, the majority of the poison cases involving baclofen were suicide attempts. "It's rare, but overdose from large quantities of gabapentin or baclofen can be fatal," Reynolds told me via email.

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Chronic Pain is an Impossible Problem

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  • by BrendaEM ( 871664 ) on Wednesday December 11, 2019 @01:38PM (#59508698) Homepage
    Many forms of pain killers--including opioids allow people to continue their lives, whereas they might have otherwise chosen to end them. We have so much anti-opioid hysteria that we have forgotten what these drugs where meant to do: relieve pain and suffering.
    • They need to manage it better though. I have chronic back issues, and part of the healing process is the spasms that harden the back muscles, which some meds block. I think in many cases they should give the opioids for night, but have intense PT during the day, to address the retraining of the body. Opioids alone are the equivalent of a government responding to reports of insurrection on the news by turning off the news. Take the needed actions to fix the problems, then you can turn off the news.

      • by Mashiki ( 184564 )

        For you that worked, but what about those of us who have neuropathy from nerve damage caused by the injury? It's the reason why those pain meds work so well for some people, but other things don't. For spasms they should have given you something like baclofen which reduces the spasms. Downside to baclofen is it can cause numbness in some people and disassociation.

        • For spasms they should have given you something like baclofen which reduces the spasms

          You didn't read his post very carefully. He had meds that reduced the spasms. That was the problem; in his case the spasms were part of the healing process and suppressing them prevented him from getting better.

          • by Mashiki ( 184564 )

            You didn't read his post very carefully. He had meds that reduced the spasms.

            No, I read his post carefully. He didn't say *what* anti-spasm medication they used, going by what they *did* say it was likely a spasm and relaxant combo, which is the exact opposite of what they needed. Spasm+relaxants are the standard after serious injuries to allow the muscles to return to a close-to undamaged state and allow them to heal. Keeping them *on* that medication causes issues like introducing muscular dystrophy which I wouldn't be surprised is what happened. It doesn't take long for that

      • by AK Marc ( 707885 )
        Reminds me of when I got my knee operated on. I was handed 2 months of Vioxx to help manage discomfort. I asked the doctor "will this speed up recovery?" He said no, but it was for pain and discomfort from swelling. I never took a pill. Before the 2 months was up, Vioxx was recalled. At least Google will always remind me of when I had knee surgery, 2 months before September 2004, since Vioxx will forever be immortalized. Or my first international business trip. I held tickets for September 12. But
        • by Mal-2 ( 675116 )

          That Vioxx would have doubled or tripled your nearly nonexistent heart attack risk for the duration of taking it. Vioxx was withdrawn due to bad press and people who don't understand statistics, not because it is dangerous.

    • We have so much anti-opioid hysteria that we have forgotten what these drugs where meant to do: relieve pain and suffering.

      I had a tooth extraction and a root canal. Sent home with Tylenol. They refused to prescribe a real painkiller.

      How addicts get a hold of enough of the stuff to get addicted, I have no idea.

      • You were sent home with Tylenol. Was it Tylenol 3 perhaps, which does contain an opioid?

        I have first hand experience with how it is done thanks to my junkie ex. They lie to doctors at walk-in clinics. They find people who are poor and have been injured and aren't in a lot of pain and the offer them money to tell the doctor that there pain is getting worse and worse so they get more and more powerful pain pills. They go from doctor to doctor looking for one that is liberal with pain pills. They go to mult
      • I've never been in a situation where I've been prescribed more than a token amount of opioids, like 20 Percocets of the lowest strength, and this covers my entire adult life (I'm in my mid 50s).

        I honestly don't know how people turn into frothing addicts with this little medication. Between the short half-life of 5 mg oxycodone and the risk of Tylenol poisoning, I don't quite see how you could take enough or take them long enough to actually get addicted.

        Say you got your wisdom teeth extracted, you got 20 P

        • Happy for you, you seem to have had a healthy life and not needed anything more serious than the usual dose of pain pills for the obvious, well done.
          I also generally end up with more pain pills than I need and don't have any serious injuries, even after being in two bike accidents, my knee still acts up, but it's nothing serious.
          Others are not so lucky.
          My ex used to do horse jumping when she was younger, messed her back up badly. A life time of not knowing how to lift properly (which she still doesn't d
    • by HiThere ( 15173 )

      Opioids are a lousy choice for long term pain. Once habituation sets in you get better results with aspirin. OTOH...

      Marijuana has been shown to make much long term pain tolerable. I have no idea whether CBP or whatever it's called works as well, since I've seen no reliable comparison studies.

      Another report was that LSD made even terminal cancer pain tolerable. It didn't kill the pain, but it made it seem less important. (I presume that this wasn't just during the trip, but I didn't see the original rep

      • by dryeo ( 100693 )

        Well hopefully with the changing climate there will be more and better studies on these drugs.
        Another consideration with LSD and Psilocybin is the surroundings, including a good guide, are very important when used therapeutically.
        One story I heard was that back in the '60's there were studies happening with LSD in Saskatchewan, really good results, alcoholism being cured, terminal people being able to handle being terminal, pain management. After the initial study, the establishment Drs came in to verify th

      • You get better results with aspirin because drug police interfered with medical decisions and now doctors can't just increase the dose (medically safe). It's like saying you get places faster with your bike, but not mentioning that's because the government restricted cars to 1mph (a very appropriate comparison to what they did with opiate doses).
        • by HiThere ( 15173 )

          It's an interesting theory, but I know of no support of even an anecdotal nature. The studies I know of said that habituation will progress until the dosage cannot be safely increased. And for some people before that stage it starts amplifying the response to pain. (Not just not being effective, but anti-effective.)

          FWIW, some of these studies were done in Victorian England, where there wasn't much government control over access to drugs. So for those studies your theory is definitely wrong. (OTOH, they

    • by bobbied ( 2522392 ) on Wednesday December 11, 2019 @02:16PM (#59508872)

      Many forms of pain killers--including opioids allow people to continue their lives, whereas they might have otherwise chosen to end them. We have so much anti-opioid hysteria that we have forgotten what these drugs where meant to do: relieve pain and suffering.

      Exactly this. My wife was on high strength pain killers (not the Oxy stuff abused by the kiddies, but serious narcotics like dilaudid) for over a decade and it kept her alive. I'm sure that if the same thing happened to her today, she would kill herself to get relief because I seriously doubt they be giving out dilaudid at the pharmacy anymore, even if her and her doctor decided she needed it.

      I'm all for being careful and not handing out pain killers like candy and making sure folks are not getting addicted to them, but there ARE people who need these medications regularly who now simply cannot get them or it's really difficult for them. Somehow we have to do both things here and the current "you are not getting them, no way, no how" mindset is not a workable solution.

      • Re: (Score:3, Interesting)

        by Anonymous Coward

        It is, in fact, a nightmare with the FDA cutting down supplies every year. I go to a small hospital pharmacy for my wife's prescriptions, because it's nice to have someone who knows my name. Sometimes they can't get the most expensive one, though. It's a huge pain to find a place which can fill it to begin with, because they won't tell you over the phone; they assume you're casing the joint before robbing them, I guess (which is why this is anonymous - I don't need some jerk breaking in to my house looki

      • I know it seems like things in the US are bad but in the country where I live poppyseed bagels and lemon poppyseed muffins are illegal and even terminal cancer patients are not prescribed opiates. No one is. And no one really cares because empathy is not a thing here. That is how far this hysteria against happy pills can go. At least in the US you can still get opiates in a hospital setting and if is completely obvious you must be in a huge amount of pain.

    • There are several reasons for the opiod problem. First was the bad marketing that proclaimed to doctors how much more effective and less addictive the new formulations were. In the past doctors would be wary of over prescribing, making sure that patients were weaned off whent he pain wasn't chronic, and so forth. And you were mostly stuck with what the doctor said, because getting prescriptions pill illegally wasn't necessarily easy. The second big cause of the problem then was that these pills became e

      • by sjames ( 1099 )

        Another part of the problem is pressure on doctors from the DEA (who are definitely not doctors) driving them to cut people off rather than treating addiction as a medical issue. That leaves some patients seeking opioids on the black market while propaganda shames them as degenerates

        All of that from people who apparently have never experienced chronic pain or even severe acute pain. The treatment of pain needs to be treated as a healthcare issue, not a legal issue.

        Adding to that, many of the alternatives to

      • by dryeo ( 100693 )

        The third problem is that what is bought on the streets is unregulated and often not what it was presented as. This is one of the main causes of the opioid poisoning crisis, and it is poisoning rather then ODing as the users didn't intend to OD.

    • by twocows ( 1216842 ) on Wednesday December 11, 2019 @02:50PM (#59509038)
      My mom was on opioid pain killers long-term due to her MS, it was about the only thing that seemed to stop the intense pain she would have. She was on them for the better part of a decade at least, I'm sure she was "addicted" in that she couldn't exactly stop taking them but she never had any problems while she was on them at the prescribed dosage. She eventually passed in 2016 due to complications from lymphoma, completely unrelated to heir painkillers or her MS.

      I think it's important to differentiate between reliance on a drug and abuse of a drug. Being reliant on a drug is not ideal, but if it's better than the alternative, it's not a problem, it's just a necessary measure. Abusing a drug to the point where it causes you physical ailments is certainly a problem, and if there are people abusing opioids, we should do something but that "something" shouldn't be banning them or making them harder to get for people who might need them.

      I worry that if she was still alive today, this backlash against opioid painkillers could potentially take away an essential tool in keeping her pain in check and, by extension, letting her live a normal life. I wonder how many people are currently in a similar situation to the one my mom was in. I agree, we need to be careful that this hysteria doesn't interfere with the original mission of the drug: getting rid of pain.
      • Numerable people have found that Cannabis has the pain relieving minus the threat of ODing.

        • No threat of an OD? You've apparently never listened to the 911 call from the cop who ate a pan of brownies with his wife and then time stood still and they thought they were dead.

          Cannabis has the most fucking hilarious ODs of any drug. Definitely not fatal ones, however.

  • Here in the UK, amitryptiline is often used to treat pain. And since it's also used as an anti-depressant, perhaps it could also lower the number of suicide attempts.

    https://www.nhs.uk/medicines/a... [www.nhs.uk]

    • by Chris Katko ( 2923353 ) on Wednesday December 11, 2019 @01:59PM (#59508782)

      Anti-depressants don't prevent suicides. In fact, many increase it. Because they don't stop the REASONS for feeling suicidal, they stop the FEELINGS that would have WARNED YOU to try to correct your life.

      Source: 7+ years on anti-depressants and chronic pain.

      Alternative Source: Any intelligent doctor.

      • Anti-depressants don't prevent suicides. In fact, many increase it. Because they don't stop the REASONS for feeling suicidal, they stop the FEELINGS that would have WARNED YOU to try to correct your life.

        But in many cases the reason you feel suicidal have nothing to do with how you're living your life. Clinical depression is generally not a result of lifestyle choices, it's a chemical imbalance in your brain. That may not have been your situation, but it is a very common one.

    • by Mashiki ( 184564 )

      amitryptiline

      It's terrible shit for a lot of people, it helped my grandfather who had phantom limb problems and let him sleep. For my grandmother who had multiple herniated discs it gave horrific nightmares, for me it was horrific nightmares as well. The worse cases from the pain clinic I went to before the doctors "noped the fuck out" because of anti-opioid hysteria refused to give it to patients because it could cause hallucinations and 'waking dream' type experiences, both of which are dangerous to people who work

      • Also amitriptyline like other powerful anticholinergics has been linked [harvard.edu] to an increase rate of dementia in older people. There is some evidence that anticholinergics are bad for your brain.

    • amitryptiline made me feel like a zombie. When I went off it, it took about 2 days, but it was like a light turning on. Everyone around me noticed.

      Oh, yeah, I have a migraine....every day for hmmm 8 years now. Trust me, it is not a fun way to live for me or my family.

      I have actually taken sleeping pills so I could sleep 3 days solid, waking every 12-14 hours for a snack to eat, a drink, and another sleeping pill then sleep again.
      Nothing works long term, it may help for a few months, then the effective
    • amitryptiline itself is a pretty effective suicide drug though. I had to hide my stash from a suicidal friend for a while and actually amitryptiline usually only helps with neuropathic and atypical pain. Opiates are probably the most effective anti-suicide drug I know. I challenge anyone to kill themselves after taking a high enough dose of oxycodone for instance. Goodbye depression. Yes I know it's temporary but it's highly effective. Far more effective than antidepressants for many people.

  • Addiction (Score:4, Insightful)

    by bugs2squash ( 1132591 ) on Wednesday December 11, 2019 @01:53PM (#59508756)

    Am I right in thinking that opioid additction is mostly about avoiding withdrawal ?

    ie. of course anyone can get oxycodone outside of the medical profession and decide they like it enough to kill themselves, but is the main issue that people have had it prescribed and got hooked because they were not prescribed a reasonable regemen to taper off of it ? Or is is the withdrawal process simply medically unadressable at present ? or is addiction largely unrelated to withdrawal ?

    • Am I right in thinking that opioid additction is mostly about avoiding withdrawal ?

      Nope. It's about getting high. Which feels quite good to some people.

      If you're taking oxycodone for an injury/post-surgery/any other very short-term use, there's usually no withdrawal symptoms.

    • No. Less than 1/4th of those addicted have ever been prescribed the opioid medication to which they are addicted. Those who are prescribed it and need it are monitored by their doctors for addiction. The problem is party people who illegally obtain the drugs to get high because they are weak boring people with boring empty lives who can't have fun unless they are high.
    • by DarkOx ( 621550 )

      No addition is about a substance causing physiological changes that make the patient feel they must seek out more of that substance even when doing so is harmful to them in some way. Withdraw is symptom that may be experienced when an addiction is not satisfied; but its in no way a requirement to be an addict. Withdraw can be quite severe even lethal if not managed in some cases. There are a multitude of ways modern medical practice avoids or treats withdrawal. These can be as simple as slowly reducing the

    • The withdrawal problem is very easily addressable with a simple over the counter med. But if you take 400-600 pills at once to overwhelm the P-gp pump that keeps this med, loperamide (an opioid of the same general type as fentanyl), out of your brain (thus making it normally impossible to get high, but all physical sickness is ended), well like 5 people have died from the associated prolonged qt (heart rhythm issue) so there's a real conundrum where as more people find out, calls to put it behind the counte
  • Not impossible (Score:5, Insightful)

    by LatencyKills ( 1213908 ) on Wednesday December 11, 2019 @01:57PM (#59508766)
    There's no silver bullet, no, but my sister took a specialty in pain management at Albert Einstein during her residency, and she is now director of anesthesia and pain management at the VA. You study the reaction of the patient to drug therapies and actively manage the pain/quality of life balance. When I shattered my clavicle skiing, my surgeon threw 50 Oxys at me for pain management prior to surgery, but two pills in I knew it was doing nothing for me. My sister prescribed me a cocktail which we balanced over the next several days - half a bill of this, a quarter of that, Oxy, Vicodin, Hydromorphone, others I don't recall - which kept me both functional (I continued to go to work) and pain free up to and through the surgery. Perhaps instead of being impossible, real pain management requires a degree of personal medical care that is no longer available in today's mass production medical care model.
    • And a willingness from the Dr. to prescribe varied and *gasp* potentially abusable medications. Prescription opiates are actually relatively safe, even in fairly high doses used for recreation. They're undeniably safer than a gram of whatever the hell some guy put in a baggie and says is heroin. I really despise this country's puritanical roots.
    • by I75BJC ( 4590021 )
      Bingo!

      "Thank You!" USA Federal Government that has totally screwed the USA Medical Care System by making medical professional into factory workers and technicians. Too little time to resolve health issues and produce healthy citizens. (This crap has been dished out to the USA people since POTUS Nixon's Wage & Price Control down through ObamaCare. American Health Care suffers any time the Feds get involved. One size does NOT fit all!)
      • American Health Care suffers any time the Feds get involved.

        If by "get involved" you mean "gut the existing system" then yeah.

        I haven't done the research to confirm this, but I suspect if you plotted increased federal spending on healthcare you'd find national health outcomes consistently improving after, lagging by a few years.

        (Waiting for the inevitable strawman argument that I'm claiming more money is always the answer, which is not what I said. Note that increased federal spending could mean decreased private spending.)

    • My sister prescribed me a cocktail which we balanced over the next several days - half a bill of this, a quarter of that, Oxy, Vicodin, Hydromorphone, others I don't recall

      You might not want to broadcast that to the world. In most countries, doctors prescribing narcotics to either themselves or family members get into very serious trouble, very quickly and for very good reasons. For example in Canada the CMPA says [cmpa-acpm.ca]:

      A physician's prescribing privileges may be revoked if narcotics or controlled drugs are prescribed to family members or if a physician self-prescribes these substances. Treating or prescribing any drugs, especially controlled substances, to oneself or to family or friends could lead to allegations of professional misconduct.

      My dad was a doctor and would write minor prescriptions for us when we were kids (e.g. antibiotics for an ear infection etc.) but if we got anything more serious one of his partners would treat us and write any needed prescription. He certainly would never have p

  • Self-care (Score:4, Interesting)

    by Surak_Prime ( 160061 ) on Wednesday December 11, 2019 @02:08PM (#59508830)

    I am *absolutely NOT* saying that painkilling drugs are never necessary - they definitely are, especially for surgeries and certain conditions. Toothaches are freaking murder. But I really feel like people don't learn enough about the built-in means that we have for pain management. Controlled breathing including Lamaze and kiais. Mental discipline for dismissing pain after acknowledging and accepting what it is trying to tell us (it can work, and I know firsthand), and for not allowing ourselves to panic into a state where the sensation of pain gets much stronger both because we're focusing on it and because we're letting our bodies do exactly the wrong things to control it. Making sure we are well-rested as best as possible, so that the body has the resources to resist pain and illness.

    I think these things should be taught in elementary school as a second resort, and that drugs should be a *third* resort - both following the first, which is detecting and eliminating the *cause* of the pain in the first place, when possible. People aren't always able or willing to connect the dots between things they're doing and the pain they're feeling. Bad headache? Try having a good bowel movement - drink fruit juice to help if needed. My idiot ass woke up this morning with pretty nasty back, shoulder, and neck pain. Well, no duh - I ate enough at supper last night for three people because it was something I really enjoy, and of course I slept uncomfortably and like crap.

    It's cliche, and no one wants to hear it, but diet, exercise, proper sleep, and proper hydration are KEY, and a lot of us are willfully awful at those and then "wonder" why we feel like shit - and why they get worse when we take pills to ignore the effects and allow us to do it wrong some more.

    Oh, and not that there's anything horrible about people who are, but I'm no New Age evangelist. I eat meat, don't do yoga, and I don't mind *intelligent* GMOs in my diet. These things are just simply true.

    • by Nidi62 ( 1525137 )

      I am *absolutely NOT* saying that painkilling drugs are never necessary - they definitely are, especially for surgeries and certain conditions. Toothaches are freaking murder. But I really feel like people don't learn enough about the built-in means that we have for pain management. Controlled breathing including Lamaze and kiais. Mental discipline for dismissing pain after acknowledging and accepting what it is trying to tell us (it can work, and I know firsthand), and for not allowing ourselves to panic into a state where the sensation of pain gets much stronger both because we're focusing on it and because we're letting our bodies do exactly the wrong things to control it. Making sure we are well-rested as best as possible, so that the body has the resources to resist pain and illness.

      You can only mental away so much pain. I have a herniated disc in my back that causes permanent (but slight) weakness and numbness in my right foot/ankle and occasional pain up and down my leg. I can live with and tolerate that, and have learned techniques to relieve the pressure/pain temporarily. I also walked around on a broken foot for 3 days before it was diagnosed and treated. Wasn't exactly fun but I did it. But I also have kidney issues and that is one pain that is incredibly difficult to ignore

      • Acupuncture alleviated my back pain. It is even accepted by the WHO for that kind of thing. It may help in your case or not, but either that or a chiropractor I think are things to consider.

      • I refer you to my first two sentences. There are definitely exceptions. But there's also a lot of people causing their own pain, and a lot of people with manageable pain that they don't know how to manage. Like what you said about your leg pain.

  • What?! (Score:4, Insightful)

    by Shotgun ( 30919 ) on Wednesday December 11, 2019 @02:16PM (#59508868)

    The medicines are bad because some people choose to misuse them?

    Pro Tip: There are no medical "side effects". There are only effects. If the drug has no effects, there is no way for it to be effective.

    If somebody uses a drug to get high, or commit suicide, it is not a problem with the drug, any more than it would be a problem with the gas tank, car, gun, knife, model glue, spray can of gold paint, or roof. All of those items have valid uses which are not impacted by someones desire to use them for something else.

  • by gestalt_n_pepper ( 991155 ) on Wednesday December 11, 2019 @02:29PM (#59508934)

    I suffer from fibromyalgia, arthritis and restless leg syndrome. Most of the potions prescribed end up being worse than the immediate problem.

    The only useful things I've found for fibromyalgia are selegeline and harmaline derived from plant sources (tricky to dose, but effective). They're not even recognized as useful by the medical community.

    As for inflammatory pain, there's just not much. Breathing exercises, massage, acupuncture, focused meditation ON the pain. They all help, but nothing is a slam dunk fix.

    It's all about management. Pain *management* is as good as it gets.

    • I've got minor arthritis and RLS as well. My personal experience is that a bar of Irish Spring under the fitted sheet really does help with the RLS. I find that over time as the bar gets polished the effectiveness diminishes, so every few days when the RLS starts to be a problem again I scuff the bar up with some sandpaper and it begins to help again. I've been on the same bar for more than a year now.

      It's complete fairy-tale bullshit and there's no scientific/medical reason behind why it should work, an

      • Yeah, I've heard this but always assumed it was BS. Doesn't work for me but glad it works for you. You might have more luck by smearing your legs with something like Ben-gay, tiger balm or Kwan Loon oil. Anything that produces sufficient neural noise in your legs seems to diminish the symptoms.

        I've also had good luck with herbal tranquilizers like passionflower, lemon balm, hops and kratom. You have to take a lot of each though. About 5 times whatever it says on the label.

    • by Mal-2 ( 675116 )

      Be careful with the harmaline, it's a MAOI (MAOI-A specifically, I think) so you need to avoid all the other things people on MAOIs have to avoid while you are using it.

  • My Dr prescribed Gabapentin for me a while back. It did nothing for me. Pretty much a placebo for me. I understand opioids are addictive but some folks need the relief. Or maybe a lobotomy is the answer...
  • by DatbeDank ( 4580343 ) on Wednesday December 11, 2019 @02:56PM (#59509066)

    Here's a question: why haven't doctors ablated (aka remove) nerves in areas causing chronic pain? Is the research into this field not complete yet?

    I know this opens up a whole host of issues such as not being able to feel pain. But if someone is in that such a state where they're contemplating suicide or hardcode opioid addiction, I just don't see why ablation can't be a solution.

    • Re:Nerve Ablation? (Score:4, Informative)

      by belthize ( 990217 ) on Wednesday December 11, 2019 @03:48PM (#59509342)

      They do.

      My wife has radio frequency ablation performed every 6 months for chronic neck pain. She has a stress fracture and compressed disk that impinges on a nerve and causes a fair bit of pain. Every 6 months she goes in and they cauterize it. For about 2 weeks there's some residual pain from the procedure, then roughly 4 months of 'relatively' pain free existence and then 2 months of increasing pain till the process is repeated. The final month is kind of rough, it's akin to torture strategies where the knowledge that pain is coming is almost more problematic than the pain itself.

      Still it's fairly effective and beats opioids.

      https://www.mayoclinic.org/tes... [mayoclinic.org]

      • If opiates were effective, in what universe would that nightmare beat them? The only problem with opiates would be the consequences of getting cut off.
  • Comment removed based on user account deletion
  • by williamyf ( 227051 ) on Wednesday December 11, 2019 @03:36PM (#59509270)

    I suffer from headackes and migraines.

    When I was a Kid, aspirin worked but after 10 years (more or less) not so much. I moved to acetaminophen/Paracetamol, until after 10 (again, more or less) years, it not worked anymore.

    I moved to Ibuprofen, until after 15 years (more or less) it not worked anymore. So i Moved to Potasic Diclofenac, until I got my gastric sleeve and could not take it anymore, so I moved (it still works 20 years latter, is just that I can not take it becaise of the gastric scar).

    Now I take Etoricoxib, and it more or less works.

    The point is, sience has moved forward since the discovery of aspirin and Paracetamol/acetaminophen, and there are many generations of NSAIDs available. Indeed a plethora of NSAIDs. So, tell your doctor, in no uncertain terms: "No opioids!" "No stuff that makes me an addict!" "No stuff that makes me want to suicide" "No stuff that gives me a high" "Just Analgesics"

    If you suffer from long term pain (for example, while healing a fracture, or migraines like me) or chronic pain, climb the ladder (with suppervision from your doctor, of course) until you find an NSAID that works for you and stick to it. If it stops working after some years, climb some more and find the next one. Is better than to risk your life on something that can be used to commit suicide, or can make you an adict.

    Yes, NSAIDs have some bad side-effects too, kidney things come to mind, but at least, if those side-effects manifest, you can stop or change medication cold turkey, without withdrawl sindrome, or becoming an addict... And they really alleviate the pain, instyead of drugging you so that you still feel the pain, just not care about it.

    On a side note, In 1993, I had a fracture + ankle sprain in Canada. They offered me opioids (type 3 tylenol), but I refused. Instead I used 600mg of Ibuprofen 3 times a day, and it worked like a charm. Then, back at home (in venezuela) in 2007 after my knee surgery, I was prescribed again type 3 tylenol, but this time around I took it, and guess what? It did not stop the pain AT ALL, instead, it made you not care about the pain due to the codeine. That made me realize, I took the right decition in Canada. So no more opioids for me...

    • NSAIDs don't help with all types of pain and kill thousands of people a year too.
  • Who in their right mind would think gabapentin or baclofen would be safer than opioids? Are you stupid? Gabapentin is essentially alcohol in a pill and baclofen is pharmaceutical phenibut. Both are highly addictive and the withdrawals can KILL you unlinke opioids which only make you sick from withdrawal.
  • Chronic Pain is an Impossible Problem

    It is not an impossible problem unless we are setting the goal of completely eradicating it.

    There are many aspects to chronic pain. For starters, it doesn't start overnight, and it is the accumulated result of other problems.

    Those "root" problems are a big problem in this country because they affect (typically) those at the lower end of the economic spectrum. Why is that a problem? Because health care in America is uber-expensive.

    Our lack of a generally affordable preventive care system aggravates th

  • In my mid 40s I developed aggressive arthritis in my C2-T1 vertebrae following a severe whiplash. This eventually lead to the sensation of having 10,000 volts shooting down my right arm and into my hand. With surgery being my last resort, I agreed to go on Gabapentin for a time. It's hard to explain what it was like being on it, except that I initially felt a sense of euphoria which eventually fell away over a period of 2-3 days. Afterward, it became clear this drug was not going to address my problem,

"The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts." -- Bertrand Russell

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