The opioid crisis


#143

The link I was able to find was about relatively weak opiods in an ER scenario on a single kind of injury, and the study was set up in such a way that there was a very large standard deviation, and then treated lack of a “significant” result as evidence of lack of correlation.

I’d love to see a study that actually backs up some of your very broad claim.


#144

If you Google something like “opioids less effective than ibuprofen” you’ll find a number of studies, not just the one ER study, although even the issues you being up regarding that study support the notion that opioids aren’t actually BETTER. And they have far, far more negative side effects. If you take a large dose of ibuprofen and acetaminophen, you get some of the highest rates of reported pain relief.

The thing is, until recently, no one really bothered comparing different painkillers. It wasn’t until we started getting high addiction rates throughout society that folks have started doing serious studies comparing things to opioids, and the results this far have not really supported the notion that opioids are super awesome.

The problem though, is that measuring the effectiveness of painkillers is entirely subjective.


#145

I hear that if you try to pick up a marble with your butt cheeks, you will be so distracted that you won’t feel any kind of pain.


#146

I can only speak from my own experience; opioids made a huge, qualitative difference. While the pain was still there, it helped feel more distant and therefore bearable. I totally understood how they could be addictive after that experience.


#147

Yeah, the question is though, whether you could have achieved a similar effect with other painkillers. I’m not sure the answer to that is “no”. It may be, but I think that folks haven’t researched it enough to know one way or the other yet.


#148

Well, I was on the other painkillers and they didn’t do the job. Then I went on opioids, and they did (at least a bit better). So… no?


#149

It’s totally possible that is the case, although it may be that the dosage of the others could have been upped and achieved the same effect. Also, different folks body chemistries are different, so it may have just been that opioids were the best choice for you. And you didn’t suffer ill effects, so it worked out.


#150

From personal experience, a low dose of oxycodone kills severe pain a million times more effectively than a high dose of ibuprofen which in turn is vastly more effective than acetaminophen. On the other hand hydrocodone seems to have no effect on me at all, with or without acetaminophen. For any kind of ordinary pain, ibuprofen is quite good enough, however.


#151

Even Tramadol has massively better effectiveness for me than extremely high daily doses of Ibuprofen, Acetaminophen, Aspirin, and/or Naproxen Sodium (most days, I take at least 3 of those four, very close to max suggested dosages).

The time I got some stronger opiates after wisdom tooth surgery was fucking magical. It’s the only time in the last 18 years I haven’t felt my back hurt at all. God I fucking miss that sensation. Which is why I never push for anything harder with my doctors. I’d get addicted in a fucking heartbeat to not feeling trapped in my decaying shell of a body.


#152

When I got out of surgery after they drilled a hole down my femur and inserted a titanium rod, the amount of Ibuprofen or Acetaminophen that would have killed the pain would have killed me as well. Slowly and painfully as my liver was destroyed first. Just some anecdata. Thank dog for morphine.


#153

Yeah, the limiting factor of NSAIDS and Acetaminophen is the potential of damage to the liver or kidneys.

The thing they got going for them though, is that they actually increase your pain threshold by interfering in the chemical process that our body goes through when cells are damaged.

Since you can buy them over the counter, folks seen to often think of NSAIDS and Acetaminophen as weak, but they are extremely effective. Not for everything, but for a lot.

For things like having your femur drilled, I dunno if there’s really anything you can do to block that much of a reaction, so opioids for a short time to make you just kind of… Less present? For the pain is probably the best option.

For longer term stuff though, opioids have problems, both due to addiction and tolerance, as well as all the side effects. Marijuana likely has a role in that type of pain control, but has been blocked by our government for decades.


#154

Very true. I was maxed out on Advil, and it didn’t do the trick. But like you said, everyone’s bodies are different. That’s why the doctors started me on the non-controlled stuff first to see if that would do the job.

Yep. I know exactly what you mean. I was frankly stunned the first time I went on them. I’ve been prescribed them a couple times since, and I’ve always cut myself off as soon as possible, because it would have been sooooo easy to keep going long after I absolutely needed it.


#155

If I remember right, that’s how it was for me shortly after my surgery. I still felt the pain, but it didn’t seem like such a bad thing. Later, when I was in less pain and got a lower dose, it wasn’t very effective.

Another reason I’m glad that I didn’t get on opioids long-term is that I was able to feel when I got a new and different kind of pain in my hip. I went in and got x-rayed and they found they had to remove the pins. If I had still been on vicodin, I might not have realized what was going on until it was too late.


#156

Well that’s the thing. They took me from Demerol, which wore off too soon, to morphine and then eventually to codeine. When I was home it was tablet codeine for a while and then liquid (which I actually think was a mistake) then nothing. By that time the pain was minimal. By the time I got out of the wheelchair I wasn’t taking anything.


#157

My understanding as a layman who’s dealt with workers’ comp cases for 20+ years is that opioids remain very effective for managing severe acute pain such as pain from terminal cancer or pain from surgery. However, the problem is that they were utilized for chronic and ongoing pain and for that, there can be some fairly severe problems.

It’s wrong to say that anti-inflammatories are flatly “better or equal” than opioids, from my understanding. They treat different things and affect pain in different ways.

I’ve deposed a lot of doctors about pain, including numerous specialists in pain management and they agree that pain exists on a continuum. Pain has a range of causes and contributing factors, from the mechanical cause of the pain (tissue damage, inflammation, etc.) up through the peripheral nerve transmission of pain, through the central nervous system transmission of pain, through the brain receiving the signal all the way to the mind interpreting the signal.

Opioids will not do anything for the underlying source of the pain, but if that source is inflammation, then anti-inflammatory meds can help a lot. Conversely if the underlying source of the pain is not related to inflammation or if the pain is generated by the peripheral or central nervous system or by the brain or by the mind, anti-inflammatory meds will accomplish only a placebo effect.

In the long run, serious pain management requires a range of treatments, not just take an ibuprofen and call me in the morning.

There is one common source of pain where both opioids and tylenol are probably not very good compared to anti-inflammatory meds and that is the garden variety non-surgical back strain. It’s one of the most common work injuries, and one of the most common ailments, and anti-inflammatory meds can help a ton. However, if there is real spinal damage, all the ibuprofen in the world ain’t gonna do much in the very long run.


#158

This is important. One of the issues I had after I returned home from the hospital, and after the pain had pretty much gone, was neuropathy in the leg with the rod. I was still taking codeine at the time. My left leg and foot had a burning, itching, electric pain that I could not stand. It wasn’t like a physical throbbing. It was, well, I can’t describe it better than that. Burning, and the way your foot might feel after it was really cold and then you are in the house. After the numbness of an asleep limb?

Anyway, codeine did not touch it. Nor did any over the counter pain med. I ended up sitting at my computer table with my foot in a bucket of water and icecubes. That numbed it enough that I could function. Of course, bedtime was: Soak foot in ice until it’s numb. Lie down with my cold, wet leg on a towel. On my back, which I hate. Try to get some sleep until the pain returned. Then sit up with my leg in ice until I could sleep again. Rinse, repeat.

I believe that there are now drugs for that very specific kind of pain. I was lucky that it eventually ‘went away’.


#159

Click for infographic showing the dramatic rise in opioid overdose deaths. Poster is from Pew Research.


#160


#161

That chart is extremely discouraging. What the hell is going on?


#162

I don’t understand why the conversation is only about opioid abuse. I don’t mean this topic persay which fits the title, but the country wide conversation as if the other drugs are not also a problem trending up.