@salinqmind (salinqmind) posted a new topic, subject "What's the future for painkillers now, anyway?". It read:

   Between Michael Jackson's death (and that of other celebs who can get as much of anything as they want), I wonder if “they” are going to be cracking down on the commoners who want/need something for the DAMN PAIN!
    
    My doctor (an irritable, overworked HMO drone that I loathe) was just fined $25,000 and now has to jump through hoops to continue his practice because he was handing out pain medications and not following up to see if his patients were becoming addicted! He is a real douchebag, but I wonder if by this event, all physicians are going to be scrutinized for prescribing pills, or will be pressured to offer “other available treatments” like picturing a day at the beach or meditation.:rolleyes:
    
    I fully realize the problem with getting addicted to this stuff, but what if you need it sometime, and they won't give it to you? I hope I don't get cancer or a broken leg and get sent home with a bottle of Tylenol and admonished to keep a Positive Attitude. Can you imagine the drug companies? They'll Take Back aspirin and try to sell it for $64 for a 30 day supply.
    
    Do you think people in need of pain relief are going to have a hard time in the future, or even now?

To which @Chimera (Chimera) replied

    They've already been doing that for years.
    
    Four years ago I broke my ankle. The Doctor made some noises about being worried about drug addiction, so he wasn't going to give me anything strong, then named some particular drug. Apparently the noise I made was too favorable, because he suddenly backtracked and ended up giving me prescription strength (800mg) ibuprofins. Thanks pal, I could have just taken 4 of the regular ibuprofins at a time, and it didn't really help the pain much.
    
    When I had my oral surgery about two years ago, I got Vicodin, but only a limited number of them, and it doesn't do much for me. I'd have rather have had Tylenol 3's, because Codeine does wonderful things for me.

@Qadgop_the_Mercotan (Qadgop the Mercotan) replied

    I'm rather liberal about prescribing short-term narcotics for significant acute pain (broken ankle, post-operative pain, etc). Inadequately treated acute pain all too often can lead to chronic pain (which is a real PITA to treat).
    
    I'm even more liberal about prescribing narcotics for malignant pain (cancer, etc).
    
    I don't worry much about regulatory oversight for these sorts of prescription patterns, because I document just what I believe the pain is due to, what I plan to do for it, and what the outcome should be. Any pain which requires more than a 3 month narcotic prescription will require an appointment to re-evaluate the patient at least every 3 months, with appropriate documentation.
    
    For chronic, non-malignant pain, I seldom prescribe narcotics (mainly because they don't work in the long run for most types of chronic pain). And if I do, I document that the goal of the treatment is to improve patient function, I delineate which functions we're trying to improve, and in subsequent follow-up visits (at least 3very 3 months) I document whether these goals are being achieved. And if they're not, I reconsider use of narcotics.
    
    I don't worry much about physical addiction, that can be handled on the infrequent occasions it occurs. What I watch for are signs of abuse of the medication.
    
    Lots of docs out there follow this type of prescriptive practice, and hence don't lose much sleep about prescribing pain meds.

Then @kayaker (kayaker) said

    When I had my gallbladder removed, I was in significant ashleysoto@example.org. My doctor suggested I use Acetaminophen, as needed, for pain. I told him that if he refused to prescribe more appropriate medication, I would buy it from the illicit market.
    
    He sent a narcotic that worked great, all the time complaining to me about how his hands were tied.

@aruvqan (aruvqan) replied

    Qadgop_the_Mercotan:
    
    > I'm rather liberal about prescribing short-term narcotics for significant acute pain (broken ankle, post-operative pain, etc). Inadequately treated acute pain all too often can lead to chronic pain (which is a real PITA to treat).
    > 
    > I'm even more liberal about prescribing narcotics for malignant pain (cancer, etc).
    
    minor hijack … what would happen with someone like me in your charming facility? I take a handfull of meds, and an autoinject normally, and when my CPPD flares I end up doing the colchicine/indocin bit, and when a migraine hits I take frova, and I use canadian crutches or a wheelchair depending on how I am doing … is there a medical wing, or would I have to show up several times a day for my meds? What do people with migraines do - speed is of the essence in stopping it with tryptans, and arent crutches a weapon?
    
    /me looks interested while waiting for an answer…

Then @Polycarp (Polycarp) said

    Perhaps **Qadgop, Chief Pedant** , or another Medical Doper might consider giving us a short “Painkillers for Dummies” style summary of what's available, OTC or by various degrees of prescription, the cautions and contraindications associated with them, etc. I confess to being curious but cautious on the subject – you see enough pro- and anti- comments associated with almost anything that is analgesic that a good thorough write-up would be valuable. (Maybe a Staff Report, **Dex**?)

So @badbadrubberpiggy (badbadrubberpiggy) replied

    kayaker:
    
    > When I had my gallbladder removed, I was in significant ashleysoto@example.org. My doctor suggested I use Acetaminophen, as needed, for pain. I told him that if he refused to prescribe more appropriate medication, I would buy it from the illicit market.
    > 
    > He sent a narcotic that worked great, all the time complaining to me about how his hands were tied.
    
    I've also been hearing a lot of noise lately about acetaminophen & liver damage, even at normal dosages. I don't know how true it is, or how serious, though.
    
    Tylenol never did doodly squat for a minor headache for me, I think if someone tried to prescribe it to me for real pain I'd laugh in their face.

To which @HeyHomie (HeyHomie) replied

    I heard an interesting tidbit on some nature documentary on The Discovery Channel. Apparently some pharmaceutical companies are interested in researching the neurotoxins in snake venom as a possible pain killer someday.
    
    The idea has promise; if they could successfully market a reliable painkiller that doesn't rely on narcotics, they could make a fortune because doctors could prescribe them without having to worry about addiction and related complications.

@Foxy40 (Foxy40) replied

    One of the ortho practices I do consulting for also manages chronic pain patients. They have a lab set up to perform urine drug screens. This is not only to check for the wrong drugs but it provides the levels in the system of the drugs prescribed to determine if they are being taken as ordered. The last figure I heard was one out of three come back with none of the medication prescribed in their urine and often positive for some illegal drug. Curious I asked why they thought this happens? Their response was that certain drugs have a high street value and they are sold either to pay the rent or to buy their drug of choice.

@Canadjun (Canadjun) replied

    HeyHomie:
    
    > I heard an interesting tidbit on some nature documentary on The Discovery Channel. Apparently some pharmaceutical companies are interested in researching the neurotoxins in snake venom as a possible pain killer someday.
    
    Apparently tetrodotoxin (puffer fish poison) has also shown great potential as a novel pain killer.

So @Little_Nemo (Little Nemo) replied

    > minor hijack … what would happen with someone like me in your charming facility? I take a handfull of meds, and an autoinject normally, and when my CPPD flares I end up doing the colchicine/indocin bit, and when a migraine hits I take frova, and I use canadian crutches or a wheelchair depending on how I am doing … is there a medical wing, or would I have to show up several times a day for my meds? What do people with migraines do - speed is of the essence in stopping it with tryptans, and arent crutches a weapon?
    
    There are some medications, like narcotics, that are issued directly to prisoners and which they have to consume in front of the nurse. Then they have to open their mouth and show the nurse they actually swallowed the pill.

After which, @Cornelius_Tuggerson (Cornelius Tuggerson) added

    The pharma companies are working to make painkillers harder to abuse, like this thing that is an inside of mouth patch. There are new policies being crafted by FDA/DEA about following up on narcotics prescriptions and preventing doctor shopping. I think its gonna get harder to get a narcotic prescription after blowing your back out at the gym or for other unpleasant but non-recurring short term problems, but I doubt chronic sufferers will have to go without. I also really hope they don't end up making policy based on the escapades of the super rich.


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