NY screws up handling Vicodin etc, urges rest of nation to do the same.

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Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
Oh one other note the overdoses from those who are taking too much, or are abusing, are dying from the high levels of acetiminophen, not from the opiod itself. In addition pain patients who are "undertreated" for their pain start taking advil, and tylenol in addition to what they have been prescribed and end up with kidney, liver issues big time. If they are properly treated for their pain, and not undertreated by a skiddish doctor worried about the DEA coming to wreak havoc on their practice, you might not see so many in the ER from these issues. Again, it is education that is needed, and there are far too many doctors who only get 2-3 days tops in training in medical school on the use of pain medications. Don't believe me? Start researching it online and find out how little they are actually trained on this. Nor are they given real training on chronic pain patients, and how best to treat them.

When you take away inexpensive affective opiod pain medication and then start prescribing in-affective expensive medications (where the cost may or may not be covered by medicare or regular health insurance) , that is a huge problem too. So now a person gets put on Celebrex to treat pain and is paying 100 dollars out of pocket cost as compared to 3$ for a 30 day supply of vicodin, or codeine that works far better.

Even worse is, at least in my area, I know quite a few people who have chronic pain issues and their doctors are putting them on SSRI's like Cymbalta. They say it helps a little bit but nowhere near worth the money. To top it off, the withdrawals from the non-narcotic Cymbalta are FAR worse than the opiods.

That and all the higher end opiod addicts will switch to heroin when they can no longer fuel their addiction through pharmaceuticals. Boy does that ever sound like a great fucking idea, more heroin junkies. And to sweeten the pot even more a bunch of them will be clogging up the ER since they are switching from a pharmaceutical, in which they can very easily get the dosage right, to a drug most of them will be relatively new too and its strength can vary from one day to the next.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
Dr. Charles Argoff, director of the comprehensive pain management center at Albany Medical Center, said the FDA should accept the advisory panel's recommendations. "Scientifically, it's pretty open and shut. Hydrocodone is more potent than morphine, yet it's more accessible. That's never made much sense to a lot of us in the pain management world."

This Dr. seriously just said that? That's crazy talk. He's crazy.

The statement IS factually correct.

However, in the actual form they are talking about (10mg or less and mixed with APAP) it isn't comparable with any type of morphine that you can be prescribed.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
I agree. But not jail - jail they can get released from. Torture that results in pain.

Naw, just use them as a crash test dummy until they have some really fucked up discs in their backs. Then refuse them any pain medications...... ever.
 

waggy

No Lifer
Dec 14, 2000
68,145
10
81
Even worse is, at least in my area, I know quite a few people who have chronic pain issues and their doctors are putting them on SSRI's like Cymbalta. They say it helps a little bit but nowhere near worth the money. To top it off, the withdrawals from the non-narcotic Cymbalta are FAR worse than the opiods.

yeah my Pain doctor wan'ts me to do Cymbalta. from what i read it does not work and worse then any heroin paid medician.

BUT its also far more expensive to buy
 

xj0hnx

Diamond Member
Dec 18, 2007
9,262
3
76
yeah my Pain doctor wan'ts me to do Cymbalta. from what i read it does not work and worse then any heroin paid medician.

BUT its also far more expensive to buy

Yea, I stopped going to my PM doc when he started pushing Cymbalta.
 

abj13

Golden Member
Jan 27, 2005
1,071
901
136
Again, it is education that is needed, and there are far too many doctors who only get 2-3 days tops in training in medical school on the use of pain medications. Don't believe me? Start researching it online and find out how little they are actually trained on this. Nor are they given real training on chronic pain patients, and how best to treat them.

False. Badly false. I don't think you even understand what entails medical training. Most adult physicians who are going to see chronic pain (Internal Med/Family/ER/Anesthesia) receive more training, its called residency. Its 3-4 years of training after medical school. There they treat, under the supervision of attending physicians, chronic pain. Given the rise of chronic pain clinics, residents are trained in real time in the proper management. Heck there are now entire FELLOWSHIPS dedicated to pain medicine. So your research isn't correct.

As most adult physicians will tell you, chronic pain isn't just "pain." Its a complex interplay of coping mechanisms, behavioral development, psychosocial medicine, and actual pain itself. More and more physicians are understanding that treating pain isn't just prescribing opioids, but its treating the patient as whole, including with SSRI/SNRI's, and medications like gabapentin. Heck, I've worked with a city "riddled" with chronic pain patients, Janesville Wisconsin. When I was there (December 2008, before Obama was inaugurated), the auto plant had just closed (yes, the one referred by Paul Ryan), and many people were coming into clinic with complaints of "pain." Many were the autoworkers just laid off from their job. Any rightful person would recognize their pain isn't just "pain" but severely complicated by the fact they just lost a well-paying, retirement secure job that they held from 10+ years.
 

nanette1985

Diamond Member
Oct 12, 2005
4,209
2
0
As most adult physicians will tell you, chronic pain isn't just "pain." Its a complex interplay of coping mechanisms, behavioral development, psychosocial medicine, and actual pain itself. More and more physicians are understanding that treating pain isn't just prescribing opioids, but its treating the patient as whole, including with SSRI/SNRI's, and medications like gabapentin. Heck, I've worked with a city "riddled" with chronic pain patients, Janesville Wisconsin. When I was there (December 2008, before Obama was inaugurated), the auto plant had just closed (yes, the one referred by Paul Ryan), and many people were coming into clinic with complaints of "pain." Many were the autoworkers just laid off from their job. Any rightful person would recognize their pain isn't just "pain" but severely complicated by the fact they just lost a well-paying, retirement secure job that they held from 10+ years.

So there's nothing that is real pain?? Just tell someone who's coming to you for help that it's all in their head.

Where did this BS come from?? I've had Rheumatoid Arthritis since I was a child. In those days pain was called pain, and it was treated as such, and the treatment made normal life possible. In the last 8-10 years this doo-doo of it isn't pain, it's all in your mind has become the norm from your precious trained physicians. It isn't treating the patient as as whole if you're not allowing the pain-riddled body to function The body is a part of the whole.

These days (after my 5 strokes) I always get told to get psychologic therapy. Oh, for goodness sake, I've had therapists for many years. Interesting, but no pain relief has ever happened with them. Also, pain doc's these days are recommending alternative therapy - acupuncture is commonly suggested. Homeopathic remedies - Bach flower preparations - usually mentioned, Bach Rescue Remedy. Then Yoga, Reiki, EFT, that type of thing.

Meditation is thrown out as a sure cure. Can anybody meditate successfully while they are in intense physical pain? I can't.

Things are getting really bad for members of my RA support group. When pain gets to a certain level, they don't want to live any more.
 
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Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
yeah my Pain doctor wan'ts me to do Cymbalta. from what i read it does not work and worse then any heroin paid medician.

BUT its also far more expensive to buy

I have heard (all anecdotal but they are actually on it) that it has some effectiveness. I just shudder at the thought of putting people on SSRI's that have worse withdrawals than the opiods and FAR more side effects.
 

TheVrolok

Lifer
Dec 11, 2000
24,254
4,076
136
yeah my Pain doctor wan'ts me to do Cymbalta. from what i read it does not work and worse then any heroin paid medician.

BUT its also far more expensive to buy

Just out of curiosity, where did you read that it does not work?
 

TheVrolok

Lifer
Dec 11, 2000
24,254
4,076
136
So there's nothing that is real pain?? Just tell someone who's coming to you for help that it's all in their head.

Where did this BS come from?? I've had Rheumatoid Arthritis since I was a child. In those days pain was called pain, and it was treated as such, and the treatment made normal life possible. In the last 8-10 years this doo-doo of it isn't pain, it's all in your mind has become the norm from your precious trained physicians. It isn't treating the patient as as whole if you're not allowing the pain-riddled body to function The body is a part of the whole.

These days (after my 5 strokes) I always get told to get psychologic therapy. Oh, for goodness sake, I've had therapists for many years. Interesting, but no pain relief has ever happened with them. Also, pain doc's these days are recommending alternative therapy - acupuncture is commonly suggested. Homeopathic remedies - Bach flower preparations - usually mentioned, Bach Rescue Remedy. Then Yoga, Reiki, EFT, that type of thing.

Meditation is thrown out as a sure cure. Can anybody meditate successfully while they are in intense physical pain? I can't.

Things are getting really bad for members of my RA support group. When pain gets to a certain level, they don't want to live any more.

The post of abj13's that you quoted is dead on, and at no point did he deny that there was "real pain." Pain, it's etiology, and treatment are far more complex than - "I have pain, I need pain pill."
 

nanette1985

Diamond Member
Oct 12, 2005
4,209
2
0
The post of abj13's that you quoted is dead on, and at no point did he deny that there was "real pain." Pain, it's etiology, and treatment are far more complex than - "I have pain, I need pain pill."

More complex, okay, I'll drink to that. But why is the very simple "It's in your head"the primary response to "I have pain."
 

AyashiKaibutsu

Diamond Member
Jan 24, 2004
9,306
3
81
Just out of curiosity, where did you read that it does not work?

I've been on a variety of anti-depressants (largely for other reasons, but with the hope it'd also affect pain) and none of them have had a significant effect on my pain levels. I can understand them being included in an overall treatment plan, but frequently you hear of them being substituted for pain medicine.
 

TheVrolok

Lifer
Dec 11, 2000
24,254
4,076
136
More complex, okay, I'll drink to that. But why is the very simple "It's in your head"the primary response to "I have pain."

I'm not aware that it is, or at least it hasn't been in my experience.

I've been on a variety of anti-depressants (largely for other reasons, but with the hope it'd also affect pain) and none of them have had a significant effect on my pain levels. I can understand them being included in an overall treatment plan, but frequently you hear of them being substituted for pain medicine.

I've seen them used in an "adjuvant type" role, or when other therapies have failed. Or for specific types of pain that are more responsive to them than other analgesics. I haven't seen them used as a replacement on the whole, though. I suppose as always YMMV.
 

abj13

Golden Member
Jan 27, 2005
1,071
901
136
So there's nothing that is real pain?? Just tell someone who's coming to you for help that it's all in their head.

Where did this BS come from?? I've had Rheumatoid Arthritis since I was a child. In those days pain was called pain, and it was treated as such, and the treatment made normal life possible. In the last 8-10 years this doo-doo of it isn't pain, it's all in your mind has become the norm from your precious trained physicians. It isn't treating the patient as as whole if you're not allowing the pain-riddled body to function The body is a part of the whole.

These days (after my 5 strokes) I always get told to get psychologic therapy. Oh, for goodness sake, I've had therapists for many years. Interesting, but no pain relief has ever happened with them. Also, pain doc's these days are recommending alternative therapy - acupuncture is commonly suggested. Homeopathic remedies - Bach flower preparations - usually mentioned, Bach Rescue Remedy. Then Yoga, Reiki, EFT, that type of thing.

Meditation is thrown out as a sure cure. Can anybody meditate successfully while they are in intense physical pain? I can't.

Things are getting really bad for members of my RA support group. When pain gets to a certain level, they don't want to live any more.

Clearly you didn't read my post, despite quoting it. Pain is a complex interplay of coping mechanisms, behavioral development, psychosocial medicine, and actual pain itself. That's what is said.

In many situations, there is an underlying etiology contributing to pain. If you don't treat the underlying etiology, and just treat the pain, you aren't really treating the true issue. There's multiple reasons why different people respond differently modalities of treatment. Treating pain comes with treating the patient, not just pain. Its multiple modalities including opioids. Yes, we could through opioids at your RA. But that doesn't treat the RA. That's the role for the biological agents, and disease modifying drugs. That's going to make much more of a difference in your pain, then simply playing around with various narcotics.
 

Oldgamer

Diamond Member
Jan 15, 2013
3,280
1
0
False. Badly false. I don't think you even understand what entails medical training. Most adult physicians who are going to see chronic pain (Internal Med/Family/ER/Anesthesia) receive more training, its called residency. Its 3-4 years of training after medical school. There they treat, under the supervision of attending physicians, chronic pain. Given the rise of chronic pain clinics, residents are trained in real time in the proper management. Heck there are now entire FELLOWSHIPS dedicated to pain medicine. So your research isn't correct.

As most adult physicians will tell you, chronic pain isn't just "pain." Its a complex interplay of coping mechanisms, behavioral development, psychosocial medicine, and actual pain itself. More and more physicians are understanding that treating pain isn't just prescribing opioids, but its treating the patient as whole, including with SSRI/SNRI's, and medications like gabapentin. Heck, I've worked with a city "riddled" with chronic pain patients, Janesville Wisconsin. When I was there (December 2008, before Obama was inaugurated), the auto plant had just closed (yes, the one referred by Paul Ryan), and many people were coming into clinic with complaints of "pain." Many were the autoworkers just laid off from their job. Any rightful person would recognize their pain isn't just "pain" but severely complicated by the fact they just lost a well-paying, retirement secure job that they held from 10+ years.


I see...

Maybe my memory is just foggy then, I recall reading some articles about the inadequate training of doctors with regard to pain medication and nerves, and how these nerves and the brain go into some kind of "pain cycle".. gosh I wish I could remember the articles I read and link them.

But I agree with what you have posted that depression and anxiety and psychological issues can make pain seem worse. I understand that, but if you have someone who is dealing with real chronic pain that in itself can cause the depression and anxiety not the other way around. I guess the doctor will have to be well trained in psychiatry to, to figure out if it is pain caused by something psychological or real pain, or both. That would seem to be a bit tricky in my opinion. In addition some of these SSRI's and alternative pain medications have even nastier withdrawal effects than the actual opiod medications and cause some serious side effects, short term memory loss, trembling, muscle weakness, in some cases muscle atrophy, headaches, blurred vision, muscle spasms, mental impairment, high blood pressure, mood changes, weight gain.. the list can go on.

Not everyone responds to these alternatives for pain in the same way. Let's not even go into the fact that the cost of cymbalta, gabapentin, and other similar medications actually cost more than the opiod pain medications.

I think a pain patient should be required to participate in a pain management plan and have at least some time in group therapy though to talk about their issues in dealing with pain and how best to manage it. But again, not everyone will have the time or money for something like that.

Oh one more thing forgot to add, I think you are right that many different alternatives and modalities need to be utilized to find the right combination that will work for that patient. You are right it isn't just a matter of opiod pain medication by itself.

Anyway, found this other article online thought it was interesting as well
http://www.thirteen.org/metrofocus/...ption-drugs-could-spell-trouble-for-patients/
 
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Oldgamer

Diamond Member
Jan 15, 2013
3,280
1
0
Noted in the article I linked:

The distinctions are significant. Tabloid stories of celebrity prescription addicts suggest that most addicts started off as patients but simply lost control.

However, a 2008 study by the Miami School of Medicine found that 96 percent of people who were prescribed opioid medications did not become addicted to them.

Another study of 28,000 people conducted by the Treatment Research Institute in Pennsylvania found that 78 percent of people in rehab for prescription drug addiction had never been prescribed their drug of choice, and instead began buying them off the street.
 

nanette1985

Diamond Member
Oct 12, 2005
4,209
2
0
Clearly you didn't read my post, despite quoting it. Pain is a complex interplay of coping mechanisms, behavioral development, psychosocial medicine, and actual pain itself. That's what is said.
Yes, we could through opioids at your RA. But that doesn't treat the RA. That's the role for the biological agents, and disease modifying drugs. That's going to make much more of a difference in your pain, then simply playing around with various narcotics.

Throwing opoids at RA keeps physical movement happening. Movement helps RA recovery, as I'm sure you know. It most certainly does treat the RA itself.

Sadly, biological agents and DMARDS are so much more costly than opoids, and haven't yet proven to be effective for the majority of us RA sufferers. Hopefully someday they'll work it out. Personally I have more hope for DNA methylation research. Though I doubt I'll live long enough to see actual usable results.

Gotta respect MD's who survive the medical culture. It's hard enough for patients, but probably worse for MD's

P.S. I did read your post. Please don't mistake my comments for dislike. Obviously this is a subject I have massive interest in. Sorry, because of pain I'm not very good at clearly expressing myself.
 

momeNt

Diamond Member
Jan 26, 2011
9,297
352
126
A strong blow dealt to abusers.

I believe this action by NY will swing the war on drugs in their favor.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
I see...

Maybe my memory is just foggy then, I recall reading some articles about the inadequate training of doctors with regard to pain medication and nerves, and how these nerves and the brain go into some kind of "pain cycle".. gosh I wish I could remember the articles I read and link them.

But I agree with what you have posted that depression and anxiety and psychological issues can make pain seem worse. I understand that, but if you have someone who is dealing with real chronic pain that in itself can cause the depression and anxiety not the other way around. I guess the doctor will have to be well trained in psychiatry to, to figure out if it is pain caused by something psychological or real pain, or both. That would seem to be a bit tricky in my opinion. In addition some of these SSRI's and alternative pain medications have even nastier withdrawal effects than the actual opiod medications and cause some serious side effects, short term memory loss, trembling, muscle weakness, in some cases muscle atrophy, headaches, blurred vision, muscle spasms, mental impairment, high blood pressure, mood changes, weight gain.. the list can go on.

http://www.thirteen.org/metrofocus/...ption-drugs-could-spell-trouble-for-patients/

Actually, certain SSRI's like Cymbalta are supposed to help with the actual physical pain and aren't necessarily prescribed because any depression exists. The problem I have with that are the withdrawals, which we alredy discussed, the fact that it is a brain altering substance, and the itsy bitsy list of side effects.

Cymbalta may be associated with serious side effects. Call your healthcare provider right away or seek emergency help if you experience any of the following:


  • Itching, right upper-belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of life-threatening liver problems. Severe liver problems, some fatal, have been reported
  • High fever, confusion, stiff muscles, muscle twitching, or racing heart rate, which may be signs of serotonin syndrome, a potentially life-threatening condition
  • Abnormal bleeding, especially if Cymbalta is taken with aspirin, NSAID pain relievers (like ibuprofen or naproxen), or blood thinners
  • Serious, possibly life-threatening skin reactions, which may include skin blisters, peeling rash, mouth sores, hives, or other allergic reactions
  • Abnormal mood (mania), which may include greatly increased energy, severe trouble sleeping, racing thoughts, talking more or faster than usual, and reckless behavior
  • Seizures or convulsions
  • Decreased blood pressure upon standing, which can cause dizziness or fainting, mostly when first starting or increasing the dose. Cymbalta can also increase blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
  • Headache, weakness or feeling unsteady, confusion, problems concentrating, or memory problems, which may be signs of low sodium levels in the blood. Elderly people may be at greater risk
  • Problems with urination, including decreased flow or inability to pass any urine
  • Changes in appetite or weight. Children and adolescents should have height and weight monitored
  • People age 65 and older who took Cymbalta reported more falls, some resulting in serious injuries
Do not stop Cymbalta or change your dose without talking to your healthcare provider, as you could have side effects.








I mean........ seriously???


No wonder why these things have an increase chance of suicide, it isn't due to depression its from the damned side effects.
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
A strong blow dealt to abusers.

I believe this action by NY will swing the war on drugs in their favor.

Someone PLEASE tell me that my meter is broken. PLEASE!!! If it is not, lie to me and tell me it is. My faith in humanity is already at an all time low, it doesn't need to be pushed lower.
 

Oldgamer

Diamond Member
Jan 15, 2013
3,280
1
0
Actually, certain SSRI's like Cymbalta are supposed to help with the actual physical pain and aren't necessarily prescribed because any depression exists. The problem I have with that are the withdrawals, which we alredy discussed, the fact that it is a brain altering substance, and the itsy bitsy list of side effects.

Cymbalta may be associated with serious side effects. Call your healthcare provider right away or seek emergency help if you experience any of the following:


  • Itching, right upper-belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of life-threatening liver problems. Severe liver problems, some fatal, have been reported
  • High fever, confusion, stiff muscles, muscle twitching, or racing heart rate, which may be signs of serotonin syndrome, a potentially life-threatening condition
  • Abnormal bleeding, especially if Cymbalta is taken with aspirin, NSAID pain relievers (like ibuprofen or naproxen), or blood thinners
  • Serious, possibly life-threatening skin reactions, which may include skin blisters, peeling rash, mouth sores, hives, or other allergic reactions
  • Abnormal mood (mania), which may include greatly increased energy, severe trouble sleeping, racing thoughts, talking more or faster than usual, and reckless behavior
  • Seizures or convulsions
  • Decreased blood pressure upon standing, which can cause dizziness or fainting, mostly when first starting or increasing the dose. Cymbalta can also increase blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
  • Headache, weakness or feeling unsteady, confusion, problems concentrating, or memory problems, which may be signs of low sodium levels in the blood. Elderly people may be at greater risk
  • Problems with urination, including decreased flow or inability to pass any urine
  • Changes in appetite or weight. Children and adolescents should have height and weight monitored
  • People age 65 and older who took Cymbalta reported more falls, some resulting in serious injuries
Do not stop Cymbalta or change your dose without talking to your healthcare provider, as you could have side effects.








I mean........ seriously???


No wonder why these things have an increase chance of suicide, it isn't due to depression its from the damned side effects.

Yes, this is what I mean though, and I agree. What is happening is the pushing of alternatives to opiod pain medication (because of the "knee jerk" reaction to possible addictions and dependency), and the side effects are far far worse on these alternative medications, with more serious consequences in my opinion. Yes, the withdrawals from Cymbalta, Neurontin, and other such items used for pain relief are about as bad if not worse than opiod pain medications. Then you have the cost factor. Medicare for elderly patients cannot get the latest and greatest because the new medications are not accepted. People with basic health insurance end up paying a larger out of pocket cost for these new alternative medications.

Opioid pain medications are very inexpensive. Cymbalta and other alternative newer medications are very expensive and most insurance companies are not going to cover them or they are going to make the patient pay a much higher out of pocket cost to obtain it. A friend of mine is on Cymbalta, she has insurance through her work, it costs her about 200.00 a month for her pills. That is a big bite out of someones budget.
 

TheVrolok

Lifer
Dec 11, 2000
24,254
4,076
136
No wonder why these things have an increase chance of suicide, it isn't due to depression its from the damned side effects.

The suicide risk isn't due to depression, it's due to the medicine relieving enough depression to give one the energy/motivation to actually go through with it. Essentially the drugs work well enough to off oneself.
 

waggy

No Lifer
Dec 14, 2000
68,145
10
81
Throwing opoids at RA keeps physical movement happening. Movement helps RA recovery, as I'm sure you know. It most certainly does treat the RA itself.

Sadly, biological agents and DMARDS are so much more costly than opoids, and haven't yet proven to be effective for the majority of us RA sufferers. Hopefully someday they'll work it out. Personally I have more hope for DNA methylation research. Though I doubt I'll live long enough to see actual usable results.

yeah. that is what people don't understand With RA you need to keep moving. That is hard with RA.

Opiads help keep the pain down enough to move.

Just out of curiosity, where did you read that it does not work?

i belong to a few other forums. many deal with health issues i have and chronic pain.

as someone listed the list of side effects cut out many. Add in the fact they are far more expensive to buy (many can't buy them at all. my insurance wouldn't cover it).

hell for a while they wouldn't cover Lyrica for my fibro (btw the stuff works and is amazing).
 

Darwin333

Lifer
Dec 11, 2006
19,946
2,328
126
The suicide risk isn't due to depression, it's due to the medicine relieving enough depression to give one the energy/motivation to actually go through with it. Essentially the drugs work well enough to off oneself.

They get happy enough to kill themselves??? That makes no sense to me but I am not a doctor so perhaps you're right.