RJM posted:2019Lefty21 posted:Pedaldad posted:
Personally, I never write for opioids for anything other than significant trauma and post-operative pain control. Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries. Heaven forbid you show up on the operating table with a crushed limb. But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control. I will promise you that you will appreciate it. I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction. If you abuse/misuse it, that is where the problem is.
I have had major surgery including brain surgery as a result of a tbi from a fall, and have been able to avoid taking opioids as a personal choice and have gotten through the pain management issues, but how do you tell someone else to “suck it up buttercup” and avoid things they are prescribed? I have a son who is a freshman in college, and will now be receiving treatment from trainers and doctors away from me if necessary, and reading this thread scares the hell out of me. From a doctors standpoint, if you try to manage pain from surgery under a lesser painkiller will the pain eventually go away as the surgical wounds heal? Just trying to understand why anyone would ever want to risk the opioid addiction?!
I sucked it up post aortic dissection surgery after being sent home. I have a very high pain tolerance level. During my five week recovery at the hospital and rehab I was given Percocet for five weeks. But being in the hospital it was monitored. My cousin, a doctor took the Percocet away from me when I went home. He called the hospital and told them to prescribe something less dangerous. I went through withdrawal. It was a pleasant distraction from my recovery (sarcasm).
The problem is patients back on their own, unmonitored with powerful, addictive medications. Relative to baseball you can’t just send a player home post TJ surgery with powerful, additive meds and expect everything to be ok. He wants to get back on the field as soon as possible before he loses his job. The player has to be monitored for signs of addiction.
I can fully understand a person playing around with levels of medication and thinking they’re smart enough to handle it. I did it while dealing with negative side effects. But I wasn’t playing around with opioids.
I can't explain the choice to keep someone on Percocet five weeks post surgery, especially not for aortic dissection surgery. Without knowing the details, this does not seem appropriate.
As to why to take pain med post procedure:
There is a real risk of developing a pain syndrome if you are under medicated during a serious injury or post surgery. Complex regional pain syndromes (CRPS) are rare but very real in the extremities. So let us assume pitcher x has a UCL repair (Tommy John) and has fear of opioids and chooses just to "deal with the pain". There is increased chance that this individual develops CRPS.
Imagine a grown athlete that comes in a few weeks post surgery crying in unbearable pain with his throwing arm wrapped in a pillow because even the breeze of a fan causes an intense sharp, stabbing pain that can't be stopped. This is a rare but real entity post injury/surgery. Talk to someone who has had it and you will come across people in extreme desperation.
Now you are facing being unable to work, sleep, drive, or even move because every small stimulus creates so much pain that it takes over your life. You start to self medicate with alcohol or whatever you can get your hands on. Your hope changes from full recovery and return to the field to maybe someday just being able to get back to normal daily activities. Individuals have even committed suicide because of the despair.
Generally, I advise my patient to take their prescribed pain med for the day of surgery/injury, the day after surgery/injury, and beginning day 3 to take it only if needed. Most individuals will turn a corner about 3-5 days after surgery, once the inflammatory phase of healing has been passed. That does not mean they are pain free, but have enough reduction in acute pain that they don't need medicine. The need to take opioids beyond this point starts to raise flags for me.
There are medicines that can assist in pain control, but in my world we generally avoid NSAIDS (ibuprofen, naproxen, etc) if bone is involved because it adversely affects healing times. Other meds also have potential for abuse and intravenous tylenol is sometimes employed to reduce the quantity of opioids required for pain control in extreme situations.