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Comment by creshal | Hacker News Reader

> overprescription of opioids because they're cheap

It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom.

Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.

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> I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom.

To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause.

As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.

Phantom limb is actually an interesting case that may reveal more about idiopathic pain as we study brain/body mapping better. If anyone is interested check out the work of VS Ramachandran, here's a somewhat old article about his work with phantom limb patients: http://www.npr.org/2011/02/14/133026897/v-s-ramachandrans-ta...

His latest work has been investigating body integrity identity disorder which is sort of the opposite of phantom limb: where you feel like a part of you doesn't belong.

I believe this gist of the work is that there is a mapping between our body and our brain (this is what enables one to 'know' where your body is in relation to itself when your eyes are closed) that sometimes is overloaded or malformed and can result in these issues.

Interesingly, there are antidepressant-like drugs used for pain like phantom limb and neuropathy (like demyelinated nerves due to Shingles)... because it can "ignored" to varying degrees. As someone who's been both deeply major depressed, where tiny pains become an all-consuming focus and not depressed where a hand sliced open is not a big deal... Pain definitely interacts with mental well-being, and can lead to a spectrum of suffering between all-consuming focus or compartmentalized item. More research needs to be done on the functional perception of pain, because it could radically reduce pain prescriptions by instead controlling the suffering of non-survival-beneficial pain at its ultimate destination rather than carpetbombing patients with addictive substances.

http://www.webmd.com/pain-management/tricyclic-antidepressan...

It's interesting that the more limited your knowledge is, the more things happen 'with no apparent cause'.

In middle ages, millions dies of plague 'with no apparent cause'. I guess humankind just said 'ah, these things happen, let's not investigate further'. </irony>

Pain gets investigated extensively (there's a natural abundance of demand for making it go away). If you go to a doctor complaining that you have it, they're not going to make you a research project. You'd need to go to a researcher.

If you have pain and you know why, you'll generally volunteer that information to your doctor. If you have pain and you don't know why, they will look at the area that hurts. If there's nothing obvious there, they'll give you painkillers, because all the safe money is on the idea that no matter what they try, they'll never be able to eliminate or even identify the cause of the pain. This is what you want them to do.

Exactly. Pain evolved as a guide to improve survival but it also can also create deadly stress when it gives chronic, false positives. If suffering is life-altering, it's on the patient or their advocate/s to keep on their medical providers to eliminate causes and manage pain, hopefully without causing more problems like addiction or surgery complications.

Looking at it from the doctor's viewpoint: Does this patient complain a lot? Is this complaint important? Hard to answer, expensive to find out with current technology and discoverability of relevant knowledge, techniques and advances is an everyday battle that hasn't been addressed consistently.

Some patients, like my grandmother, avoided complaining to not seem "fussing" when she dismissed heart disease as indigestion, ultimately had to have a quintuple bypass and coded three times in the OR. Slowly, she came back but it gave her back more energy than the previous decade and she's still alive.

sad but true reality of medical care - many people assume that because we have portable amazing portable supercomputers with internet(insert any recent progress), we are also in star trek era of personalized medical care with portable scanners revealing every aspect of our body matter down to molecular level, instantly.

well, we're not, and unless you are billionaire/us president, we won't get there in our lifetimes, nor our children's. fiancee is an internal doctor in one of biggest hospitals in Switzerland (read - you don't get much better public healthcare anywhere in the world), and they are

a) overwhelmed by amount of people, especially old whose bodies are just a massive clusterfuck of issues - welcome to being old. all they try is to keep them somehow alive when today this was failing, tomorrow that etc. there are simply no resources in medicare to treat your non-fatal condition which doesn't stem from something obvious.

b) 50% of people are sometimes in pain. each body is unique. what makes one thrive brings other to its knees.

c) as said here before, doctor's role is not detective investigation, that's research. doctors these days are overwhelmed with patients and must prioritize their incoming queue, even if it's with somebody's pain. Every patient also means hours of bureaucratic hell, same for incoming as for outgoing ones. that's why rich people have private health care - it's not about having best doctor available (same as you don't find brightest IT people in say SAP consulting), it's mainly about having someone dedicating as much time as needed to you.

I wish it would be so too, but that's simply not reality now

But the pain isn't in the hand. Pain is in the head, caused by signals which normally come from the hand, and results in feelings that the head places onto the hand. So phantom pains in amputated limbs are caused by real things. Maybe the nerve that use to communicate the pain from the hand is sending in a false signal due to another reason. Maybe something in the brain is misfiring and some other sensation from another part of the body is registering as pain in the hand. Even if there is no outside of the brain cause for the pain, the brain is still feeling the pain so there is still an actual problem, just one with the brain.

So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days, I would still suggest significant pain be checked out and a doctor you are paying should help look into it.

> So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days

Chronic pain lasts for years, or forever. An incredible amount of effort has gone into understanding it. We can't blame practitioners for knowing that they don't understand pain and aren't likely to in the future, and therefore deciding to treat it with painkillers.

I know chronic pain can last a lifetime. I was more so talking about one off aches that you can't find a cause for but which do often go away within the week.

Pain sometimes occurs with no known cause. I don't know if I'd go so far as to say "often."

This is prominent in the experience of doctors, which is what's relevant to how they behave. People who aren't seeing a doctor because they have nothing wrong with them and aren't in pain rarely complain about how the doctor treats them, and have virtually no effect on doctors' worldview.

>Phantom Hand

New Metal Gear game?

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