After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

Since when is that a requirement for knowing what is best for your patients? The doctor is basing their judgement on current consensus within their field, which hopefully involves careful studies.

The pain buster don't realy do that much as neither did the oral morphine

Slightly less anecdotally, I have a lot of doctor friends and while they may indulge in overwrought "look at how clever I am" medication schemes for ailments that do not really warrant it, I think that it's mostly because they feel that they don't have the time to rest like the author of the article (and this doesn't involve routine painkiller use either).

Some people argue that in my country (Italy) there is a cultural aversion to painkillers due to the historical influence of the Catholic Church, but it's hard to measure the effect.

My grandfather was an open-heart surgeon. In the days following surgery, he would always insist that his patients get up and take a short walk. They would not want to, but he insisted that this was an important and valuable part of recovery (in several dimension) and that they needed to push past resistance and force themselves to do it.

Later in life, he underwent a surgery requiring general anesthesia and found himself in the same position. He said, "If I had known it was like that, I would not have made them do it."

So I think the surgeon's personal experience of the situation is -- in fact -- highly relevant in practice, even if not in theory.

You should be hesitant, unless you're a doctor.

I can only assume that the second round of treatment in their home countries would be either another round of drill torture or tooth extraction.

You don't need a prescription to get paracetamol, acetaminophen, and ibuprofen

Having some experience with Medicare's version of the guidelines, most of them are sensible and do directly relate to whether someone's being treated in a way that will lead them to be healthy and happy in the long term. But it appears that one was a major mistake.

Warmth and daily stretching, massage and exercise fixes most sore tight spots that, if left untreated, can escalate to chronic pain setting you up for an unending painkiller loop eventually making you a walking stiff.

Almost my whole body was a painful solid wreck until I started to work on it more or less every day. My lower back still has some tight achy spots but it's getting there. These days I can actually flex some muscles I had no idea I had or could control.

I might take a naproxen if I have a bad headache or I tweak my neck and I can't stop working to take care of myself, but that's maybe two or three times a year (and I am being well-compensated for it). I know people, healthy people, who pop an ibuprofen in the morning just out of habit.

Last Monday evening, I had an accident with an angle grinder in my garage. The cutoff disc went through my leather glove and bit deep into the middle finger of my left hand. After deciding against gluing the cut back together, I drove myself to urgent care and received five stitches.

Did I need any painkillers, the doctor asked? I declined; my finger was pumped full of lidocaine at the time.

In the middle of the night, the lidocaine wore off, and while the finger hadn't hurt in the immediate aftermath of the injury, it certainly hurt then. After tossing and turning for about an hour, I decided to get up and try to find something to take.

The only analgesic I had in the house was an expired tiny bottle of ibuprofen. I needed about five minutes of digging before I found even that.

I simply don't use painkillers very often. I might take ibuprofen once or twice a year. I can't remember the last time I took anything other than ibuprofen, not even acetaminophen, not even when I twisted my knee.

I'm not sure if I have a higher tolerance of pain than other people or if other people like to self-medicate when the least bit of pain rears its head. Or, perhaps, I've simply been lucky enough not to have much pain.

It doesn't help when others influence by saying "just take ... for that." I can't begin to explain why others do so, except that people generally have good intentions and are empathetic?

TLDR: Americans often don't invest the time and resources to identify and eliminate behaviors/conditions that are the cause of their ailments, and instead cope with any "quick fix" drug/product/strategy that never eliminates the cause of symptoms and often introduces new issues.

Last two thoughts: Many in modern society are very averse to discomfort - understandably, but regardless of degree/origin - and many doctors are happy to feed into this behavior instead of educating the patient that pain is sometimes a part of the process.

Many in modern society lack (or do not have the energy for) self-awareness and/or critical thinking to examine root causes of ailments/symptoms, and instead trust that taking ... will help without understanding the actual mechanisms/effectiveness of the treatment.

I had tried previous to sumatriptan many other remedies, and nothing compared. I’ve heard from my doctor many respond well to magnesium supplements as a way to head off the migraines altogether but I can’t say it worked for me (but I gave it a shot none the less).

All that being said, I’m generally averse now to opiates after seeing their long term effects on my father who was also an alcoholic. They did allow him to push through pain, which resulted in ever increasing damage to his joints (and ultimately internal organs as well). By the end, he couldn’t walk, was self medicating heavily with alcohol, and couldn’t keep himself in a physical rehab facility because his urge for alcohol and opiates couldn’t get satiated in that environment.

He died at 61.

So, I applaud the author and those who seek to responsibly limit access to medications which are highly addictive and potentially unnecessary for treatment. Pain management is very important, but it does need to be weighed against the potentially catastrophic dependency issues it can cause.

However, even within my own experience, only ~1/4 of my headaches respond this way. I've taken other medications as well, and the majority of my migraines don't respond to anything other than trying to soothe the symptoms :/ In the majority of cases ~3/4 of the time, there's nothing you can do to stop it, you just have to dig yourself in and get to a quiet dark place for a few hours until it passes.

I do think a great many people either overprescribe or are overly dependent on painkillers, opioid and otherwise, but there's also many different kinds of pain. I have a fairly high pain tolerance for most things, but certain kinds of acute pain, mouth pain or the warning pain of a migraine immediately disrupt my ability to concentrate usefully, which can be problematic when you need to concentrate to resolve the source of the pain.

There's also a weird thing where a good number of people I've known have regularly taken well in excess of the maximum safe dosage (even for Rx) of painkillers for days or weeks every month, and not think this is something they should bring up with their doctor. If this were "I talked to the doctor and made this choice based on X information," I wouldn't be as surprised, but it just never crossed their minds that it was abnormal to have crippling pain on a recurring basis.

In the US, I recently had two teeth removed that had horrendous infections (the swelling was tremendous); after the surgery, I asked them about painkillers, and they told me I wouldn't need them, just take ibuprofen if the pain gets bad and it'll go away in a day or so. I was skeptical but listened, and much to my surprise, the pain did almost magically vanish after I went to sleep that night.

AIUI the reason they still tried opiate painkillers is that there aren't really many non-opioid alternatives available other than the OTC stuff - and the effectiveness of both types varies wildly by person, but since the distribution is wider for the opioids, on average you're more likely to get pain relief from it. (My brother, for example, gets almost no benefit from any non-IV opioid painkiller, whereas if I take a single hydrocodone I'm both pain-free and borderline asleep.)

It'd be nice if we could find ways of relieving crippling pain without risk of physiological addiction, but so far, I don't think I've seen much compelling research toward that.

I think you got the wrong list.

The experience of being uncomfortable is not a bad one to have, nor a bad one to make peace with. Pain and discomfort are a part of humanity: when they don't exist, we invent ways to have both. And there certainly exists a line where chronic pain makes it humane to blunt it--but most folks don't have that problem at all.

And "content" is what you are left with when the soul is leached out of creativity by people who lack it. It is a soul-suckingly awful construct in the twenty-first century and decent people should reject it. Please don't promulgate its notions.

In the US, FMLA generously "guarantees" 12 UNPAID weeks of medical leave in any 12 month period while still being able to return to work (provided you've met other conditions of hours worked, and the location where you work has 50 or more employees, etc etc.) Enforcement may require lawyering up, so it's de facto useless for low-wage workers - or middle-class workers who don't want to be blacklisted from future employment, as, yes, background check databases do prominently flag people who have sued their employers.

And did I mention FMLA leave is unpaid? If you can't afford to take unpaid time off work, you're using vacation days unless you're in one of a handful of localities that require employers offer a few paid sick days per year.

It's true... in a population of 350MM (the USA), that's over a million people reporting abuse or dependence. Though I'd like to see a further breakdown of what abuse means in this context.

Of course, the question that needs to be asked: how many of those began as legitimate prescriptions and ended in dependence? Certainly not all of them, perhaps even a small fraction. But a well-to-do person become addicted after minor surgery tends to get more attention than poor people substituting fentanyl for heroin.

Finally, there's a cost/benefit analysis. Painkillers have an obvious benefit for people who need them - whether to treat chronic pain or temporarily after surgery. What is the cost to restricting access to those who have a legitimate need for these drugs?

I don't have answers to these questions. I will note that public health policy has a checkered past when it comes to unintended consequences. Our attempts at wide-scale social engineering, particularly that driven by outrage and headlines, rarely work the way we expect.

To whit, I can't help but think that the crackdown on prescription painkillers in our recent past (central registries, jailing physicians, imposing production ceilings on opioid manufacturers) has directly lead to the rise of synthetic alternatives we're seeing today.

But IIRC you got to pay it yourself in many cases.

Or avoid them.

Sadly, many Germans believe in homeopathy...

How a doctor reacts depends highly depends on the illness. If you have a cold, your doctor will recommend some tea and rest, but if you have a tonsillitis, you will get anti-biotics. And there is no such thing as a pain index.

And an overview by Focus (german)[1]

[0] https://www.tk.de/techniker/service/leistungen-und-mitglieds...

[1] https://www.focus.de/finanzen/versicherungen/krankenversiche...

But "universal healthcare" to some extend means that the electorate can decide "what's right". By law, the public insurances are explicitly allowed to cover homeopathy. Weird enough, but understandable if a large chunk (and generally more important chunk) of voters are also Homeopathy adherent patients.

While Homeopathic doctors are by no means the majority here, the majority of "science" doctors will shy away as much as possible from confronting their patients with their stance on alternative medicine.

Near as I can tell, doxylamine has literally no purpose in these medications except to cause drowsiness. It doesn’t do anything for the cough or for a runny/stuffy nose caused by an infection. You’ll find this combo in NyQuil.

So yes, it’s really a thing, though it probably shouldn’t be (the doxylamine part at least).

[1] https://www.huffingtonpost.com/leo-galland-md/aspirin-and-vi...

Yet she really only needed zero vicodin. Just like the person in the NYTimes article.

But thanks for your illuminating anecdote of someone who had some procedure and ignored some medical advice and took something else than the something that was prescribed.

From my experience, there's very clear difference to be in pain for a quick moment, few hours, day or two, a couple weeks.. Fortunately I didn't have to experience it longer than that.

But I feel pretty confident to say it grows at geometrical progression. Short, even very strong, pain is nothing compared to week-long, even much lesser, pain. Post-surgery pain for a day or two is a joke compared to chronic lifelong pain.

When I read comments like "just one Vicodin and you're addicted for life!", "nobody should take opioids" and "opioids are destroying our country" it's moral panic.

As for the number of overdose deaths, take a look at other countries that never saw the massive overprescribing of opioids like Canada. The deaths are due to synthetic opioids mostly coming from China.

Without taking a political stance on regulated pain killers, I'd like to point out that the concept of 'temporary pain' is largely a myth. There has been much work done (mostly with chronic pain sufferers) to show that pain (and more generally over-excitation of nerves) can cause permanent nervous system damage, brain chemistry changes, and CNS rewiring/plasticity-like changes.

Much of this research originated from the correlation between chronic pain sufferers and un-treatable (or difficult to treat) depression.

So does underprescribing in a world where extremely effective yet more addictive illicit painkillers are easy to come by. I've had to resort to this for a few days after a wisdom tooth removal and would much rather have had access to better regulated options.

Not just pain killers but also things like cold medicine.

But he did say his English was poor so i can see how that might get lost in translation.

It advocating for less pain management in the US? or better pain management in Germany, I cant tell

It is critical of the idea that citizens of the US desire to eliminate pain? I am critical of cultures that endorse and support living with/in pain

"Excessive" consumption is subjective depending on your point of view. Further the increasing number of people addicted to opioids is a complex issue that has some correlation to prescriptions but can be debated on if that is the cause as other factors can be at play, further the increase in DEATHS as a result of said increase in addiction IMO can be more closely linked to the ever increasing desire to treat addiction as a crime not as a medical issue which causes a whole host of black market issue including quality and potency inconsistency in supply chain directly leading to more Overdoses

Although he had the surgery circa 2014 and the stated purpose was to study the need to avoid opioids, not to reduce hospital stay. But like the 2006 study someone cited earlier, it was colon surgery.

After a certain point, the brain shifts, we're not in growth, we're in maintenance mode and every problems is void of side value, it's just this, a problem.

Maybe it's also because these are self or externally inflicted sensations, compared to surgery for an internal disease.

I don't think people should suffer pain "needlessly" either, but pain has a purpose. Long-term health consequences (whether they are risk of addiction, or a worse healing process) has to be part of the calculus when making decisions about pain management.

Every person reacts differently to procedures and to pain, some people having their wisdom teeth removed may not be painful, others it might be terrible pain. It should be up to the individual as a adult to make those choices for themselves

I am sure that will be an unpopular opinion given the state of society is that no one should be treated as adults and that governments or "others" should tell people have to live ...

At multiple times in my life I have been given hydrocodone, I have almost never used the entire prescription, but when I needed them I would glad to have them. The idea that a 3rd party can tell me "ohh your pain is not that bad just live with it" when there is a easy solution to allow me not to live it it, well I find that morally reprehensible

Opioids are only 30-40% addictive, meaning the vast majority of people taking them never develop an addiction. 30-40% is high no doubt, the highest of all pain killers, but the idea we should disallow people in pain from taking them simply because some people go on to abuse them is not rational IMO

Never said she should have or would have been better off. I am making the claim that choice should have been hers and hers alone after getting advice from professionals.

Doctors could have told her "You do not need them, here are the reasons why" that is fine. the legal prohibition is what I have a problem with

>Real pain is treated here in Germany

That is not my understanding and I have known a couple people that have come to the US for pain management because they were unable to get it in the EU, I dont know if they were in Germany or not however. My understanding is that many EU nations have very strict and subject definition as to what "real pain" is. This is evidenced by the personal stories being told here how people "went through X and did not need pain meds" that is fine for them, people have different tolerance levels for different types of pain, and a tooth extraction may be a minor pain for some people and excruciatingly painful for others, yet most of these nations treat pain based on the average response by type of procedure not in individualized reactions.

Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's managed by independent entities and not the government, and they even compete. The private insurances are quite significant in Germany too. You are allowed to leave the government-mandated "Krankenkassen" if you earn over a certain amount of money per year, then you have to get private insurance - which is less expensive if you are young, but unlike the Krankenkasse family members (e.g. non.working spouse, children) are not included and it may become much more expensive when you get older, it's hard to predict because it depends on many factors including if you picked the right insurance company (that didn't lose as much money and now has to raise prices).

Also the german healthcare system is not all financed by tax payers. "paid for by the public health care system" would be a better sentence.

https://www.theguardian.com/us-news/commentisfree/2018/jan/1...

In my own back of the woods in Europe, the same would cost you nothing.

No, the US government pays almost as much per capita for health care as the German government.

https://visual.ons.gov.uk/how-does-uk-healthcare-spending-co...