Comment by genmud | Hacker News Reader

Comment by genmud | Hacker News Reader

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It is absolutely insane right now with medication... My wife blew out her knee last year, breaking her tibia, patella and femur. Do you know how many painkillers they gave her to take home? 12 pills! They said to come back to the ER to get more if she needed them, before surgery the following week(?!). I think it was like a 3 day supply and we both were like WTF.

My 1 year old dog (who is batshit insane, but we still love her) had to have part of her tail amputated because she kept breaking it open, the vet had us giving her 3x painkillers 2x a day. The pharmacy tech insisted they weren't going to fill a followup script because she had already been prescribed 60 pills, 10 days before and refused to perform basic math. (3*2*10=60)

I'm all for trying to address our opioid issues, but it feels like instead of addressing the issue of doctors running pill mills, over-prescribing these drugs, they are focused on just not allowing them to be prescribed at all... Even for people who genuinely need them.

I mean, you do know that regular Tylenol still works as pain medication? You don't necessarily need narcotics for broken bones.

I think there's two schools of thought on this one.

A: Time limited access to narcotics is safe and effective pain management for severe but temporary injuries and I don't exist to suffer in this world -- give me the good stuff.

B: If I can reduce my pain into "bearable" with nsiad painkillers then I don't want to take narcotics.

I think one of the dangers of B in the real world is that for severe pain doctors are terrified of prescribing narcotics that they put you on the nsaid cycle with extremely high doses which can wreck your stomach lining and liver.

When I was recovering from surgery they gave me Xanax, Vallium and Tylenol to basically sedate me for 2 straight weeks because of this nonsense and it was miserable. Just trading one kind of high for another but the new way you mostly keep the pain.

I’m not trying to say that narcotic painkillers are ineffective or necessarily dangerous.

I am saying that many kinds of pain can be managed with OTC medication. There aren’t necessarily two schools of thought. It’s more that if let’s say ibuprofen isn’t helping the pain, it may just be that you aren’t taking enough of it. It is a very effective pain medicine.

What a shitty take. There’s only so much ibuprofen you can take before the risks start outweighing the benefits, and there’s plenty of pain that is much stronger than that.

Actually you can take quite a bit of ibuprofen for a short period of time with no long term problems. You can also take ibuprofen and acetaminophen. It is quite the hot take that narcotic pain meds are safer.

I’m not at all suggesting ibuprofen for pain management of cancer patients or people immediately after major surgery.

But for a big chunk of outpatient procedures enough OTC pain meds will actually work just fine.

I’m not some granola advocate here. Nor am I trying to say that everyone should just tough it out. But you can’t seriously say that 800mg ibuprofen is more dangerous or less effective than opioids for wisdom teeth removal

Have you suffered excruciating pain for multiple days in a row? Non stop? Like so bad that your muscles recoil in horror that then causes even more pain in a recursive loop of horror?

Actually yes, in Germany if you break your bones you get ibuprofen, if you get your wisdom teeth pulled, you get ibuprofen.

We don't have an opioid crisis anymore.

Pain is a fact of life. The problem in the US is that there's the expectation to work the next day. It's ok to be in pain, it's also ok to miss out on work.

If you accept these two basic facts you don't have an opioid crisis anymore.

Ibuprofen is a poor substitute for opioids. You can keep your life and I think I'll accept the opioid crisis then, if the trade off is what you say.

Some other people may die, but that is a price I'm willing to pay.

You what? Did you really just say “other people may die but that is a price I’m willing to pay”? Like you’re in charge of who dies and who lives or something

Oh I absolutely agree with him. The opioid crisis is tragic but denying people medication for their injuries, illnesses, mental health (adhd) in a completely ineffective attempt to curb a crisis that is mainly caused by the importation of cheap fentanyl analogs is the greater of two evils.

> Pain is a fact of life

I see you have never been in any real pain, ever. What do you get for cancer in Germany? Still ibuprofen?

There's a reason opioids exist and were such a revolution in medicine. They really work. Ibuprofen et al are fine for what they are, but anti-inflammatories can only do so much. We should be able to solve the over-prescribing and addiction issues as a society without throwing the baby out with the bathwater.

>I see you have never been in any real pain, ever. What do you get for cancer in Germany? Still ibuprofen?

I guess not. My point still stands though. Americans in Germany whine all the time about not getting "proper" pain medication. It's an attitude problem.

I have been in pain multiple times, mostly broken bones, wisdom teeth, tendons and the like, and in the moment it doesn't feel good to only get ibuprofen.

But most pain is not too much to take and it's ok for you to feel it. It's better than getting an addiction problem for life.

As you say it's an over-prescribing issue. Keep opioids only for extreme pain. Not for normal pain.

I would much prefer to be given more than ibuprofen for surgery, thanks. Have you have had tumor removed from your body? That would hurt like the dickens with just some tylenol and no real pain meds or anesthesia.

> If you accept these two basic facts you don't have an opioid crisis anymore.

This is an incredibly simplistic view of a very complex issue.

>I would much prefer to be given more than ibuprofen for surgery, thanks.

If you didn't read my response why should I care?

>This is an incredibly simplistic view of a very complex issue.

It's backed by facts though. You can't give out opioids like candy and expect people to be responsible with them.

Why is it so hard to understand? I don’t think anyone here is saying there is no legitimate use for narcotic pain killers. If anyone is in huge amount of pain, by all means, take what you need. However it should almost never be default first line pain management outside of the hospital.

People don’t give ibuprofen enough credit.

How familiar does the following sound to you?

"I've had some back pain and got prescribed opiates, now i'm addicted"

We're not talking about getting some opiates after surgery or severe and mostly rare things. Americans get opiates for all kinds of small inconveniences, like a wisdom tooth removal, or some back pain. Opiates don't heal or fix back pains. They just mask the symptoms and create a new problem.

I've been in a lot of pain in my life and never took any opiates, because they are reserved for extreme situations where i live. In america, i would have had easy access to prescriptions for those in most cases.

We have no opiate crisis here.

I’ve had opiates for wisdom tooth extraction and a couple of relatively minor but very painful injuries. I was very glad to have them. They made the experiences much more bearable. I did not experience any addiction issues, and I’m glad that my access to these medications was not limited due to some people’s inability to handle them.

I really don’t think forcing needless suffering on everyone is the answer to this problem.

Opiates for wisdom teeth extraction are entirely unnecessary.

Source: had six very painful teeth extractions, with bone grafts and two sinus repairs. I was almost pain-free on 600mg ibuprofen + 600mg acetaminophen every 6 or so hours. I say "almost" because I was not dumb enough to try any type of exercise, or eating crunchy cereal, but I had no problem falling and staying asleep or going back to work in 24 hours.

So I am not entirely sure why you think opiates were necessary or provided you the type of relief that OTC meds could not provide. My double-board-certified, extremely expensive dental surgeon doesn't seem to think so.

I also had abdominal surgery, for which I can concur opiates do help quite a bit, which is entirely separate story.

Who is suggesting ibuprofen for cancer? Come on now. There is absolutely time and place for narcotic pain killers. But there are a lot of doctors prescribing them for really minor things. Few years ago I got vicodin after a root canal. It was baffling

Broken boke pain and cancer pain seems very different.

Sweden sounds the same as germany, you get 800mg ibuprofen and normal 500mg paracetamol.

We DO have opioids for cancer pain.

Breaking a bone doesn’t perpetually hurt like a Charlie horse that never stops tightening. Gout for example in the big toe can be the most painful experience ever, speaking as someone who’s been in many accidents. It can last several days, it feels like a shark biting your toe off every second.

Actually in the US you also get ibuprofen. I had very invasive jaw surgery and sinus repair. It hurt. I got 600mg ibuprofen and 600mg acetaminophen for the pain every 4-6 hours. It definitively took pain down to tolerable levels.

as a counterexample, I had an infected tooth over the weekend. I took ibuprofen and acetaminophen around the clock, and it did jack shit. I was lying in bed and whimpering in pain, so close to going to the ER, but I knew they wouldn't do anything for me.

I actually have mild PTSD about that incident. It was the second-worst pain I've experienced in my life, and it wouldn't stop.

Question 1: how much did you take?

Question 2: what makes you think opioids treat infections?

1. 1000mg acetaminophen every 6 hours, 600mg ibuprofen every 4 hours.

2. I expect opioids treat the pain from infection. it was the weekend and I had to suffer through the weekend before seeing the dentist.

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