4 ms·

American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is

by Kluny 10y ago

American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is in pain, give them as much painkiller as they want. Their ability to use their extensive training and judgement to make a better call is somewhat limited.

kwhitefoot 10y ago
I'll have to take your word that the guidelines say effectively to give the patient what they want, it seems a strange idea. Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision. In some cases they can prescribe more suitable drugs and more suitable delivery methods. For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief. I'm not a doctor, just speaking from personal knowledge of someone very close to me.
DanBC 10y ago
> The guidelines currently say that if someone is in pain, give them as much painkiller as they want Can you point me to those guidelines please? I'm struggling to find them. I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example. Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
- Kluny 10y ago
  I went looking for you. The guidelines appear to have been updated since last I checked, and are no longer as irresponsible as I thought they were. Here's what I found: (easy version) https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a.pdf https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a... (hard version) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
  - tylersmith 10y ago
    Giving people in pain opioids is irresponsible but spouting misinformation isn't?
  - 3131s 10y ago
    It's actually pretty hard for legitimate patients to get opioids in many circumstances. My mother has chronic pain from a surgery and has been on a very low dose of oxycodone for years now (10mg a day, I think), and she regularly is subjected to urine and other tests to prove that she's not an addict. My grandpa just had an operation and later at home ended up in a lot of pain, but he could not get oxycodone for two days -- the first night because he went in after 7:00 PM and apparently Indiana has some law against prescribing them past that time.
    - martinald 10y ago
      10mg of oxy is not a low dose. That's equivalent to 75mg hydrocodone (Vicodin) or 150mg codeine.
      - 3131s 10y ago
        Huh, I might be basing my perception on what is high vs. low from knowing some people who abused oxycodone. I believe my mom takes 5mg twice a day, and from what I'm reading that still seems pretty light. Oxycontin pills are minimum 5mg, correct? Erowid puts that in the "light" category for users with some tolerance, FWIW: https://erowid.org/pharms/oxycodone/oxycodone_dose.shtml https://erowid.org/pharms/oxycodone/oxycodone_dose.shtml

by Kluny 10y ago

kwhitefoot 10y ago

I'll have to take your word that the guidelines say effectively to give the patient what they want, it seems a strange idea. Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision. In some cases they can prescribe more suitable drugs and more suitable delivery methods. For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief. I'm not a doctor, just speaking from personal knowledge of someone very close to me.

DanBC 10y ago

> The guidelines currently say that if someone is in pain, give them as much painkiller as they want Can you point me to those guidelines please? I'm struggling to find them. I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example. Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

Kluny 10y ago
I went looking for you. The guidelines appear to have been updated since last I checked, and are no longer as irresponsible as I thought they were. Here's what I found: (easy version) https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a.pdf https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a... (hard version) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
- tylersmith 10y ago
  Giving people in pain opioids is irresponsible but spouting misinformation isn't?
- 3131s 10y ago
  It's actually pretty hard for legitimate patients to get opioids in many circumstances. My mother has chronic pain from a surgery and has been on a very low dose of oxycodone for years now (10mg a day, I think), and she regularly is subjected to urine and other tests to prove that she's not an addict. My grandpa just had an operation and later at home ended up in a lot of pain, but he could not get oxycodone for two days -- the first night because he went in after 7:00 PM and apparently Indiana has some law against prescribing them past that time.
  - martinald 10y ago
    10mg of oxy is not a low dose. That's equivalent to 75mg hydrocodone (Vicodin) or 150mg codeine.
    - 3131s 10y ago
      Huh, I might be basing my perception on what is high vs. low from knowing some people who abused oxycodone. I believe my mom takes 5mg twice a day, and from what I'm reading that still seems pretty light. Oxycontin pills are minimum 5mg, correct? Erowid puts that in the "light" category for users with some tolerance, FWIW: https://erowid.org/pharms/oxycodone/oxycodone_dose.shtml https://erowid.org/pharms/oxycodone/oxycodone_dose.shtml