Digestive problems are so common with long-term use that some doctors think that they should co-prescribed with omeprazole and other agents to head them off. (Long-term omepraloze will give you B-12 deficiency if you don't supplement; it is an unusual side effect, but I can't sleep if I take omeprazole.
Cardiovascular risk from Vioxx was enough to pull the drug from the market; risk is also seen with Celebrex and other COX-2 selective NSAIDS. The risk with non-selective NSAIDS is less understood but still present.
My doc does not want me taking acetaminophen because she thinks it causes me to get elevated liver enzymes.
Like opioids there are problems when people don't "use as directed". My grandmother used to take Bufferin by the handful and one day at the dinner table we saw her throwing up blood like something out of a horror movie and she was subsequently hospitalized..
Acetaminophen overdoses can easily destroy your liver and are one of the most common forms of fatal poisonings.
The verdict is that we don't have truly 'safe and effective' medicines for pain in 2017.
(Unless by 'safe and effective' you mean NEVER have side effects, in which case we probably don't have any 'safe and effective' medications.)
Chronic pain is difficult to deal with and wasn't addressed in this study. Generally opiates are not recommended, but its tough to find other alternatives that are consistently safe. Opiates often end up being used and... epidemic. (... == long complicated story)
Paracetamol/Acetaminophen has an incredible safety profile - in people who use it responsibly and don't have liver disease.
It is, after all and as you are obviously well aware, responsible for the highest number of ED presentations for overdose, and it does kill a number of people each year. But that's a mental health issue, and you can overdose on Water (or food, as I indicate in opening paragraph), and die. For people who take it responsibly and without intent for suicide, it is incredibly safe and effective.
Same with ibuprofen - although with the proviso of Do not take for more than several days. But, the same could also be said of opiates - safe for short periods. it's chronic use that will cause problems in lots of cases (ie. add in benzos as well)
It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high afterwards, so I've become pretty hesitant about it.
That being said, it is very likely less addictive and has far fewer side-effects for those who it helps. For that reason I am extremely positive about legalizing it and studying it further. :)
Sorry to pick on you, but people should realize that if all they want to do is try cannabis for pain management, they shouldn't let a dislike for the recreational effects deter them because the two can absolutely be separated.
FWIW, I manage my pain with meditation techniques and it's the only form of pain management that I recommend whole-heartedly, so I'm not recommending anyone try CBD. But I know people who take CBD for pain and I think people should, at least, understand how cannabis is used medicinally before saying negative things about it.
Doctors and I were convinced he was not telling the truth or his stuff was laced. Ended up that he was telling the truth and was clean other than pot. Sad thing was he would keep using pot which ended up messing with his health.
I never see why people care to be sedated emotional. Worst thing about pot to me. They miss out on so much emotionally.
PS: Not to defend Cannabis, it can trigger Heart Attacks and is associated with a host of Lung issues. I just never heard of those symptoms.
On the bright side, at dispensaries you can know precisely what you’re getting, so at least I can say “this weed will pleasantly reduce my anxiety and pain, that weed will blast me unwillingly into space” which is an option I never had before.
It's legal where I live and the handful of times I have used during the week, I can't remember what I did the day before as well, or what my tasks for the day are. My performance at work noticeably degrades. I'm also more tired the day after, despite generally getting more sleep.
It's great for the weekend when I can just sleep it off or my only tasks are to go for a hike and get groceries though. Better than alcohol at least.
That being said, I may have exaggerated the memory issues. It isn't like full blown amnesia. More so it just takes longer than usual to remember things. I'd compare it to a cache miss. Smoking clears my brain's cache the next day and I end up feeling like I am pulling short-term thoughts and memories from colder storage.
An uncle and some other older physicians who are on long-term measured acetaminophen usage reported supplementing their regimen with n-acetyl cysteine (NAC) with no apparent diminution in analgesic effect. WebMD has a description of the chemical mechanism:
https://www.webmd.com/vitamins-supplements/ingredientmono-10...
As an aside it's also the primary antitoxin for the treatment of acetaminophen poisoning in veterinary medicine:
http://orrongpharmacy.com/content/s_vet/vet_poisoning.htm
So it might be useful to bring this possibility up with your personal physician.
https://en.wikipedia.org/wiki/NSAID_hypersensitivity_reactio...
NSAIDs-exacerbated respiratory disease
N.E.R.D.
I found out that (scientifically speaking) I am a NERD (or have NERD, whatever)
Did the script say "P.R.N?" PRN means "as needed" in medical terms. It's an abbreviation for "pro re nata." Just for future reference.
I've also found that, for me, naproxen (Aleve) works much better than opioids. Opioids just make me feel very, very sick (from nausea). If they do help with the pain relief I can't tell over the nausea and vomiting.
But, yeah, YMMV.
There's a fairly big camp of people both online and in real life that is strongly against questioning medical authority. I've encountered it before.
For example (and I know this is purely anecdotal), after doing a few hours of extensive research and photography comparisons online I came to the conclusion that my sister had shingles. I mentioned this to the doctor when I took her and he dismissed it and said that it is unlikely since she is so old. I mentioned this on a subreddit that I frequent and a bunch of people jumped on me and told me to stop doing my own research and to let medical authorities do their job without me pestering them. However, after taking her to a different doctor, he immediately recognized it as shingles and prescribed her the appropriate medicine.
On the one hand, I get why doctors don't want the "ignorant masses" doing their own research and coming op with cockamamie theories, but on the other hand, doctors can only hold so much information in their heads whereas the internet has vastly more information available and I can become an expert in one tiny little niche fairly quickly.
If the doctor hadn't been so sure of his diagnosis, this would have been caught years earlier. I'd specifically asked, more than once, about the possibility.
A lot of scrambling on their part, that day, to get me a same-day appointment for consult with a well-regarded surgeon.
the UK has had a campaign recently around sepsis where people are being trained to ask these questions.
I have a lot of medical knowledge and I try not to be a wise ass with my doctors. Sometimes though, it pays to pay attention.
Yes doctor, no doctor, I don't think so doctor, yes doctor also my left foot. => He thinks I have a sprained ankle, I think I'm not sleeping well (or whatever) and I'll mention what my guess is at the end (not before) and ask him why my guess is (presumably) wrong.
Of course if you think there's something unusual or your symptoms are severe then of course go to the doctor without delay, but it's also helpful to get a bit of a personal education when you've got time with a specialist.
I did get a big script for norco when I was discharged, but their instructions were to take it if the pain became distracting.
The nursing and medical staff at the hospital (CPMC Davies) overall seemed great, so it may just be the difference between staff that listens/tries and staff that doesn't.
I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of those two "heavy duty" prescription drugs.
I will say, though, that doctors in the U.S. have been damned cavalier about ibuprofen. One doctor with a popular radio show would cite the nickname, "Vitamin I", and routinely tell people to use it non-stop for a month or two.
I've found that now, a few days on it will make me rather lethargic. My cardio strength and sometimes rhythm feels impaired. And lo, there are studies now coming out that indicate it may carry as much risk as Vioxx and the like.
(Incidentally, a doctor prescribed me Vioxx a month or two before it was yanked from the market. I questioned this, remarking on recent news I'd read indicating it had problems. He had no clue and told me it was perfectly safe. Sure, it was still on the market, then, but he appeared to have no clue about the looming controversy.)
With any medicine, it really seems TANSTAAFL. You have to carefully weigh the benefit against known as well as suspected risks. And the U.S. medical system completely falls down in not fully informing not just patients but also doctors to the existence and nature of these.
1) Well, that urgent care experience -- a new facility opened by the premier area hospital -- was itself a horrible experience. Deserted facility, by all appearances, yet it took about 2.5 hours to see a doctor. Who gave me no neck brace; family took me to their chiropractor, the next day, who DID give me a neck brace -- which provided the first real relief and stopped me from constantly retriggering the injury with every movement.
To be clear, I refuse to have my neck cracked. And the chiropractor wouldn't have, at that point, anyway, given my severe spasming. But at least he had the sense to immobilize my neck. (Then he provided some ongoing care to encourage the release and healing of the spasming. To whatever extent this may have helped, that initial immobilization was key. WTF was wrong with that fully credentialed MD serving the urgent care's rather extensive ER facility?)
A slight distinction that might not matter sometimes, but i often wonder how many antibiotics/pain killers I've taken prescribed from urgent cares that were possibly overkill.
That ER doctor just gave me the prescriptions and sent me off. No follow-up care. I guess you'd have had to see my level of discomfort. My family was equally surprised and disappointed.
I take your point. And much of the U.S. health care system keeps pushing patients towards urgent care and "the doctor at hand". Not that there aren't good urgent care staff; nonetheless, it doesn't exactly promote medical management.
Also, I've delayed some care because I've been uncertain of the approach and awaited more information and perhaps improved procedures and techniques. This might well be called a conservative approach -- and these days, so much of the U.S. rhetoric is about the need to be "conservative". Well, much of that is actually "Conservative", which is actually a rather different ideology.
Yet, insurance keeps worsening by the year. Patients who might otherwise be inclined to be conservative and await better knowledge as well as what would normally be lower costs (in most other industries, "product" costs decline with age and with technical improvements and growing marketshare). Well, in U.S. health care, patients can feel compelled to "act now", because while technology and standards of care may improve, next year's insurance may well not cover it or cover it enough for it to be affordable ($5000 deductible? $7500?), if one even has insurance next year.
Had you continued the muscle relaxant (the problem was an involuntary muscle spasm), you possibly could have avoided further treatment (the neck brace).
If I suffer a muscle spasm that can't be massaged out, then a muscle relaxant + ibuprofen serves well for 1-2 days and, after that, only ibuprofen.
IMO muscle relaxants + narcotics is not a useful combination, their purposes(muscle relaxation vs pain-reduction) being orthogonal, except in cases of severe injury where near-immobilization is required.
I was on the muscle relaxant for a full day, and I was no better. Any time I moved, I was retriggering the spasm.
The neck brace stopped that. I still had to be careful, but at least I could walk around and sit and such without constantly re-spasming (which I suspect was actually exacerbating the injury).
I do agree in concept with the concern about combining such an injury / muscle relaxant with strong pain killers. The pain is warning you as to damage; numbing it seems like it might well promote furthering that damage and/or hindering healing.
In my case, once I was braced and stopped retrigging -- and possibly worsening -- the spasming, the remaining pain was entirely tolerable. Of course, the limited effective activity was another aspect requiring coping. That included sleeping: Getting into bed, and keeping things immobilized in bed, was a bit of effort. I learned how to sleep with a neck brace on, and I "trained" myself quickly not to roll from side to side -- despite my allergies that promote frequent shifting.
I stopped after the first one.
I have enough addictive behaviors, I don't need to add a chemical one.
God do I hate medical professionals like that. It's as if they don't want you to steal any of their elite knowledge or that you as a patient are beneath them. How dare one of us ask a semi-intelligent question!
The problem isn't the extreme cases, it's the every day ones. Opiates are being massively over-prescribed in cases where OTC medicine or a shot of whiskey would suffice, and this over-prescription is a driving force behind the addiction epidemic.
Not sure if you said it in jest or not but alcohol is also highly addictive, prone to abuse, and harmful to your health and IMO would really not be a step in the right direction.
edit: I almost added to my comment "It's almost taboo in our society to mention this fact" but didn't. I was almost immediately down voted so I guess maybe I'm not wrong...
A while back I was talking to a course tutor who in the UK gave the "dealing with staff with serious addiction problems" course - he commented its when you find 3 or 4 stashes of vodka hidden in the office that you know you have a problem
Took Percocet after a shoulder surgery, I just slept through the pain. I also understand now why people get addicted.
I get raging migraines, Excedrine is the only thing that works for that.
True story, when my daughter was in the hospital (cancer) we overheard a nurse and doctor discussing what to give a child (also with cancer) for tooth pain... "morphine". The nurse was like "for a tooth? can't we tell the mother to give him Tylenol?"
Also, true story Tylenol is not "formulaic" (I may be saying that wrong) at many hospitals. Meaning THEY DON'T KEEP IT IN THE PHARMACY (the one that fills orders for internal use). I was very surprised to learn this.
On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a knee. When the surgery was done and I was being discharged, a nurse came to me with a percocet script and told me to take one every xx hours. Having taken percocet in the past and being familiar with the aforementioned side-effects, I asked her if she wanted me to take it for pain management, or if there was another reason to take it (blocking the formation of blood clots for example). I'm fairly pain-tolerant, so if it was a pain management thing, I wasn't going to take it. Her response was "just take the pills." That was not helpful. If doctors and nurses are just shoving these things down patients' throats it's not surprising there is a problem out there.