A Brief Word on Pain Management with Opioids

As most of you are aware, I've been off because I had my rotator cuff repaired a week ago - two of my tendons had full-thickness tears and were retracting into the cavity or whatever. I still feel pretty shitty and having to sleep in a sling sucks but the recovery has been getting easier. However, the first ~36 hours were genuinely harrowing, like a lot worse than I expected, and in part that's because I was given weak take-home pain pills.

They did this nerve block on my whole left arm and it was so weird and unhealthy feeling, like it was this dead weight hanging off of me for hours. But after surgery, when I was home (which was less than two hours after the completion of the surgery, I think) at some point in the night the nerve block wore entirely off, and oh my God. It was such crazy agony like I couldn't believe. Just stunning really. (Sorry if this makes me sound like a pussy.)

Anyway part of the trouble was that the pain pills they had given me were Tylenol plus codeine. Codeine is an opioid and can be powerful but apparently these pills were high in Tylenol and light on codeine, and they just weren't helping at all. So after that night my girlfriend (بارك الله فيها) worked the phones and got me some real pain pills (endocet), and it still sucked for the next day but it was easier and recovery has gotten better pretty quickly. The pain became manageable at a faster pace than I would have thought given the initial level.

I asked around the other day and did a little research, and I guess the Tylenol-codeine pills are sometimes preferred as a more mild alternative to more powerful pills. This is part of a larger effort to limit the use of opioids, and of course I understand why. But I have to say that they were some bullshit for such major surgery; they just were no match for the holes that got sawed into my shoulder. So if it have any surgery coming up maybe talk to your doc beforehand about what the pain management plan is.

And look, I get it - there's a big opioid crisis it there, and there has to be some sort of systematic attempt to draw down use in general, and I got the mild pills instead of the strong stuff because somebody made a decision pretty far upstream. But the reality is that the pills I was given simply weren't up to the task of fighting off my pain in the immediate post-operative period, and as is so often true in drug policy, the policy hurt me as an average patient while addicts are still getting lethal doses of fentanyl for $5. Before this past week, I hadn't taken any opioids for ten+ years, when I got wisdom teeth removed in grad school. So for me it feels like maybe the option for the heavier pills should have been put on the table before surgery. I get that the are tradeoffs to be made, though. If these nuts weren't tough, we already would have cracked them.

In any event: if you have a major procedure coming up I advise you to have a frank conversation with your doctor beforehand about pain management and what exactly you'll be leaving the hospital with. Personally, I'm already tapering and hope to sleep without pills on Friday night. I will also have a couple posts up this week, God willing.