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.
I am a physician, I think your surgeon needs to get an earful. Shoulder surgery hurts, and your pain experience is not uncommon. I could go on for quite a while about the opioid epidemic...wait, I think I actually will.
Many of the opiate addicts state that they got their start with prescribed opiates. The story goes that Freddie got his surgery and before you know it, he is shooting up Heroin and Fentanyl. Then he dies in a back alley with a needle in his arm and it is the doc's fault. That information comes from a truly reliable source...opioid addicts. Surveys of addicts state this. Don't take this wrong, but one aspect of the addiction is the lying. It is part and parcel of the problem. Even after they are no longer using, it sears the conscience to not place blame elsewhere, so doctors are an easy target. And doctors have just rolled over and accepted the blame. It is a complex problem, and we played a role in it, but I think that role is smaller than the medical community would admit.
It just seems like a stretch to me for the average Joe to transition from lawfully prescribed opiates to injectables. Ouch, my appendectomy hurts so bad, I need to shoot up some heroin!
The number of opiate prescriptions has been decreasing since 2010 but opiate deaths are escalating quickly. And the potency and number of the pills are less per prescription. Conclude what you will.
In 2004, Freddie would have gotten 40 pills of something much stronger, and if he called back in a week, would have likely gotten 40 more. We all knew he was likely becoming addicted, but we were afraid to not treat his pain adequately for fear of seeming insensitive. That was the indoctrination at the time. Unfortunately, the pendulum has swung too far in the other direction, and I am sorry that Freddie got caught in that.
On a side note, codeine is metabolized to Morphine. Some people are fast and some are slow metabolizers, so a codeine pill really gives them relief if you quickly turn it into Morphine. Since it is so unpredictable, most pain docs feel it just isn't a good pain medicine. Ultra rapid metabolizers run the risk of overdose with pretty low doses of Codeine, but thankfully, those appear to be about 1% of the population.
I am curious to hear the perspective of others about the transition between prescribed pills and Heroin or Fentanyl. And I am sure to get flamed, but I expected this.
I hear you. I have amyloidosis, a terminal disease that causes substantial organ damage and results in a lot of neuropathic pain. I can’t get an opioid prescription for over 30 days, which requires me to contact the oncologist every month for a new prescription. Additionally, the other pain medication i just started (Lyrica) is a controlled substance as well, which probably means the same call every month to get the basic meds so that I can continue to function. There really needs to be a change that recognizes that sick people need meds, and regulating the law-abiding hurts real people. Letting the illegal drug trade flourish also hurts people, but there’s no appetite for doing anything about it because that’s hard. Our political class is all about getting easy wins they can trumpet as they seek re-election while letting the actual, difficult problems stay unsolved. Time to clean house.