[cf498]

>If you even mention that you're feeling long lasting discomfort, you will immediately be met with suspicion and resistance and assumed to be a drug seeking addict and a criminal.

This was to be expected and it is absolutely mind boggling.

People not having access to proper pain medication is absolutely abhorrent. Large parts of the world still havent recovered from world wide lobbing campaign to ban opiates. Where even terminal ill patients in abhorrent pain have to exist on paracetamol and even that only if the family can afford it.

And that kind of lobbying hasnt stopped. The last push I know of was for the ban of mean party drug ketamin, which is the only reasonable anesthetics for poor regions outside of the effective range of a hospital.

I am really hard pressed to not view people pushing for tighter regulation of pain meds as simply evil. If you have people accidentally addicted to opiates, that is of course a problem, but one that can easily be fixed with better informed patients.

You just dont fight the war on drugs on the back of chronic pain patients.

[DanBC]

> You just dont fight the war on drugs on the back of chronic pain patients.

You're pushing the same line that Purdue did - that there's an epidemic of untreated pain and that it is cruel to leave people without treatment.

This point always comes up when discussing the US opioid crisis. What do we do about people in severe pain? What do we do about people in long term pain?

The US massively over-prescribes opioids. The US could reduce opioid prescribing by 80% and it would have no effect for these groups of people.

But, more importantly, for most people in long term pain opioids are the wrong choice. Opioids are a good choice for end of life care, and for short term acute pain (especially when supervised in a hospital setting). But for long term pain opioids are for most people a poor choice. The patient will develop a tolerance to the opioid which means it's not working to treat the pain. They'll need to increase the dose of opioids. This increases the risk of harm from the medication. It also increases the risk of dependency. So, you end up with someone addicted to opioids, taking very large doses, yet still in pain.

Note I'm not saying all people. Some people who are carefully selected and regularly monitored will get some benefit from opioids.

Here's a radio programme with an interview with someone who was prescribed opioids for long term non cancer pain, and how it caused him harm: https://www.bbc.co.uk/programmes/b04wv052

Here's the UK Royal College of Anaesthetists pages on opioid prescribing: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...

[slfnflctd]

There seems to be a lot of misunderstanding among policymakers and even medical staff about how this stuff works in the real world.

If people are in pain, and professionals are shaming them - basically saying 'suck it up, sissy' - when they dare to mention this, what do you they're going to do? I can guarantee you a great many will seek relief on their own terms, i.e. alcohol (cheap and available nearly everywhere!) and street drugs-- with doctors & their staff at that point being completely cut out of the loop. Are you going to tell your dentist that you drank vodka to dull the pain after your root canal? Mostly no. Is that better for you than hydrocodone? Unless you have other non-standard risk factors, also no.

I fail to see how this is better than honest dialogue between doctor & patient where each person's treatment is realistically considered on an individual basis. By all means withhold inappropriate, ineffective and dangerous treatments-- but tell your patients what you're doing & why, and don't lose sight of how they actually behave in response to this. Sometimes that response is far worse than whatever you're trying to save them from.

[FireBeyond]

For sure. If a patient of mine as an EMS provider is exhibiting physiological signs of pain I believe it is inhumane and unethical to withhold analgesia. There may be discussion of the appropriate medication, but nonetheless, we have options. That being said if you are complaining of 10/10 pain while I am interrupting you texting to conduct my exam, I may be more skeptical...