[CaliforniaKarl]

Ugh. I’m going on for surgery next Thursday, for a laparoscopic partial colon resection, and one of the things I’m most worried about will be post-surgery pain killers. Hearing stories about excessive pain killer use and prescription really make me want to avoid them, but on the other hand I’ll need to be up & moving around ASAP to speed my recovery, and pain would get in the way of that.

[Omniusaspirer]

I work as a nurse on a general surgery floor- exactly where you'll be after you leave the PACU. Your procedure is planned laparoscopic, which will considerably lessen your pain and recovery time. I've had several patients in your situation not take any opiates at all. Ask your physicians to consider a regimen of scheduled ketorolac or ibuprofen, acetaminophen, and gabapentin. Any opiates will be prescribed PRN (as needed), and generally will only be offered if you ask for them. As you alluded to, your safest bet pain-wise is to get the non-opiates on board first and only take opiates as required to facilitate your getting up and walking around- an essential part of your recovery.

As a disclaimer, you may have poor liver or kidney function which would contraindicate some of the medications I mentioned, your surgical team will make that call.

[CaliforniaKarl]

Sorry to be late catching this, I hope you come across it! It's awesome that there's a nurse reading HN! Thanks much for all of the info, I've never heard of ketorolac or gabapentin before. I know there's no way to know exactly what'll happen until the day, but it's good to hear from the "boots on the ground" that this is not at all unusual.

[akamel]

Use them only when you need them.

I was really annoyed when my wife’s doctor freely prescribed her oxi after her delivery even though my wife never asked for it and never showed any sign of needing it.

Having free flowing prescriptions is how we end up with so many addicts.

[mgkimsal]

and then... for legitimate cases... no dice.

about 7 years ago my wife got sand in her eye - was problematic enough that we went to a local clinic. she wasn't going to go blind, but it was irritated enough that after flushing it out, it still looked... bad. and she indicated it was a bit sore, that she wanted to get home to just try to get to sleep.

The doctor there offered a prescription for percocet. We said "no, no need - we'll call if there's a problem". They handed us a prescription for... either 7 or 14 pills. we took it and didn't use it.

A few years later I ended up with extreme lower back pain. I could hardly move - was bed/chair-bound for 4 days. Had called around to see if any clinic would see me to prescribe some pain killer. NOPE. Don't want to create any addicts. Clinics all have signs on them saying 'no prescriptions for...' then a list of 4-5 things.

We were basically force-fed a prescription for something way out of line with what was necessary, then when something was necessary... not available.

Yep, just my anecdote, but it's stuck with me, mostly because I don't have that many medical interactions in the first place, so the outliers tend to stick out.

[uh_what]

Asking for a prescription for a painkiller will make doctors label you as a drug seeker.

Asking for a referral for an x-ray/ultrasound for your back pain will often make them go "Here, why don't you try this opioid first and see if it gets better?"

[siculars]

The key phrase here is "a few years later". Much has changed in this area of medicine over the last few years...

[specialist]

I'm sorry for your pain. Back problems are the worst.

Oversteer is the norm. Precautionary principle and all that.

Patients with chronic pain have to train their care givers, just as they have to train you. You're building relationships, trust. Just like dating, jobs. Unhappy or uncomfortable? Move on to others you can work with.

[lostlogin]

I know that you have likely shortened the story for reading, making the phone call sound different to how it really went, but if you want to set off alarm bells, ringing around asking about a script for strong pain meds is a way to do it.

[mgkimsal]

when you're in intense pain, it's difficult to drive around to too many places (wife drove me to one), she called a few others, no one would even agree to schedule me to come in for a consultation/exam.

one office offered to schedule an appointment for about 4 weeks later, which I didn't take.

This situation has happened to me twice, both times this pain came out of nowhere, and first time it took me out of commission the better part of 4 days. Tried to get any medication (per above story) - nothing. Second time this happened, 2 years later, it lasted about 3 days, and I didn't even bother trying to get anything - just took a lot of OTC stuff. If this happened regularly, I might be able to figure out if there's some trigger to avoid, but... 2x in the last 6 years - hard to pinpoint!

I should add that this gave me a little bit of insight as to how people who live with chronic pain might feel all the time. Just a few days of that was maddening. Thinking it might be the 'new normal' - constant intense pain that rarely lapses - would really have been difficult to cope with, and I probably can emphathize (or is it sympathize?) a bit more with the prescription drug abuse situation.

[nickpsecurity]

I second this. I did this for my surgeries. If I took meds at all, I took them only early when likely pain was highest on in minimal, prescribed dose. Then as little as I could from that moment forward just enduring the discomfort, being careful about how I moved, etc. I got over it. Sometimes, the pain was low enough for OTC drugs should I have wanted to use them.

Good way to avoid getting addicted.

[vadym909]

I third this. Vicodiene when you need it is a lifesaver after surgery, but it can tempting to continue with it beyond when you need it. Just beware and stop.

[0x8BADF00D]

I did something similar when I broke my ribs. I was prescribed Vicodin and Ibuprofen. I’d only take the minimum amount of Vicodin twice a week, and the other days would use Ibuprofen only. I also made sure I never took more than the minimum required dose two days in a row.

[CaliforniaKarl]

Yeah, I remember when I got a wisdom tooth out, afterwards I got a prescription for something pretty strong. Vicodin, I think? It was years ago, and I don't remember.

But I do remember that, even though I filled the prescription, I never ended up taking it. A few days of higher-dose ibuprofen (taken with food) was enough.

[lotsofpulp]

I got a prescription for hydrocodone after having a wisdom tooth taken out. I never bought it, and I didn't take any other medication either. There was mild discomfort for 12 to 18 hours, but it's crazy they're prescribing pain meds by default for no reason. And there was no instruction from the doctor to limit the pain med to only if absolutely necessary.

[specialist]

Better to have a 3 day supply on hand just in case vs the mad scramble to get scripts filled afterwards.

[dr_]

Having post-operative pain is a legitimate reason to use them. Just use them judiciously. Your goal should not be a pain level of zero, it should be a pain level that is manageable. You will likely have the option of using Tylenol instead if you prefer, and possibly NSAIDs, so you can try either of those before you resort to narcotics. Everyone reacts different. In the past week I've had someone who underwent a hip replacement who can't get around without heavier doses of narcotic pain meds. And I've had a guy who had his leg amputated, who just takes Tylenol.

[klodolph]

What I understand is that addiction usually starts from misuse and overprescription. If you are given pain killers for acute pain or recovery from surgery the rates of abuse are lower.

[Johnny555]

There's some research showing that acetaminophen + ibuprofen can be as good or better than Opioids for pain relief, though I don't know that it applies to post-surgical pain.

https://media.jamanetwork.com/news-item/no-significant-diffe...

https://www.sciencedaily.com/releases/2018/04/180417181101.h...

[refurb]

The person who knows their need for pain control best is you.

Follow your doctor’s recommendations and communicate how the pain is.

Some people need opioids for relatively minor surgery while others can get by with NSAIDS for relatively major surgery.

[youeseh]

I have family that was on opium based pain killers after surgery. Their description was to the effect of, "that is some goood shit". Upon recovery, they stopped taking it. I suppose they no longer had holes in their life that needed filling with a pain killer, literally and figuratively, and knowing that made it easier to not become dependent.

[onetimemanytime]

Probably depends on the person, some might get addicted after a cigarette, others not even after 10 packs. But that person might get addicted to alcohol.

Either way, after an operation might as well suck it up a bit, like they did before Oxy and the likes came.

[dgzl]

If you've done other drugs before and you're currently ok, then you should be fine. If you've never done drugs before, then just remember that you're taking these drugs for a reason, and once that reason is gone, then you don't need the drugs anymore.

Recreational drug use can be fun but I don't think that's your prerogative here.

[ip26]

Have you asked about other options? Alternating acetaminophen & ibuprofen has been popular among the docs I've seen recently. Heck, around here many get a bottle of 800mg ibuprofen after a C-section, no opiods.

[CaliforniaKarl]

Ibuprofen might probably be ruled out, due to the stomach upset it can cause in larger doses, and they may not want the anti-inflammatory effect(?). But yeah, acetaminophen would work!

[leoh]

Maybe you can make sure to discuss this with your doctor until you feel comfortable?

[CaliforniaKarl]

Yup! It's one of two things I'll bring up in the pre-op meeting with the surgeon:

1. Make sure we're in agreement as to the things being done. Yes, it's been discussed multiple times, but best to be clear!

2. Ask what kind of pain killers I'll already be on when I wake up.