IV Dilaudid with a Benadryl Piggyback
The most hated statement a patient can make! We hate this statement because we will likely spend your hospital stay discussing your pain medications instead of your heart attack or uncontrolled diabetes. The long-standing diabetes, high cholesterol, high blood pressure, fast food diet, and lack of exercise are threatening your lifespan but we won’t have time for that. Instead we will have multiple conversations throughout the day explaining why you do not need narcotics and why there is no indication to get them through an IV.
Patients are not Customers
Physicians have long recognized the addictive qualities and scary side effects from these drugs but have little power to stop their use. Medicine has switched to a customer-based mentality where hospitals don’t get reimbursed if the customer satisfaction isn’t high. Guess what is on that customer survey: “How well was your pain controlled?” Patients are not customers, despite what the insurance companies want us to think. You don’t walk into a hospital and have a menu to choose from. Doctors have an arsenal of drugs, surgeries, and therapies at their disposal, but this doesn’t mean they are all the right choice for each patient. This also applies to pain patients and the use of narcotics.
The Drug Companies Role
Drug companies had a tough obstacle when developing these drugs. NSAIDs and Tylenol were already developed and are very effective in pain control. They do have side effects but not as many side effects as narcotics. So they developed a new system, the fifth vital sign, your pain level. This is such BS, pain is not a vital sign, it is a subjective score that is different based on every patient. Doctors bought this crap as well. We believed that these pain drugs were stronger and more effective. Patients became addicted, we started treating patients like customers, and now we are in an awful place of addiction medicine for a problem we created.
What Are Opioids
Opioids work on 3 receptors: mu, delta, and kappa. When these receptors are activated they have several effects, some are pain relief, others are dangerous side effects.
- Mu1: Supraspinal analgesia (pain relief), bradycardia (low heart rate), and sedation (sleepiness).
- Mu2: Respiratory depression (meaning decreased rate of breathing, can lead to complete stop in breathing), euphoria (feeling good), physical dependence.
- Delta: Spinal analgesia, respiratory depression.
- Kappa: Spinal analgesia, respiratory depression, sedation.
Why Are Narcotics So Bad
Many people become addicted or dependent on these medications. As you use them, you also develop a tolerance to the analgesic effects. Unfortunately, there is no tolerance to the side effects of respiratory depression and death. There are several cases of accidental overdoses on narcotics, even when only taking the prescribed quantity. The problem is now so out-of-control that the US government has stepped in and started regulating the prescription of these controlled substances.
Please understand that doctors are not trying to be mean or call you an addict by refusing to prescribe you an opioid. The reality is that narcotics only have proven benefit for the treatment of cancer pain. The side effects and risks of these medications has become increasingly evident and doctors are using less of them to help prevent further tragedy. Instead of covering up the pain with a medication, we are focusing on treating the cause of your pain so you aren’t dependent on a pill every 4-6 hours.
How Can I Treat My Pain
Many people with chronic pain now feel untreated as a result of the regulations and cutbacks. But there are still several methods for treating pain which actually have proven benefit. Despite many patients negativity towards the thought of physical therapy, it has the most proven benefit for many forms of acute pain. You absolutely have to continue doing the exercises prescribed to you after you stop going for formal sessions. Another option is joint injections. This involves a doctor injecting usually a steroid plus lidocaine in to the joint space. Many people can get several months of relief from these. The lidocaine helps to provide immediate relief until the steroid kicks in about 2-3 days later.
There are several ways to get pain relief without using narcotics. Talk to your doctor about your options and how you can decrease your narcotic use.