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 Post subject: My surgical experience
PostPosted: Thu Dec 09, 2010 10:01 am 
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Thought I'd throw in my story:

Two years ago next month, while I was on 24mg sub/day, I developed an infected bursa at a hip joint. I had slipped and fallen on my ass while walking on ice, thought the pain and swelling stemmed from that, and put off seeing a doc too long. I ended up going to the local ER when it became agonizing.

I did everything right in my mind....I took my subs with me and told all the docs I was on them. After a lot of tests in the ER, they discovered my kidneys were messed up and that I had a big infection. They started me on IV dilaudid on top of the sub and admitted me.

The dilaudid didn't touch the pain, and the next day my regular internist started me on a morphine pump....but they continued to give me 8mg sub/day. I was in agony, hitting the PCA button constantly and getting no relief. Finally, after my family called her, my sub doc called my internist and told him to stop the sub.

Three days later, I had hip surgery to drain the bursa. The pre-op meds did nothing for me and my pain was still out of control. After coming off the surgery, I was still on the PCA and was also given oxy-contin 80mg 2x/day. I made it through, but the dressing changes were awful. They tried upping the morphine, adding a bolus prior to the change, nothing helped.

Three days after the surgery, I was discharged. No morphine, the oxy-contin was dropped to 10mg 2x/day, and I got a script for norco. My pain began to get better, but I slowly began to go into withdrawals. Eventually, I simply re-started my sub. It was an experience I'd never want to repeat.

Months later, I began the HereToHelp program and found out that RB wants to talk to anyone who has had a surgical experience while on sub. One of their medical staff went through all this with me, and I asked what I could have done differently. Their advice was to discuss the meds with the nursing staff, something that didn't make a lot of sense to me.


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PostPosted: Thu Dec 09, 2010 10:38 am 
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Thanks for sharing your experience with us. I'm sorry it was such a negative one. Unfortunately, such bad experiences aren't all that uncommon. There are a few different ways to treat acute pain while on sub. There's an NIH paper on the subject that I posted under the "Links" section. If anyone has not read it, I'd highly suggest doing so. It's also good to give to one's doctor before any planned surgery. (I know, I'm shamelessly pushing that article again. Sorry. It's just that good.)

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PostPosted: Thu Dec 09, 2010 12:08 pm 
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The thing is, no matter what steps we take to prepare, we are ultimately at the mercy of whatever doc(s) are treating us. Sometimes it has seemed to me that the more you try to prepare, the worse things go. When my opiate addiction really took off, I had been in an accident, got some bad burns, and was continually *under*-treated for pain.


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PostPosted: Fri Dec 10, 2010 8:56 am 
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I am glad you posted your experience and I don't know what moron at the RB here to help no one program gave you that advice but it is frigging ridiculous and wouldn't have done a damn bit of good most likely. The problem is that they should have stopped your sub or reduced it extremely low immediately when they put you on the dilaudid. Then they needed to wait about a week until the sub left your system and then do surgery. I can't believe they did surgery within 24 hours of discontinuing the sub.

This is the problem. I just posted these concerns under another thread and Dr. Junig says it is possible (if the doctor does it right) to control pain when someone is on sub. But I really haven't seen it happen yet. Everything I have seen and experienced is that when you are on sub, full agonists just CAN'T get through and I don't care how much they give you. Either that, or none of us posting on this forum have ever had a doctor willing to give ENOUGH to control the pain. The bottom line is that regardless of whether or not it COULD be done, if only <1% of doctors are willing, we are still screwed in the end.

I'm sorry you had the typical horrible experience with surgery.

Cherie

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PostPosted: Fri Dec 10, 2010 9:23 am 
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IME, the problem is that once you tell the docs you are an addict (especially on ORT), instead of actually treating your pain, they give you less than a "normal" patient and/or immediately start trying to reduce that dose. I've known methadone patients that have been told by docs or dentists that they don't need pain meds cuz they're already on an opiate. Also, some of these professionals can be pretty arrogant and don't want to hear what some "goddamned addict" has to say.


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PostPosted: Fri Dec 10, 2010 9:29 am 
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I agree, there is a good chunk of doctors who under-treat the pain of addicts. When I had a surgical procedure earlier this year, my doctor told me I would need pain meds afterward. So I tapered down my high dose of sub and quit 3 days prior. Then after the procedure in the recovery room, the doctor decides I don't need any pain meds. I eventually got them (thanks to the nurse), but I never got a good explanation for her change of heart.

Many doctors erroneously believe that giving addicts pain meds for acute pain will place us at risk of relapse. But that's simply not true. Evidence shows that under-treated pain is what places the addict at risk of relapse. Again, more doctors need to be educated about addiction AND suboxone.

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PostPosted: Sat Dec 11, 2010 9:24 am 
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You are so right about under-treatment of pain, Hatmaker....at least that was my experience. When I was in an accident and burned back in '83, I told the doc about my addictions. That led to a month in hell. Demerol shots seemed the absolute worst thing for me...they hurt, and were only ordered every 4hrs PRN, and only 75mg. I'd get < 2hrs of semi-relief, then spent another hour and a half in agony and watching the clock until I could call for another. Towards the end of the month, they finally consulted a pain mgmt doc and he couldn't believe this was what they gave me.


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PostPosted: Sat Dec 11, 2010 8:17 pm 
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I'll bring my healthcare background in here again to tell you that UNFORTUNATLY, the under treatment of pain is not at all confined to those of us with opiate addictions. The under treatment of pain has been, and continues to be, well documented throughout much of medicine. In fact, there is something called "pseudo-addiction" whereby patients who are in pain, but do not have the actual disease of addiction, appear to act like addicts doing many "addictive-like" behaviors like doctor shopping, taking more medication than they should, hording their medication, etc. Once their pain is properly treated, these actions stop. Then when whatever caused their pain in the first place is either fixed or ends, they no longer take medication. Yet, they often get labeled as addicts when it happens.

The treatment of pain by emergency medical services (ambulance/paramedics) is especially poor. I have seen multiple studies that have shown less than 5% of patients in pain are given ANYTHING for that pain by paramedics. Partially because of drug addiction, the ER is often a poor place to get pain control as well, unless you have a clear or explainable cause for the pain. If you come in with burns or broken bones - no problem, you'll get something. Come in with back pain, tooth pain or a headache, and good luck. Even so, the amount of medication you get may not be at all adequate. I've seen quotes like "Severe pain + 5mg morphine = severe pain". In other words, 5mg morphine is not enough medication to control severe pain. Yet I have had both doctors and nursing staff look at me like I have two heads and was out of my mind for administering 12 or 15mg of morphine to a patient. My medical director was once called by an angry ER doc after I gave a 35-year-old male driver in a car accident 10 mg of morphine. He had admitted to 3 beers. He still had pain but was completely awake and alert with no compromise at all. Oh, by the way, the metal rod that holds the gas peddle in place was impaled through his foot! Yet, this doctor thought giving "so much" pain medication was wrong and was upset enough to track down and call my medical director to complain. I have had nurses say "12 milligrams? 12 mlligrams?" like they didn't hear me correctly or thought I said 40 or 50.

I could go on and on with these types of stories. Some docs and nurses are just plain rotten at pain relief. When you throw addiction into this mix, it only makes it worse. Then on top of it, as we have all seen the number of people addicted to opiates increase by huge amounts over the last years, we now have some medical professionals pointing at the recent focus on pain management as the reason. And it may well be at least part of it. Unfortunately the gains in pain management that had been made are in some cases going back in the wrong direction.

I guess my main point here is, I would strongly suggest that addiction is not the reason for poor pain management in the hospital. It happens all the time to people who have never had pain medication in their life, 90-year-old patients, 8-year-old kids - you name it. It's not only addicts who are often left in pain.

As to pain management while on Suboxone, I have to unfortunately agree with Jackcrack (not that it's unfortunate that I have to agree with her) she is just correct when she says it's rare that she hears of anyone on Suboxone get good pain relief from opiates. I agree with her. I have not seen much of it either. The two just are not compatable. It most often takes non-narcotic medication, huge, and I mean like five to ten times normal, doses of opiates, or 3-5 days without Suboxone to get relief.

It certainly seems like we are at least starting to get better at treating addiction with the use of Suboxone. That clearly has a long was to go as well but we are much farther ahead in addiction treatment than we are at treating pain while on Suboxone or getting off of Suboxone. We still have a long, long way to go with both of these. Limited healthcare providers understand Suboxone, but even far less understand treating pain while on it, and even less than that understand how to get a patient off of it.

If only we could get Dr. J to quit his job and travel the country giving lectures to doctors and nurses about Suboxone.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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