Re: pain scale. When we were in the USAF, a friend and I used to make fun of the pain scale's absolute subjectivity. It was used as a wellness check during the annual physical exam, which was stationary biking on an air intake monitor and electrocardiogram or something. We always thought it would be hilarious to just mimic severe heart attack style pain, sweating bullets, nearly unable to speak, in absolute agony, but when asked about the pain scale, say "TWO. TWO. ... POSSIBLY THREE."
Sooo as a cancer survivor and somebody who has had a third degree burn I have a pretty different take. Those is us who have been through some shit DO struggle with the scale. My ‘10’ is based on the experience of nerve death. So if I want a doctor to take something seriously do I use the “normal person” scale? Or do I use MY scale? It’s a stupid fucking poster.
@@munchkingod6 Sounds like we have the same take - it's an impossibly subjective scale and, in most cases, it's probably the best we can do. It's probably most useful when measuring whether moderate pain is increasing or decreasing.
I'm not a chronic pain sufferer, although I work in a kitchen and have gotten serious oil burns, and I think the scale is dumb. I could have a severe burn or be dripping blood and still say 2-3 because I can IMAGINE something worse... Even if this is the worst I've felt!
@@alexanon8345 For all its faults, in my limited experience, it's best used in health care not to determine the amount of pain, but whether pain is increasing or decreasing over time. As subjective as the scale is, its subjectivity is kind of inevitable.
@@delusionnnnnthis is the main thing. Also the subjectivity tells them if they need to help you. If someone is reporting a 9, they're likely to duck out and get some painkillers, but if it's a 2 they expect you're experiencing mild discomfort and don't need pain management. Subsequent asks are just to see how your pain has changed. If you report a 9, they give you pain meds, and an hour later you're still high at like an 8, they might get you the good stuff and/or rush you in for tests because your pain is so severe pain meds seem to be having no major effect. Appendicitis is one where this might happen, when normal pain meds have no real effect and it's gut pain, they're gonna drag you in to get you checked immediately cos you might be close to fully burst appendix.
I remember reading that the thing that really replaced lobotomies was lithium bromide, the first anti-psychotic - and it's definitely worth mentioning that the side effects of early anti-psychotics were notoriously severe; to the point where it wasn't much of an improvement over lobotomies.
The Sackler strategy was to blame the addicts for being weak because they become hooked on a drug that causes physical dependence. The Sackler's addiction to obscene amounts of money and power, well that's ok.
There’s a reason I advocate that corporate malfeasance like this should A) have penalties that START at the gross income from the bad behavior, and B) negate the limited liability of corporate behavior.
The pain scale is highly subjective but even if people are truthful women and people of color are often seen as exaggerating their pain so there are other problems too
It's worth noting that while the Sacklers and the opioid epidemic they produced have proven incredibly harmful to public health as a whole, it wasn't all bad. Opioid research has greatly improved the medical understanding of opioids and pain more generally, and Purdue's marketing to doctors emphasized that managing patient's pain was at least as important as any other symptom - which was absolutely correct. Previously, patient's pain was often considered unimportant, especially for women and black people. Naturally that lead to a great deal of unnecessary suffering. As somebody who has suffered from intense chronic pain their entire life due to a genetic disease, the willingness of doctors to actually recognize pain as a major problem is a small silver lining to the dark storm cloud of the opioid epidemic. I use the lowest dose I can get away with to treat my pain, but the only reason I'm still alive is because I relented and tried an opioid before I managed to successfully kill myself due to the terrible and intractable pain I was suffering from.
Yeah before OXy long term pain management was like a morphine stint in your spine.There has to be a happy medium between only giving strong pain meds to people who are dying and giving them to people for a sprain or toothache...
I'm lucky enough not to need that level of pain medication consistently, but I've had two vitrectomies (an eye surgery to reattach the retina after it gets detached) since last November (of 2023 - it's currently April 2024, for reference), and I got prescribed 0 pain meds for either surgery (as opposed to when I got my wisdom teeth out in college years ago, and got like 2-3 weeks' worth of some opioid, possibly hydrocodon? I needed one refill on it because the pain was still there after the meds ran out because I heal slowly and have sensory sensitivity issues, but after that refill ran out it was fine). For my vitrectomies, I didn't even get prescribed any non-opioid ones (like those big ibuprofens that you can only get by prescription, which my dad gets for his back). The worst pain wasn't so much the wounds in my face healing (that just kind of felt like I'd accidentally walked into something, but a few days back; it was a dull ache that was consistent and lessened over time). The worst was when the sutures in my eye started dissolving (which they're supposed to do) and apparently there were "jagged" eye edges/surgical cuts rubbing against each other? It wasn't even just the pain intensity, but how sudden and overwhelming it would be. OTC pain meds did basically nothing for it. Anyway, I'm not a doctor, but I feel like post-major-surgery is one of the times when you maybe do need strong painkillers. Anytime you have to get fully anesthetized for the procedure, especially a medically necessary procedure, let's say (also, chronically ill people with chronic pain should get strong pain meds if they want them, too).
Librium still exists today. It's a benzodiazepine like Valium. Librium is usually used for detoxing alcoholics (quitting cold turkey can give you seizures and kill you.) I used to get alcohol withdrawal seizures.
I worked as a secretary to orthopedic surgeons in the 90s pre-oxy and my entire day was spent on the phone with people in chronic pain. It was not fun. I realize that there needs to be moderation in prescribing it, but there was definitely then and now a legit need for good pain meds. Addiction/drug seeking behavior was constant then as well, my favorite excuse was a post-op patient who'd had a massive back surgery a couple a few weeks prior saying he lost his pills canoeing in the boundary waters. Like dude??? For real? The idea that life should be entirely pain free is ridic and so is someone going canoeing less than a month after major back surgery.
The thing about the generics… seems to me if your drug is too susceptible to abuse to go generic, then the production of it cannot be in the hands of a for-profit agency…
The new Fall of House Usher show is pretty funny overt dramatization of these monsters. the last few episodes really hit the "I know writers who use subtext and they are all cowards" vibe
They prescribed hydrocodone as a heart med for me even though I didn't want opiates specifically.... Thank you for letting me know it was a lie. I only use ibuprofen or acetaminophen on #10 bad days where I'm nearly blacking out. Most of the time it's only an #8 where it's agony but if I get injured I feel it. Last week I was in a 9 after tearing up my knee after being cutt off riding a bike.
Money. It buys bodyguards, security systems, and it means that when you turn up dead in a ditch, EVERY cop in the area is gonna be looking to close the case ASAP.
Re: pain scale. When we were in the USAF, a friend and I used to make fun of the pain scale's absolute subjectivity. It was used as a wellness check during the annual physical exam, which was stationary biking on an air intake monitor and electrocardiogram or something. We always thought it would be hilarious to just mimic severe heart attack style pain, sweating bullets, nearly unable to speak, in absolute agony, but when asked about the pain scale, say "TWO. TWO. ... POSSIBLY THREE."
Sooo as a cancer survivor and somebody who has had a third degree burn I have a pretty different take. Those is us who have been through some shit DO struggle with the scale. My ‘10’ is based on the experience of nerve death.
So if I want a doctor to take something seriously do I use the “normal person” scale? Or do I use MY scale?
It’s a stupid fucking poster.
@@munchkingod6 Sounds like we have the same take - it's an impossibly subjective scale and, in most cases, it's probably the best we can do. It's probably most useful when measuring whether moderate pain is increasing or decreasing.
I'm not a chronic pain sufferer, although I work in a kitchen and have gotten serious oil burns, and I think the scale is dumb. I could have a severe burn or be dripping blood and still say 2-3 because I can IMAGINE something worse... Even if this is the worst I've felt!
@@alexanon8345 For all its faults, in my limited experience, it's best used in health care not to determine the amount of pain, but whether pain is increasing or decreasing over time. As subjective as the scale is, its subjectivity is kind of inevitable.
@@delusionnnnnthis is the main thing. Also the subjectivity tells them if they need to help you. If someone is reporting a 9, they're likely to duck out and get some painkillers, but if it's a 2 they expect you're experiencing mild discomfort and don't need pain management. Subsequent asks are just to see how your pain has changed. If you report a 9, they give you pain meds, and an hour later you're still high at like an 8, they might get you the good stuff and/or rush you in for tests because your pain is so severe pain meds seem to be having no major effect. Appendicitis is one where this might happen, when normal pain meds have no real effect and it's gut pain, they're gonna drag you in to get you checked immediately cos you might be close to fully burst appendix.
I remember reading that the thing that really replaced lobotomies was lithium bromide, the first anti-psychotic - and it's definitely worth mentioning that the side effects of early anti-psychotics were notoriously severe; to the point where it wasn't much of an improvement over lobotomies.
The Sackler strategy was to blame the addicts for being weak because they become hooked on a drug that causes physical dependence. The Sackler's addiction to obscene amounts of money and power, well that's ok.
There’s a reason I advocate that corporate malfeasance like this should A) have penalties that START at the gross income from the bad behavior, and B) negate the limited liability of corporate behavior.
The pain scale is highly subjective but even if people are truthful women and people of color are often seen as exaggerating their pain so there are other problems too
It's worth noting that while the Sacklers and the opioid epidemic they produced have proven incredibly harmful to public health as a whole, it wasn't all bad. Opioid research has greatly improved the medical understanding of opioids and pain more generally, and Purdue's marketing to doctors emphasized that managing patient's pain was at least as important as any other symptom - which was absolutely correct. Previously, patient's pain was often considered unimportant, especially for women and black people. Naturally that lead to a great deal of unnecessary suffering.
As somebody who has suffered from intense chronic pain their entire life due to a genetic disease, the willingness of doctors to actually recognize pain as a major problem is a small silver lining to the dark storm cloud of the opioid epidemic. I use the lowest dose I can get away with to treat my pain, but the only reason I'm still alive is because I relented and tried an opioid before I managed to successfully kill myself due to the terrible and intractable pain I was suffering from.
Yeah before OXy long term pain management was like a morphine stint in your spine.There has to be a happy medium between only giving strong pain meds to people who are dying and giving them to people for a sprain or toothache...
I'm lucky enough not to need that level of pain medication consistently, but I've had two vitrectomies (an eye surgery to reattach the retina after it gets detached) since last November (of 2023 - it's currently April 2024, for reference), and I got prescribed 0 pain meds for either surgery (as opposed to when I got my wisdom teeth out in college years ago, and got like 2-3 weeks' worth of some opioid, possibly hydrocodon? I needed one refill on it because the pain was still there after the meds ran out because I heal slowly and have sensory sensitivity issues, but after that refill ran out it was fine).
For my vitrectomies, I didn't even get prescribed any non-opioid ones (like those big ibuprofens that you can only get by prescription, which my dad gets for his back).
The worst pain wasn't so much the wounds in my face healing (that just kind of felt like I'd accidentally walked into something, but a few days back; it was a dull ache that was consistent and lessened over time). The worst was when the sutures in my eye started dissolving (which they're supposed to do) and apparently there were "jagged" eye edges/surgical cuts rubbing against each other? It wasn't even just the pain intensity, but how sudden and overwhelming it would be. OTC pain meds did basically nothing for it.
Anyway, I'm not a doctor, but I feel like post-major-surgery is one of the times when you maybe do need strong painkillers. Anytime you have to get fully anesthetized for the procedure, especially a medically necessary procedure, let's say (also, chronically ill people with chronic pain should get strong pain meds if they want them, too).
Librium still exists today. It's a benzodiazepine like Valium. Librium is usually used for detoxing alcoholics (quitting cold turkey can give you seizures and kill you.) I used to get alcohol withdrawal seizures.
I worked as a secretary to orthopedic surgeons in the 90s pre-oxy and my entire day was spent on the phone with people in chronic pain. It was not fun. I realize that there needs to be moderation in prescribing it, but there was definitely then and now a legit need for good pain meds. Addiction/drug seeking behavior was constant then as well, my favorite excuse was a post-op patient who'd had a massive back surgery a couple a few weeks prior saying he lost his pills canoeing in the boundary waters. Like dude??? For real? The idea that life should be entirely pain free is ridic and so is someone going canoeing less than a month after major back surgery.
The thing about the generics… seems to me if your drug is too susceptible to abuse to go generic, then the production of it cannot be in the hands of a for-profit agency…
The new Fall of House Usher show is pretty funny overt dramatization of these monsters.
the last few episodes really hit the "I know writers who use subtext and they are all cowards" vibe
They prescribed hydrocodone as a heart med for me even though I didn't want opiates specifically.... Thank you for letting me know it was a lie. I only use ibuprofen or acetaminophen on #10 bad days where I'm nearly blacking out. Most of the time it's only an #8 where it's agony but if I get injured I feel it. Last week I was in a 9 after tearing up my knee after being cutt off riding a bike.
10:55 umm, phrasing...
Y'know, I will give kudos to the Sackler parents for naming, cause I cannot stop calling him Dick Sackler now.
Love from a Suris and Vaush fan!
In a country with loose gun laws and so many victims of these people, how are they allowed to live?
Money. It buys bodyguards, security systems, and it means that when you turn up dead in a ditch, EVERY cop in the area is gonna be looking to close the case ASAP.
Back in the day fentanyl was called China White. (Alpha methyl fentanyl) aka China White