Wednesday, August 11, 2010

About Pain Meds and MJ

After my mother gave birth to my sister and me (or, removing grammatical convention, me and my sister--I was born 10 minutes before she was), she went into cardiovascular collapse after the administration of percocet, a combination of acetaminophen and oxycodone.  My mother has long contended that she has a dangerous allergy to this medicine; she experienced the classic near-death experience, and her heart had to be restarted with paddles.  A brand new nurse broke down in tears.  The truth is that my mother probably is not allergic.  Instead, she was a very tiny woman and was not narcotic-tolerant: oxycodone should never be administered to a non-opiate tolerant patient (60 mg. of hydrocodone daily, for example), nor should it be used for short-term pain. Doing so creates the risk of breathing problems and cardiovascular collapse such as my mother's; it also carries a strong risk for addiction.  I should say that my own dose of pain medicine comes nowhere near close to qualifying me for using oxycodone, and I would be more than hesitant to use it because of the risks, whatever the benefits.  I can attest to the risks of another drug with similar effects; I had fentanyl post-surgically, and while it ameliorated temporarily agonizing pain (gas pressure on an already badly painful spine), it depressed my breathing greatly.

Given such considerations, I was highly surprised and alarmed when an ER doctor gave a relative a small prescription of oxycodone for an acute injury, especially since three ibuprofen (600 mg., standard for an injury) take her pain away and a much milder pain medicine should work if higher doses of ibuprofen need to be avoided. Frankly, I am worried and concerned from this single incident that ER doctors are giving pain medicines like this routinely.  Are we to believe that the recommendations of pharmacists and reference books are just fluff, or are we to look to individual cases like my mother's and see that the dangers are real? Do most people really need hydrocodone or percocet after wisdom tooth removal?  I don't think so.  I threw ours out!

Why do physicians often overtreat acute pain and undertreat chronic pain?  Do people believe that acute pain is a given, that chronic pain is imagined? Physically, I wonder if many people would be better off if they could use medical marijuana, at least at night to control breakthrough pain.

Cannabinoids work even where opiod receptors have been destroyed by nerve damage. While the synthetic drug Marinol is available and legal, it is as expensive as ultra-sleek disesase modifying drugs (up to $15,000 a year), and patients report it is not as effective and produces more rather than less psychologic side effects.  Certainly it is cost-prohibitive for many. It is odd to me that a drug that is so dangerous and addictive as oxycodone can be legally prescribed and yet a much milder one (cannabis) cannot be in most states.  And the form that is legal creates more psychologic side effects that people worry about than the illegal one. How much sense does that make?

Though I have long believed marijuana should be legal for cancer, glaucoma, arthritis, and other chronic pain patients, I have shied away from even discussing the topic.  But we need to speak up more, and not just for ourselves--I've been selfish not to do so.  


william Peace said...

Doctors over medicate acute pain for two reasons: 1. To provide swift and immediate release from severe discomfort. 2. To keep patient quiet, compliant, controlled and easily managed by staff.
Patients with chronic pain, especially women, are complex, time consuming whiners.

FridaWrites said...

I think you're right--I've definitely seen #2 done too. Some of the "pain" and nausea medicines given in the acute scenario are actually sedatives--phenergan and skelaxin--and people's symptoms may be worse, but they're too tired to complain about it.

That's definitely my perception of how many of my doctors see/have seen me, even though in the chronic stage I often experience a few weeks of very pain more akin to acute pain.

Penelope said...

I have a weird relationship with oxycodone. At 18 I was prescribed a low dose when tramadol didn't work for my chronic pain and had no side effects, but it also didn't do anything so we stopped it after a month. These days it's probably the best thing I could take for my pain (other than medical marijuana), but doctors won't prescribe it except for a few acute injuries I've had. I still get very few side effects from it. (I"m also fairly small 5'4", although I weight in at about 150)

I'm on Marinol for pain (well now the generic, which works as well as the name brand did for me). If you've never tried medical marijuana and your insurance covers it (there is now a generic in the US so it's getting covered more than it was a year ago), you might want to see if a doctor can prescribe you some to try it. It doesn't work as well for me as medical marijuana would (I've been to Amsterdam, I'm more functional there after smoking or using a vapourizer than I've been in years), but I do see some effect. I get a better effect when used in conjunction with an opiate (I"m on hydrocodone for this reason, but oxycodone would give me more help), but the Marinol on its own is more helpful than an opiate on its own. None of it is as good as medical marijuana for me.

There was a good article in Scientific American in December 2009 that talked about why actually things like medical marijuana are better for treating chronic pain than opiates. It was a new theory on why chronic pain happens. I keep meaning to scan it in so I can e-mail it to people. Do you want a copy when I have it?

FridaWrites said...

I think it's worth asking about the Marinol, though I don't know if a lot of doctors are biased against it. I've also read that it's not as effective, as you say, and has more unwanted side effects. It's what opponents to legislation seem to favor.

I'm definitely interested in a copy of that article--I'll also look and see if I can get it or if my husband can grab a copy when he goes to the library next.

Anonymous said...

Why do physicians often overtreat acute pain and undertreat chronic pain?

An excellent question to pose and examine.

Another suggestion re: marijuana and chronic pains is taking it in edible forms. I know the reputation of "pot brownies" is that they are intense, but they do not have to be made that way. I have people close to me that bake items in lower doses that work for them to manage their pain without feeling the disorientation that smoking can bring.

FridaWrites said...

You are right. The research says that only a fraction of the dose required to get high is required for pain relief – that's something that politicians and voters may not even realize when considering medical marijuana. Edibles are also supposed to provide longer lasting relief.