Pain Management

First, just a note to let you all know I'm out of the hospital. Slept in my own bed last night. Slept. Well.

I learned some interesting things the last few days on the topic of pain management. Pain I know well. Management has long been more of an issue.

Way back in the day something called Darvon seemed to be doctors' first choice. Never did much for me. Not for headaches, not for sprained ankles, not for abcessed teeth. Apparently I'm not alone in my lack of fondness for the stuff. It's no longer available.

It was so lousy at fulfilling its task that for decades afterwards I had no real hope of an effective painkiller without addiction strings. Codeine had weird side effects got itself tagged with "allergy" next to it. Not exactly precise, but a word that saved long discussions. Acetaminophin or aspirin were the fallbacks and again. Other than the reputation, they didn't have much going for them. Ibuprofin was a breakthrough. But still: limitations.

That was me since 1985.

About 5 years ago I discovered dilaudid. A REAL painkiller. No high, at least not for me. No problems weaning myself off. Doctors really have to be arm-twisted to give it. It seems it does the best job out there these days of leading to addiction. But hey, it still works. It's still the only thing that really does, at least for me.

When I had to leave ibuprofin behind before surgery, I got switched to Percoset. One of those oxy... drugs. It kept my knees from killing me pre-surgery. It's not perfect. Way better than nothing, though. I could function moderately around the house, and I could tolerate PT.

After surgery there were two main options, administered alternatively, occasionally overlapping. One was Perc, the other dilaudid. Perk was a tablet. Dilaudid was the reason they kept the IV port in, and usually administered shortly before PT on the theory that it let you actually get through it, and maybe even continue to live the half hour following. You know, without killing the next person you saw. But they wanted to get me off the IV before I could leave the hospital. I saw their point, since I'm not personally into self-administered IV meds., but then they went in the wrong direction.

They tried substituting tramazol. For both meds. They knew I could tolerate Percoset but pulled me off that anyway. No, it didn't leave me likely to wind up killing the next person through the door, but only because I couldn't move enough to get out of bed, much less far enough to untangle the "pain free" leg from the wad of pillows and sheets it was entrapped in. After all, a half inch of movement in the better leg was still enough to deal a hatchet blow to the bad one. Heck, I couldn't move enough to  slide my butt an inch off the latest sheet wrinkle that decided to grow into a mountain range.

So here's the list: in major pain, wrapped and trapped by bedding, in a dark room because somebody thoughtfully turned off the room light that they no longer needed. I tried yelling - oops! too much inhaling moves the chest, connected to the hip, connected to the thigh... connected to the knee.... As it turned out later, all the noise out in the center of the ward was because of some kind of staff meeting and after bedtime was supposed to be an non-demanding time on the care staff, so even if I had felt up to a full chested roar, it wouldn't have been heard. Oh sure, you say, I could've reached for the call button - if it were in reach, and if where I was pushing on whatever this thing in my had (call?) (phone?) was the right point, and if it... oh nevermind, whatever this thing had been connected to, it no longer was anyway.

I did mention pain, right? And of course by then I had to pee.

Luckily for me - or the blessings of good engineering and experience with cranky, screaming, hurting, post-op patients - their call boards are rigged up so that if/when you pull a cord out of the wall, a whole new kind of alarm goes off and somebody comes rushing in.

Also lucky for me, I had a threat and was willing to use it. I REALLY needed to pee by now, but was refusing to do so in the proper place until they got my pain levels down.

"Bring me my dilaudid!"

They did.

Two doses, IV.

Then they unpacked me, an impediment at a time, so that once I was willing to move, it would again be possible physically. I also had them remove three of the pillows wound around my legs, remove the inflator/deflator thing on the good leg, pull blankets down off my feet, and relocate me into the recliner so I had proper hand/arm support to be able to move without falling.

Nobody had to scrub the floor that night after all. And I finally had been shown how to hang where onto which exactly so that I could safely use toilet paper myself instead of relying on the kindness of strangers. Now that's what I call freedom! By some odd coincidence, every staffer who'd been in to help with that last task had been male. Yes, you do get used to it, but I always figured a girl shouldn't have to.

I returned to the chair afterwards and next thing I knew it was the start of the morning routines. I never did wind up back in that bed.

One part of morning routine was a check in by the hospital internist. We discussed my zero response to tramadol and what can be used instead. My next threat in the arsenal was to refuse to leave if they couldn't figure out how to manage my pain. I mean, this was the point of the whole exercise, wasn't it?

This doc knew not only what I was talking about, being himself immune to the possible benefits of tramadol, but having a possible solution long-term. Short term, fine, give me something different so I can sleep right now. But long term, here's a guy who actually listens to more than the actuarials  and those folks who think that Brand W should work so that's what you'll get. So let's go to work trying to prevent this happening next time.

The solution is a DNA test that Medicare will actually pay for. You caught that? Medicare will actually pay for the test!

It's about how we metabolize different drugs. For example, alcohol: I'm one of those who can have a drink, get high nearly instantly and be well into my hangover before I'm out of the door heading home. Drunk just isn't fun. I don't know if the test checks on ethanol, but it came into the conversation as an example of how metabolisms differ. Apparently there is a segment of us who  metabolize tramadol nearly instantly so nothing is left to kill pain in a few short minutes. This test keeps us from wasting money on expensive painkillers that don't work anyway and are gone so fast that a newer bigger dose seems like a good idea.

Now that seems like a big step down the road to that cherished fantasy, actual pain management.

I'm willing to give it a go.