Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP
Path: utzoo!watmath!clyde!caip!rutgers!husc6!seismo!rochester!ritcv!cci632!rb
From: rb@cci632.UUCP (Rex Ballard)
Newsgroups: sci.med
Subject: Re: Aspirin vs. Codine
Message-ID: <543@cci632.UUCP>
Date: Mon, 20-Oct-86 11:09:06 EDT
Article-I.D.: cci632.543
Posted: Mon Oct 20 11:09:06 1986
Date-Received: Tue, 21-Oct-86 23:28:30 EDT
References: <1823@bu-cs.bu-cs.BU.EDU> <529@cci632.UUCP> <21708@rochester.ARPA>
Reply-To: rb@ccird2.UUCP (Rex Ballard)
Organization: CCI, Rochester Development, Rochester, NY
Lines: 68
Summary: What to do about pain.

In article <21708@rochester.ARPA> ray@rochester.ARPA (Ray Frank) writes:
>> In article <1823@bu-cs.bu-cs.BU.EDU> bzs@bu-cs.BU.EDU (Barry Shein) writes:
>> >codeine pills which kind of wiped me out but did little to reduce the
>> >pain (I sort of laid there and complained more slowly.)
>
>  My question is this, does a person confined to a hospital bed in a modern
>hospital have any rights?

Many doctors to allow a patient to self-reduce their pain medication, or go
without if they wish, but PRN prescriptions have to be limited externally
by the doctor to prevent overuse.

> Don't doctors realize that everyone is not the same and that
>one pill every four hours is fine for one but inadequate for another?

Yes, they do.  The problem here is three fold.  The patient may have an
"anti-depressant metabolism", in which case the body tries to detoxify
itself more quickly.  Often this occurs in people with previous drug use
history, or when patients are anxious.

Another problem is the "threshold" which the patient can tolerate.  Some
people can handle a root-canal with no anesthisia, others can't handle
a splinter or a bee sting.

Finally, the safest, and most effective form of pain relief comes from
within the body itself, in the form of something called endorphines.
Unfortunately, in order for this substance to be produced, the nerves
in the area have to be able to sense the pain.  Too much medication
prevents the production of this natural form of pain relief.

>I realize that nurses cannot increase medication without a doctors orders, but
>they certainly must have the training necessary to assess the situation
>on a patient by patient basis and relay this information to the doctor.  

Unfortunately, nurses often have little input with some "egotistical" doctors.
They have the training to know what is needed, but can do nothing unless the
attending physician requests their input.

>I don't
>believe it is necessary or correct to have to wait until the next day to
>have your doctor prescribe more relief.

If there are medical complications, such as infections, you can bet something
will happen.  Pain on the other hand, is something that often cannot be
controlled.

One thing that I have seen/experienced, is the use of "Lamaze" type techniques
for pain control.  I first saw this used on my father, who for a number of
reasons could not use normal pain control medications when he had his
appendix removed.  The irony was that, even though he was recieving no
medications, he was up and on his feet much sooner than similar patients
who were given pain medication.  I have also used it for a situation where
I got some second degree burns over 3/4 of my hand (flaming oil).

In one study, originally conducted to test the effectiveness of acupuncture
as a means of pain control, both the patients recieving placebo methods and the
group using acupuncture recovered more quickly than those recieving chemical
relief.  Various meditation techniques have also proven more effective in
pain relief than chemicals.

Doctors realize that no medication will leave a patient "pain free".  The
patient might get enough relief to get some sleep, or at least relax, but
not enough to "feel nothing".  It is possible to do this, such as during
the operation itself, but the risks are very high.  More OR fatalities
occurr due to anesthesia than due to the operation itself.

>ray
rex