They really don't, at least not very long, and usually not for chronic pain! Acute pain and chronic pain are very different.
They respond to different therapies, may share common causes, and really behave, or misbehave, very differently.
Acute pain is pain you've had less than three months.
It usually follows an acute injury such as a fracture, or surgery.
With reasonable treatment it usually fades away and in a few weeks is gone completely.
It usually responds to moderate doses of opioids.
[That big word, opioids really means the large class of drugs that have effects like morphine, which comes from opium, and causes most of its effects.
Narcotics is a class of materials defined by THE LAW by simply listing them, and includes cocaine and marijuana which are not opioids.
] Chronic pain has already lasted at least three months.
That makes it chronic.
It commonly doesn't respond very well to opioids/narcotics.
It usually does respond pretty well to interventional treatment, and frequently to nutritional changes and physical conditioning.
In the rest of this paper I'll refer to the opioids as narcotics, even though that's not strictly correct.
I had shoulder surgery in July, and again in October for repair of my right rotator cuff.
My pain after surgery did not respond well to the Percocet that was prescribed for me.
I also took Ibuprofen and Aspirin for my pain.
They seemed to work better than the Percocet.
I finally decided to just take the Percocet at night, because it made me sleepy anyway.
The rest of the time I mostly used the Ibuprofen or just put up with the pain.
Why would I put up with the pain, and try to work through it? That's a cultural thing.
I was brought up in a culture of "OK, so it hurts! Now suck it up and keep going! We're burning daylight!" Putting up with unpleasantness was a major virtue.
I copied my parents' attitudes.
Now, they're both dead, and I still behave that way.
I'm not usually aware of unpleasantness in my body as 'pain.
' Different cultures place different values on bearing pain.
Some insist that in some situations it's necessary to make a racket to deal with it properly.
I'm almost three months out from the second surgery, and I hurt some, some of the time.
That qualifies as acute, and fading, pain.
I took my last Percocet over a month ago.
Lots of patients with chronic pain came to me complaining the narcotics the primary physician prescribed just weren't relieving their pain.
Some were angry; most were disgusted.
The problem with using narcotics for pain is that it's just plain tricky! Some patients get good relief with a dose that's just a little bigger than the doctor is willing to order, or the nurse is willing to give.
Occasionally the problem of 'how much is enough' is the whole problem.
More often, the real problem is that the pain just won't respond to any amount of narcotics for more than a short time.
Then the patient complains of the pain coming back and has a long list of complaints about the narcotic effects.
These include nausea, SEVERE constipation (locked bowels), and sometimes IMPOTENCE, or simply loss of interest in sex.
The list of painful problems that narcotics don't help is long.
The conditions are common.
They are nearly all related to various things that injure nerves directly.
They include: spinal cord injury, peripheral nerve injury, spinal disk disease, persistent pain after back surgery, fibromyalgia, diabetic neuropathy, and other metabolic nerve damage.
None of these respond well to narcotics.
Most of them do not respond at all to narcotics.
When the narcotics give relief, it only lasts a little while, and then the poor soul needs more narcotic to relieve the pain, then more, then more, ad infinitum.
Street Value Of The Drugs This is one huge problem, because of the law about narcotics.
Providing, and (especially) selling either the prescription or the drugs to someone other than the one they were prescribed for is a federal FELONY (LONG JAIL TIME!) Don't bug me about what the law ought to be.
THE LAW IS WHAT IT IS! I agree that it ought to be changed, but I can't change it.
I am determined to stay OUT OF JAIL.
When people didn't get relief from moderate doses of narcotics I got suspicious! Frequently they would stop using the narcotics and sell them on the street.
That can create a substantial cash flow, at least until you get caught.
A single 80mg.
Oxycontin tablet will go for about $80 on the street.
For someone on public assistance, a month's supply of 60 tabs will go for $4800, a right tidy sum! It's illegal, so they never tell the IRS about it, and don't pay taxes on it! What a racket! A note about Oxycontin Oxycontin has been in the news occasionally.
It's been called 'Hillbilly Heroin' and is very popular with some recreational drug users.
Some people have died using Oxycontin.
I researched the details of these deaths very carefully and learned two things: People who used Oxycontin as prescribed did not die; and, nearly all of those who died had gotten it illegally.
I mourn for the pain their families feel.
For them, sympathy is in the dictionary.
The Goal of All Pain therapy The only real goal of all pain treatment including narcotic therapy, is improved function, NOT PAIN RELIEF.
Hopefully, there will be few or no side effects, reasonable relief, and no increase in the street drug trade.
My primary goal was always to STAY OUT OF JAIL.
Several doctors have gone to jail for careless prescribing or deliberately feeding the street trade.
HOW DID I KEEP CONTROL ON MY PRACTICE? I got regular urinalysis for all the specific drugs being prescribed legally and some that were just on the street.
I didn't tell them when the sample would be required.
This is a lot more detailed than the usual emergency room drug screen, which just checks for 'opioids' and doesn't check which ones.
If the urinalysis didn't show the stuff I was prescribing the patient got fired from my practice.
If it showed illegal substances he got fired.
If it showed narcotics I didn't prescribe, Bye bye forever! Sam was a big, muscular guy with rough hands and muscles like a bull! He was a bricklayer.
He complained of pain and insisted the only thing that gave him relief was narcotics.
His urinalysis result showed no evidence of the Oxycontin I prescribed, and lots of methadone.
FIRED! Alex declined all procedures for pain, and initial urine showed THC and Cocaine.
FIRED! I'm devoted to doing what really benefits the patients.
They respond to different therapies, may share common causes, and really behave, or misbehave, very differently.
Acute pain is pain you've had less than three months.
It usually follows an acute injury such as a fracture, or surgery.
With reasonable treatment it usually fades away and in a few weeks is gone completely.
It usually responds to moderate doses of opioids.
[That big word, opioids really means the large class of drugs that have effects like morphine, which comes from opium, and causes most of its effects.
Narcotics is a class of materials defined by THE LAW by simply listing them, and includes cocaine and marijuana which are not opioids.
] Chronic pain has already lasted at least three months.
That makes it chronic.
It commonly doesn't respond very well to opioids/narcotics.
It usually does respond pretty well to interventional treatment, and frequently to nutritional changes and physical conditioning.
In the rest of this paper I'll refer to the opioids as narcotics, even though that's not strictly correct.
I had shoulder surgery in July, and again in October for repair of my right rotator cuff.
My pain after surgery did not respond well to the Percocet that was prescribed for me.
I also took Ibuprofen and Aspirin for my pain.
They seemed to work better than the Percocet.
I finally decided to just take the Percocet at night, because it made me sleepy anyway.
The rest of the time I mostly used the Ibuprofen or just put up with the pain.
Why would I put up with the pain, and try to work through it? That's a cultural thing.
I was brought up in a culture of "OK, so it hurts! Now suck it up and keep going! We're burning daylight!" Putting up with unpleasantness was a major virtue.
I copied my parents' attitudes.
Now, they're both dead, and I still behave that way.
I'm not usually aware of unpleasantness in my body as 'pain.
' Different cultures place different values on bearing pain.
Some insist that in some situations it's necessary to make a racket to deal with it properly.
I'm almost three months out from the second surgery, and I hurt some, some of the time.
That qualifies as acute, and fading, pain.
I took my last Percocet over a month ago.
Lots of patients with chronic pain came to me complaining the narcotics the primary physician prescribed just weren't relieving their pain.
Some were angry; most were disgusted.
The problem with using narcotics for pain is that it's just plain tricky! Some patients get good relief with a dose that's just a little bigger than the doctor is willing to order, or the nurse is willing to give.
Occasionally the problem of 'how much is enough' is the whole problem.
More often, the real problem is that the pain just won't respond to any amount of narcotics for more than a short time.
Then the patient complains of the pain coming back and has a long list of complaints about the narcotic effects.
These include nausea, SEVERE constipation (locked bowels), and sometimes IMPOTENCE, or simply loss of interest in sex.
The list of painful problems that narcotics don't help is long.
The conditions are common.
They are nearly all related to various things that injure nerves directly.
They include: spinal cord injury, peripheral nerve injury, spinal disk disease, persistent pain after back surgery, fibromyalgia, diabetic neuropathy, and other metabolic nerve damage.
None of these respond well to narcotics.
Most of them do not respond at all to narcotics.
When the narcotics give relief, it only lasts a little while, and then the poor soul needs more narcotic to relieve the pain, then more, then more, ad infinitum.
Street Value Of The Drugs This is one huge problem, because of the law about narcotics.
Providing, and (especially) selling either the prescription or the drugs to someone other than the one they were prescribed for is a federal FELONY (LONG JAIL TIME!) Don't bug me about what the law ought to be.
THE LAW IS WHAT IT IS! I agree that it ought to be changed, but I can't change it.
I am determined to stay OUT OF JAIL.
When people didn't get relief from moderate doses of narcotics I got suspicious! Frequently they would stop using the narcotics and sell them on the street.
That can create a substantial cash flow, at least until you get caught.
A single 80mg.
Oxycontin tablet will go for about $80 on the street.
For someone on public assistance, a month's supply of 60 tabs will go for $4800, a right tidy sum! It's illegal, so they never tell the IRS about it, and don't pay taxes on it! What a racket! A note about Oxycontin Oxycontin has been in the news occasionally.
It's been called 'Hillbilly Heroin' and is very popular with some recreational drug users.
Some people have died using Oxycontin.
I researched the details of these deaths very carefully and learned two things: People who used Oxycontin as prescribed did not die; and, nearly all of those who died had gotten it illegally.
I mourn for the pain their families feel.
For them, sympathy is in the dictionary.
The Goal of All Pain therapy The only real goal of all pain treatment including narcotic therapy, is improved function, NOT PAIN RELIEF.
Hopefully, there will be few or no side effects, reasonable relief, and no increase in the street drug trade.
My primary goal was always to STAY OUT OF JAIL.
Several doctors have gone to jail for careless prescribing or deliberately feeding the street trade.
HOW DID I KEEP CONTROL ON MY PRACTICE? I got regular urinalysis for all the specific drugs being prescribed legally and some that were just on the street.
I didn't tell them when the sample would be required.
This is a lot more detailed than the usual emergency room drug screen, which just checks for 'opioids' and doesn't check which ones.
If the urinalysis didn't show the stuff I was prescribing the patient got fired from my practice.
If it showed illegal substances he got fired.
If it showed narcotics I didn't prescribe, Bye bye forever! Sam was a big, muscular guy with rough hands and muscles like a bull! He was a bricklayer.
He complained of pain and insisted the only thing that gave him relief was narcotics.
His urinalysis result showed no evidence of the Oxycontin I prescribed, and lots of methadone.
FIRED! Alex declined all procedures for pain, and initial urine showed THC and Cocaine.
FIRED! I'm devoted to doing what really benefits the patients.