Painkillers That Won't Kill

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The continuing controversy over the long-term side effects of nonsteroidal anti-inflammatory drugs highlights the medical profession's unreasonable aversion to opioids, which are considerably safer and would be a better choice for many people with moderate to severe chronic pain. While NSAIDs have long been known to cause stomach and/or liver problems in large doses and are now believed to raise the risk of heart attacks, the main long-term problem with opioids (in appropriate doses) is constipation, which can be countered with laxatives. But the opiophobia instilled by the war on drugs prevents an honest weighing of painkillers' risks and benefits.

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  1. “While NSAIDs have long been known to cause stomach and/or liver problems in large doses and are now believed to raise the risk of heart attacks,”

    Maybe, but as was pointed out in this article, sometimes the risk is worth the reward (lesser pain). I think doctors now monitor dosages of NSAIDS more closely and may combine them with an opioid, or perhaps something like a Duragesic patch.

    “the main long-term problem with opioids (in appropriate doses) is constipation, ”

    Boy howdy, ain’t that the truth. Your point, Mr. Sullum, is spot-on. How can a doctor give an objective opinion on proper medical treatment when he’s busy thinking about the possible consequences to HIM? Sad, really.

  2. My wife suffers severe hip pain. The drug that works best for her is Vicodin. She takes about 1.5 per week–no addiction here! Due to fucked-up govt. regs, she can’t get a refill without going to the doctor each time (big $$$), and the doctors are afraid to prescribe it because of fear of federal prosecution. All she wants is the one substance on Earth that relieves her pain without making her sick, yet those stupid, evil bastard politicians make it as difficult as possible for her. I hold each and every pro-drug-control pol responsible for her pain, and I wish each great unrelieved pain and suffering for the rest of their pitiful, useless lives. These people PURPOSEFULLY cause needless pain. They are evil. There is no other explanation for the great harm that they do.

  3. Bill,

    Your wife suffers severe hip pain and only needs 1.5 vicodin per WEEK? Perhaps half of a Percocet will do the trick.

  4. Some preparatory comments: 1) I believe that essentially all drugs should be legalized 2) I am a doctor (general/trauma surgeon). That being out of the way — all drugs have side effects. Narcotics essentially always cause constipation and actually this has (and continues to) cause death due to bowel perforation (pseudo-obstruction or stercoraceous perforation). It is not always benign. Secondly anyone on narcotics should not drive or operate heavy machinery because narcotics do make you drowsy, confused, etc. Third, chronic use of narcotics essentially always requires steadily increasing doses because of up-regulation of opiod receptors. This does lead to dependance in a majority of chronic users, addiction (defined as dependance that negatively affects the patient) in a smaller but not insignificant number. Finally NSAIDS, unlike opiods are not just painkillers, they decrease inflammation. When inflammation is a significant component of the pain (acute injury, fracture, arthritis, etc.) the anti-inflammatory effect actually treats the problem rather than suppressing the symptom.

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