What is the most pain you have ever felt

[Ed Lada]

Lotta pressure on you guys - not just the burn guys but all of you that treat painful medical problems - to not “over prescribe”. In my never to be humble opinion most of that “surveillance” is not patient focused but is image “we’re doing something to combat the opioid crises” focused. Toss in a few politicians and attorneys and Docs are really hampered in providing care according to their judgement and experience. Sad case of cultural and corporate overreaction.

Absolutely and it isn't just opioids.

My daughter suffers from moderate to severe anxiety. She talked to her GP about it. The doc refused to prescribe benzos for her. My daughter won't go see another doctor because she is afraid of hearing the same thing, furthering her anxiety! It's just fucked up.

WTF, even if my daughter, an intelligent hard working mother of 5 year old twins, takes benzos for the rest of her life, who cares. If it provides relief it's worth it. Just one more thing about how fucked up America is getting because of an out of control epidemic that drug companies started and now doctors are afraid to provide not terribly harmful drugs and let their patients suffer needlessly. I'm glad I have German insurance I can get as many 1 mg Lorazepam tabs as I want anytime I want them no questions asked.

 

[hasher]

Taking care of a loved one through their final years, months, days, is probably one of the most difficult things a person can ever do. It drains the body physically and it drains the mind emotionally. It requires a delicate balance of care for the loved one and care for oneself. Outside help, family, friends, hospice, etc. eases the physical burden but not the emotional one. When the end comes, the crisis is over and eventually the memories of the event fade somewhat but they never go away.

We can take comfort that we did the best we could in a terrible situation. We can remember the good times and try to forget the horror of the bad times. We can remember our loved one for what they were in our life and not what they became at the end. At least we can have that satisfaction although it seems completely inadequate at times. On that happy day when we make the vow to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, until parted by death, we aren't thinking about the bad things, we want to believe it will all be good, and our love one will pass gently and quickly in their sleep. And the lucky ones do. But we never know what can happen and there is no way to prepare for it whether it s quick and peaceful or long, drawn out and a living nightmare. All we can do is the best we can and when it's over we try to pick up the pieces and live our lives as best we can. And we can draw our strength from the happy memories and not let the bad ones bring us down for too long or too far.

It is wonderful PB that you could find happiness again after losing your 1st wife. It speaks highly of your character and your inner strength and will. Now that you are facing your own demise, I'm sure you will do everything you can to make it as easy as possible for your wife.

I understand your pain. I went through 6 months of hell when my mother passed away from a malignant brain tumor. I've endured many painful trials and travails of life in my 67 years but nothing was even close to as bad as that experience. 37 years later I still think about it. I can still hear her screaming and see her body thrashing in her bed as the tumor slowly destroyed the brain of a wonderful, compassionate, loving, very intelligent woman. But I remember the 30 years of love and happiness my mother gave me and I cherish those memories. I think about her often and I remember her beautiful smile and the warmth of her love for me.

In the not so distant future I will take measures to pass peacefully and not put anybody through the painful ordeal of taking care of a useless lump of meat that used to be me. I am fortunate enough that I can do this without any trouble. I will do it for myself and for the people that care about me. Losing someone close to you is painful but I want to minimize that pain as much as I can.

It is reprehensible that for many reasons very few places in the world allow assisted suicide. What rational, empathetic person believes it is better to prolong human suffering because of some religious, moral, philosophical, or political reason. What right does any other person have to tell another person that they have no control of the only one thing we as individuals have complete control over, our very personal decision to end our own life when we believe it is untenable. Why should people who are already suffering have to have the anxiety of trying to chose a method of dying that ensures success. The anxiety of worrying that they didn't do it correctly and end up in an even worse condition and placing that burden on those around them. The anxiety of possibly suffering terrible pain as they take their last breath, The anxiety of breaking some law or causing some kind of trouble for themselves and others. That makes a difficult situation worse and it's just inhumane. States take many measures to kill criminals in a humane way out of vengeance. Yet they don't allow the same consideration to terminally ill individuals. I am the only one that thinks that is just completely irrational and sick?

I spent a number of years helping people in some kind of mental health crisis. I helped people to decide to live rather than impulsively end their life for a situation that had a reasonable alternative action that could be taken. There is great satisfaction in saving a human life. But there are times when ending ones own life is a reasonable, rational and appropriate decision. And in my mind, that should be an inalienable right. What kind of society do we live in where we allow our animals a pain free, quick and peaceful death to end their suffering and we don't allow our fellow humans to have the same dignified and peaceful death when it's appropriate. It is the right thing to do for the individual and for their loved ones.

My daughter is a psychology major. She has taken care of the elderly. It's easier to take care of old houses. She is a property manager now.

My father has no quality left in his life. I will not allow myself to be in that place.

 

[Captain Ketamine]

Although we use pain scores as a rough guide, they are just that rough. Probably better as a linear assessment of therapy. Sometimes it’s all a bit confusing and easier to ask if it’s bad or not for the patient. So really a simplified scale, mild moderate or severe. I appreciate that we’re all looking for some reproducible metric but pain scales are not always helpful. (We still use them a lot in research).
Often just observing the patient is just as good, though not always with chronic pain.
However we’ve all had patients with limited coping mechanisms sitting up, smiling, rating their pain as 12 out of 10 after quite minor injuries.
Getting pain control can be fraught with difficulty depending on the cause and patient factors. Opioids aren’t bad but you will only reduce pain scores by 30%, before you start to get side effects of the opioids. So we combine with adjuncts. Like burn doc, we use a lot of ketamine infusion (often combined with midazolam to reduce psychic effects). well use an opioid IV bolus or pad, we may be giving IV paracetamol, possibly IV paracoxib (depending on renal function and hydration status). We may add other stuff orally if the gut is absorbing, but we tend to approach in what’s known as a multi modal approach. The only problem is the multimodal can become poly pharmacy with drugs interacting causing problems.
But these drugs are short term. There’s no such thing as a free lunch, and invariably when you take medication long term you’ll often have issues like tolerance or hyper Algeria where the drug is lowering the pain threshold. It’s weighing these factors up. Unfortunately the opioid crisis has meant the pendulum swung the other way making people reluctant to prescribe opioids that may be the most appropriate.
My interest also includes the potential use of psychedelics in modern medicine. Though I’m not sure as an analgesic per set like traditional drugs. There are potential specific areas where they may be of use. This includes anxiety depression existential crisis and to some extent pain, in terminal illness. Other potential is in chronic pain with maladaptive pain behaviours, ie help get patients up and re engaged in their community. There are others. But these all should be done in the context of a supportive environment. It’s still very much in its infancy of research. There’s a lot of hype and bullshit out there. But the science is very interesting and expanding at a dramatic rate.

 

[Captain Ketamine]

Sorry hyperalgesia nothing to do with Algeria or de Gaulle or the OAS, though from memory in the original Day of the Jackal I understand testicular electrodes were applied to one of the gentlemen that was helping them with their inquiries. So I suppose he would have rated high high pain score (just saying )

 

[ShortForBob]

Hearing all these tales of pain and injury makes me wonder about men's health in general.
When I was in hospital last year (or was it the year before?) doc asked me what else I'd ever been in hospital for. I said nothing other than babies. she grinned and said "I bet you have" and looked up my records (Socialist medicine keeps a central admissions record of all PH records)

Then looked at me and said. well done.

Makes me wonder if on average (and discounting babies) men have more health issues and injury than women.

 

[veni vidi vici]

My daughter is a psychology major. She has taken care of the elderly. It's easier to take care of old houses. She is a property manager now.

My father has no quality left in his life. I will not allow myself to be in that place.

Yeah isn’t that what everyone says but most often people are just never ready to let go

 

[veni vidi vici]

Although we use pain scores as a rough guide, they are just that rough. Probably better as a linear assessment of therapy. Sometimes it’s all a bit confusing and easier to ask if it’s bad or not for the patient. So really a simplified scale, mild moderate or severe. I appreciate that we’re all looking for some reproducible metric but pain scales are not always helpful. (We still use them a lot in research).
Often just observing the patient is just as good, though not always with chronic pain.
However we’ve all had patients with limited coping mechanisms sitting up, smiling, rating their pain as 12 out of 10 after quite minor injuries.
Getting pain control can be fraught with difficulty depending on the cause and patient factors. Opioids aren’t bad but you will only reduce pain scores by 30%, before you start to get side effects of the opioids. So we combine with adjuncts. Like burn doc, we use a lot of ketamine infusion (often combined with midazolam to reduce psychic effects). well use an opioid IV bolus or pad, we may be giving IV paracetamol, possibly IV paracoxib (depending on renal function and hydration status). We may add other stuff orally if the gut is absorbing, but we tend to approach in what’s known as a multi modal approach. The only problem is the multimodal can become poly pharmacy with drugs interacting causing problems.
But these drugs are short term. There’s no such thing as a free lunch, and invariably when you take medication long term you’ll often have issues like tolerance or hyper Algeria where the drug is lowering the pain threshold. It’s weighing these factors up. Unfortunately the opioid crisis has meant the pendulum swung the other way making people reluctant to prescribe opioids that may be the most appropriate.
My interest also includes the potential use of psychedelics in modern medicine. Though I’m not sure as an analgesic per set like traditional drugs. There are potential specific areas where they may be of use. This includes anxiety depression existential crisis and to some extent pain, in terminal illness. Other potential is in chronic pain with maladaptive pain behaviours, ie help get patients up and re engaged in their community. There are others. But these all should be done in the context of a supportive environment. It’s still very much in its infancy of research. There’s a lot of hype and bullshit out there. But the science is very interesting and expanding at a dramatic rate.

Legit and a pioneer

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[Point Break]

Yeah isn’t that what everyone says but most often people are just never ready to let go

Pop used to say “nobody wants to be 100 till they’re 99”. Then after a pretty tough run, looked at me and asked “is it okay if I just stop? I’m so tired of it”. I told him yes and that he ran the full distance. He was dead in just a couple more days.

 

[Snaggletooth]

My eiyes startted leakeng withe that oune PB...

 

[MR.CLEAN]

My interest also includes the potential use of psychedelics in modern medicine. Though I’m not sure as an analgesic per set like traditional drugs. There are potential specific areas where they may be of use. This includes anxiety depression existential crisis and to some extent pain, in terminal illness. Other potential is in chronic pain with maladaptive pain behaviours, ie help get patients up and re engaged in their community. There are others. But these all should be done in the context of a supportive environment. It’s still very much in its infancy of research. There’s a lot of hype and bullshit out there. But the science is very interesting and expanding at a dramatic rate.

been microdosing psilocybin for 15 years. It definitely helps the body better manage chronic pain, for me at least. The number of people who are doing it has skyrocketed.

 

[Snaggletooth]

been microdosing psilocybin for 15 years. It definitely helps the body better manage chronic pain, for me at least. The number of people who are doing it has skyrocketed.

No wondere youre poestes haive beene so crazed and frantic lattley....

 

[veni vidi vici]

been microdosing psilocybin for 15 years. It definitely helps the body better manage chronic pain in the ass , for me at least. The number of people who are doing it has skyrocketed.

😉

 

[MR.CLEAN]

😉

Glute spasms are definitely are part of my back pain issues :0

 

[MR.CLEAN]

No wondere youre poestes haive beene so crazed and frantic lattley....

Procrastinating. Have a convertible promissory note package to draft, fucking 45 pages.

 

[veni vidi vici]

Procrastinating. Have a convertible promissory note package to draft, fucking 45 pages.

Only need the first and last page , no one will read the middle 43

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[Snaggletooth]

Wowe, VVVs a lawyere!

 

[Snaggletooth]

Procrastinating. Have a convertible promissory note package to draft, fucking 45 pages.

Be licke Bob, tacke babey steppes......

 

[MR.CLEAN]

Only need the first and last page , no one will read the middle 43

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Automate your customer service with ChatBot and never miss a chance to sell or help your customers. Build your own chatbots from scratch, no technical skills needed!

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ChatGPT may be good enough to (barely) pass a law exam, but 50% correct would not make my malpractice insurance carrier happy.

 

[Point Break]

I think it’s a real shame that the one size fits all ultra “conservative” approach to pain management has intimidated/robbed many physicians from prescribing according to their judgement and experience. I get that there is a need to encourage some “small” number (I have no data to support it’s a small number) from “over prescribing too big too early in the progression of increasingly powerful agents to find each individuals relief sweet spot. Post operative you can sometimes get reasonable short term relief but chronically or - in my experience pre-operatively - good luck.

My hips were rapidly deteriorating during the two years of the late Mrs PB’s illness and eventual passing. Constant pain but I was the care giver so her need was much greater. After she passed I went to see my Ortho the next month to get the replacements. I picked a really good Ortho guy with a strong outcome record but the down side was a 3 month wait to get on his surgical calendar. So I’m looking at 3 months of increasing pain. Couldn’t climb stairs, even walking was painful, lots of difficulty sleeping. The most powerful agent I could get were T3’s. Didn’t touch it. I have a VERY high resistance to narcotics that require more than the “normal” person to achieve any pain relief.

I opened my pantry one morning and there were a large number of Mrs PB’s fentanyl transdermal patches left over from her end stage care. They were the lowest dose available and I thought I really need some relief, I’ll give one a try. Just short of a miracle. I didn’t feel high, I didn’t get any “buzz”, I didn’t have any noticeable side effects…..I just didn’t hurt as much. It did not eliminate the pain but it brought it to a tolerable level and I was able to sleep better and walk enough to grocery shop etc. Stairs were still a bit painful but I didn’t have to negotiate those in my normal routine. Thank goodness there were just enough to get me to the surgery. I did advise my anesthesiologist pre surgery that I had been using them because I wanted to know how long prior I needed to stop for a safe anesthesia. He appreciated that. Post surgery and after a two day stay on IV pain control, I was prescribed a course of oral oxy to take as needed at home…….I took only one and shifted to Tylenol the next day. I didn’t see a need to manage the associated side effects if I didn’t need it for pain control…..which it turns out I didn’t.

Moral of the story…..there was no way I’d have gotten pharmaceutical relief pre surgery in todays environment. The doc and I had a conversation about my personal history with various pain relief agents over my lifetime but he was really reluctant to go bigger. I understand that pre surgical pain relief is not an approved indication for fentanyl and the use would have been far off label so I doubt anyone would have jumped to that agent off label but there was also no chance of anything stronger than T3. Thank goodness I had my own options.

 

[Snaggletooth]

signal malte skotch frome 1954?