Morphine to the rescue?

I'm a German married to an American. You'd think that these two cultures are similar enough that we don't keep running into cultural misunderstandings or even problems. And the truth is, we don't - much. Whatever problems we have, we can usually solve without too much agony. This is not the case for our families, though. Some of those problems are funny or comical, most are simply annoying, a few are dead serious and have almost caused a rift. Politics and religion are now forbidden topics in the US family whenever I'm present. I think you can imagine why. Raising kids is another area of friction. It's amazing how much even modern concepts of childcare differ between Germany and the US. I would think the fact that both sides manage to raise their children without killing them off in large numbers indicates that there is more than one right way. A favorite is always health care. Long hospital stays after childbirth in Germany cause frowning in the US. Heh, we just believe that a woman should thoroughly recover after birth and get a few days to adjust and rest. It's not as if we restrain new mothers in their hospital beds. If they want to go, they can go. If they want to stay for some days, they can stay. I find this concept utterly convincing.

A recent heated family discussion involved my dear husband and his double hernia surgery. His family was indignant that he was given ibuprofen for his post-surgery pain and not morphine. My family was horrified by the idea of giving morphine to anyone but terminal cancer patients. My sister-in-law told me that she was given morphine after her c-section. I've had two c-sections and I was just fine with less drastic pain killers. If the pain got too much, I would ask for higher dosage or something more potent, but morphine was never on the menu. We were both more or less openly horrified at the other doctor's choices. While my family thought Doug was popping pills like candy, his family was upset about him never being offered morphine. "But he just had major abdominal surgery! Ibuprofen is ridiculous! He was in pain!" Well, yes, he was. I am the last person who wants to see Doug in pain but I understand the concept of some pain to prevent post-surgery patients from running marathons. Knocking them out with morphine is not a good idea, I don't think. Granted, morphine is generally administered too late in Germany. My country is one of the strictest in that respect and palliative medicine is somewhat, hm, backward. At German dentists, you have to ask for anasthesia, otherwise you won't get any. It's also not paid for by the health insurance since it's not deemed necessary, unless the dentist suggests it for root canal treatments and such. On the other side, my conception is that in the US there is an over-treatment of pain to the point where every single little itch has to be eliminated. Topically numbing the gums before the anasthesia shot is administered? How ridiculous is that? We call that shooting at sparrows with cannons. It's one of those "you'd have to grow up with it" cultural concepts. Now I wonder what my boys will turn out to prefer. BTW, the new icon is taken from this site. Copyright remains with them, of course.

Comments

[Gareth Wilson]

(Apologies if there was a double post)
That's interesting, I would have guessed the US would be stricter about narcotics than Germany. Any idea how the rest of Europe compares? I know that in the UK they often use heroin for heart attack pain relief, but any use of the drug is illegal in the US.

[Jen]

My (Romanian) dentist always numbs my gums before the shot and I am eternally grateful to her.

[Bernard Guerrero]

"At German dentists, you have to ask for anasthesia, otherwise you won't get any."

Good. Lord. You've actually managed to shock me, Claudia. I've got a wisdom tooth coming in about a half-decade late, so this is rather top-of-mind.

[claudia]

No, Bernard. We are not stuck in the Middle Ages. Of course we use anasthetics for wisdom tooth removals, or root canals, or anything nasty.

Just normal fillings, bits of drilling, smoothing, cleaning, those are done without. Normally.

Mind you, I never let my dentist anywhere near without anaesthetics. But then, he's my cousin, and used to my frivolous self.

[Carlos]

Is it safe?

[Douglas]

Yes, it's safe, it's very safe, it's so safe you wouldn't believe it.

Doug M.

[johne]

Perhaps it varies with the part of the US; my wife got one Ibuprofen tablet after her breast tumor was removed in Seattle, and did not feel the need for anything further (to throw in another variable, she is Ecuadorian; but Ecuador is not noticeably opposed to pain killers). At the dentist, I refuse anasthesia about half the time, after learning that you could from an elderly aunt much prefers pain to a numb mouth. The only morphine use I have personal knowledge of involved a relative suffering from terminal cancer, but again, we're talking about Seattle.

[Lois Aleta Fundis]

My mom used Nuprin (a brand-name of ibuprofen here in the U.S.) for her pain when she was dying of cancer. She didn't switch to morphine until about a week or two before she died. (This was in 1986.) Even then she worried about becoming addicted!

Some of it depends on the patient, but some of it depends on the cancer -- a disease of infinite variety -- too.

[Charlie Stross]

Diamorphine (heroin(TM)) is the drug of choice in the UK for dealing with acute heart attacks -- i.e. while they're in progress -- because in addition to it being the best damn painkiller on the planet, it's an anxiolytic and a coronary vasodilator. In other words, it calms the patient down and it dilates the coronary arteries, both of which tend to contribute to their survival. In my opinion, the last thing anyone should be worrying about during an acute-phase infarction is the risk of future addiction (when there's a 50% chance of fatality, if it's a first attack!) and denying the best available medicine to the victim for ideological reasons is tantamount to murder.

[Castiron]

My childhood dentist in Virginia didn't believe in using anesthetics for fillings either; I had two cavities filled when I was eight, and both times my sole pain relief was pinching the base of my ear. (It must have worked -- I remember that it hurt, but I don't remember it being sheer agony.)

[Natalie]

Drugsdrugsdrugs. Bring 'em on! I CRIED when I stood up for the first time after my c-section, and that didn't happen until the next day. The only way I was able to function at all on days 2 and 3 post-op was due to Demerol and/or Percocet. Thank goodness I was here and not there... Allison (not surprisingly) was a bit extra sleepy the first couple of days due to the narcotics.

I like your new icon. :-)

[Rich Rostrom]

I had an inguinal hernia fixed last year. It was remarkably easy... Outpatient surgery, and they had me up and walking with only minor discomfort a few hours later. They gave me some Vicodin, but I only used one or two, and not even Ibuprofen after that.

This was a huge difference from the hernia repair I had fifteen years ago: overnight in the hospital, bedridden for days and in serious pain for about a week. Really serious pain - I can sympathize with chronic pain sufferers who get addicted to opiates.

YMMV, of course: not all hernias are created equal.

[hemaworstje]

schne Grusse , ich als Niederlander gehe auch nach eine partner in the USA, ich mag das land nicht , was soll ich machen?

[Rob]

Within the past year I have been diagnosed with severe temporo mandibular jaw dysfunction/myofascial pain, severe migraines, severe fibromyalgia, severe rheumatoid arthritis and carpal tunnel. This all struck swiftly and very painfully. Each and every passing day my body was literally being consumed by more and more pain. After shuffling from family physician to two different ENT's and now my current rheumatologist I was put on a myriad of painkillers in the midst. I tried tylenol 4, vicodin 10mg/500, ultracet, darvocet, every NSAID you can think of, percocet, heavy doses of steroids and even lidocaine patches. Nothing helped my pain...it was so deep and seemed untouchable that I honestly told my rheumatologist I was considering suicide. She finally threw in the towel (as she was reluctant due to my age of only 19) and sent me where I should of been in the beginning, a pain management specialist. My first visit was yesterday, he prescribed me 2 30mg controlled release morphine sulfate pills daily, with darvocet 100/650 for breakthrough pain. It was a chose between a life of pain, an early grave or the threat of dependency. I obviously chose the meds. Morphine has an over-hyped mark branded on it in my opinion due to WWII addictions, terminal illness use and since the notorious Diamorphine (Heroin) was derived from it. In all actuality morphine orally is 5-6x less potent then it is taken IV'd. Oxycodone I.E. percocet, percodan, tylox, oxycontin, oxyfast, roxicodone etc... is actually far more addictive and more potent mg for mg orally compared to morphine due to its high bioavailibility. All in all I would say that short term use of morphine in a patient with no abusive history would be more effective and less addictive then almost any other narcotic analgesic on the market. Don't suffer if you don't have to is my thought.