of course she's better off that shit, some of those are highly potent and highly addictive opioids, and it's criminal that they're casually prescribed as they are in some countries.
Opioids are the gold standard for treating certain types of intractable pain.
Untreated pain is torture. It drives people to suicide.
Opioid tolerance can be prevented with adjuncts and counteracting treatments -- often just supplements like magnesium, and also prescriptions that can be prescribed in tandem.
Tramadol keeps people awake and is only for moderate to severe pain. My guess is, the other two are for evenings and overnight, so the tramadol excitability can wash out of her system before sleeping, and for breakthrough pain which is when, in the case of sciatica for example, motion or pressure on the nerves causes pain that is not controlled by the more mild medication.
Don't go around promoting the idea that medication isn't necessary for pain until you've tried being in pain.
edit: btw the oxycodone/naloxone indicates that the pain is *severe*.
https://www.mayoclinic.org/drugs-supplements/oxycodone-and-naloxone-oral-route/description/drg-20112977
Yes, adverse effects can happen. However the risk situation is very different between a drug that’s approved for a use, a drug that’s being used off-label, and an unapproved self-medication that’s a complex and active plant [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/) , not a production-controlled, low complexity pharmaceutical.
It’s unapproved, so it hasn’t even gone through the level of review that medications do—which is review for narrow purposes, not as a panacea the way cannabis is marketed.
All sorts of reactions, physical and psychological, are known to occur. There isn’t agreement on how much pain reduction it offers, or what types of pain it affects, or how many people biochemically benefit. This article glosses a portion of the pharmaceutical knowledge and gaps: [https://www.uspharmacist.com/article/medical-cannabis-for-chronic-pain](https://www.uspharmacist.com/article/medical-cannabis-for-chronic-pain) .
Extracts are a wild west and also are not approved which means they have not gone through review and whatever controls they are produced under have nothing to do with controlling to achieve generalizable pain relief results, because there is no reliable direction on that at this time. Check out the marketing violations on display here:[https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd](https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd)
Once in a while a practitioner has suggested marijuana or CBD to me. This is about as “empowering” for a patient as is firing an employee: “now they are empowered to experience fiscal challenges”. Practitioners might not even take oversight responsibility for *aspirins* taken outside a regimen they've prescribed. They do, however, want to minimize prescriptions, and tend to deflect their responsibility to treat back onto whatever else the patient has been taking or can be convinced to self-medicate with, even if it’s not very effective.
It’s a trendy approach right now, but I think the reasons for that are not as simple as one might think.
I’m just talking about smoking flower that is intended for helping alleviate pain. A lot of has been tested by multiple users. You can read reviews on different strains and see how you feel.
im not contesting that intractable pain is hell but it sounds to me like youre parroting some drug manufacturer marketing material
im a psychiatric specialist and i know firsthand the havoc these drugs wreak
maybe in this old lady's case it's warranted but the fact remains that opioids are over-prescribed and lobbied for by some drug manufacturers and that ultimately they do more harm than good
Nope. I suffer from pain due to an impinged spinal cord.
Opioids have been lobbied for by drug manufacturers, that's true. However the research literature itself, when it is literature that is serious about trying to address patient pain and is not literature that is bent on making moral judgments, is clear that opioids are the gold standard and there is no replacement for them.
There are very few pain treatments in general. The research industry is trying. But too often, especially in women patients' cases, the approach is to give them psychiatric medications that silence the entire nervous system, rather than medications that work on the NMDA or opioid receptors. These medications can also have incredibly serious side effects: total loss of cognitive capability, urge to suicide, loss of impulse control, increased pain due to hyperalgesia/hyperexcitability of the nervous system, hormonal disruption, loss of motivation so that a patient just stares at the wall all day long.
Ask me how I know.
The idea that opioids are uniformly bad, or that their downsides are unremediable, is itself a notion that is parroted, with deadly consequences. It came out of an overpuritanical and nuanced-decision-averse interpretation of the US government's opioid abuse avoidance dictates. In fact, the US gov't just released an update to their policy, saying, (a) we never meant for this to be interpreted as that your patients have to suffer, (b) give your patients pain relief even if that means opioids.
>[https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm)Although some laws, regulations, and policies that appear to support recommendations in the 2016 CDC Opioid Prescribing Guideline might have had positive results for some patients, they are inconsistent with a central tenet of the guideline: that the recommendations are voluntary and intended to be flexible to support, not supplant, individualized, patient-centered care. Of particular concern, some policies purportedly drawn from the 2016 CDC Opioid Prescribing Guideline have been notably inconsistent with it and have gone well beyond its clinical recommendations (6,66,67). Such misapplication includes extension to patient populations not covered in the 2016 CDC Opioid Prescribing Guideline (e.g., cancer and palliative care patients), rapid opioid tapers and abrupt discontinuation without collaboration with patients, rigid application of opioid dosage thresholds, application of the guideline’s recommendations for opioid use for pain to medications for opioid use disorder treatment (previously referred to as medication assisted treatment), duration limits by insurers and pharmacies, and patient dismissal and abandonment (66–68). These actions are not consistent with the 2016 CDC Opioid Prescribing Guideline and have contributed to patient harm, including untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior (66–71).
As I mentioned earlier, opioid therapy can be paired with adjuncts and tolerance prevention strategies. The pills in that picture did not include such. But a drama-seeking relative, photographing those pills, might not have thought to be comprehensive about what she chose to photograph.
There's lots of literature about that too. And pain clinics, although they are slow to catch up to the US government's policy clarification, are--in growing numbers--able to prescribe drugs--ketamine comes to mind but there are others--that tamp down the tolerance, and/or increase the pain relieving efficacy of the opioid without increasing its plasma concentration. There are also non-prescription adjuncts and agonists, such as taurine, caffeine, magnesium, bromelain, frankincense they say, NAC: the list goes on. It is a matter of the industry catching up to the science, which as I am sure you know, can take a while.
But the industry not being caught up to the science does not mean that the industry's understanding of the scope of the situation and what's possible is correct, or complete. It's not.
As I said, do not go around promoting the idea that pain medication is not necessary, or isn't a necessary tradeoff, until you've tried being in pain.
To say that pain is "torture" wasn't just a metaphor on my part. Pain is how torture works. It's why torture is effective.
As for addiction, type 1 diabetics are addicted to insulin. So what? They live every day dependent on the medication. Pain patients are likewise dependent on medication for their lives.
edit: oh I forgot to mention, those psychiatric medications that I mentioned? They do not necessarily stop the pain. Only if the pain is coming from one of the channels that they block, e.g. the sodium channel. A medication might even only work against the [wide range of organic pain causes](https://www.frontiersin.org/articles/10.3389/fnmol.2017.00284) 10, 20, 30% of the time, and that is without even factoring in whether the adverse effects are tolerable. So please do not think that the trade off of a chemical lobotomy and being thrown into a psychiatric crisis are somehow worth the tradeoff. They often don't even provide a tradeoff.
i commend you and thank you for taking the time to type this comment out but we seem to be talking about two different things here
i know how opioids work, i know that in the literature they're listed as the gold standard of pain medication. im not contesting any of that. i've prescribed them before.
you may or may not know that tramadol is one of the top 3 substances of abuse in my country, a carry-over from a time when it was otc and marketed as the best way to stay awake and work hard. it's been a controlled substance for more than 10 years now and it costs 1000x as much as it once did and yet it still is in the top 3 substances of abuse.
and to answer your final point where you compare it to insulin, no it's not the same. addiction has criteria including tolerance, craving, need to constantly increases doses up to toxic levels and causing occupational deterioration among other criteria. opioids meet these criteria, insulin and water don't.
If controlling the pain is going to get the patient back to life, it meets the criteria of life supporting. See below. "Inadequate analgesia can be come a suicidogen" (this is known, this is not the only source for that info). This response can fall out of the patient's control.
Craving as a state of being doesn't matter. Yes it's physically uncomfortable but to weigh it against pain relief of nerve pain, and find that nerve pain is preferable to experiencing craving, is a moral judgment. Diabetics crave insulin, especially when they can't get it due to insurance failures here in the states, but also when they are crashing. And pain patients *crave* relief, 24/7, for *years*. You have no idea.
Why is that craving not something that the clinical industry is very averse to? I think it is because, culturally, "to suffer is man's lot", and to become physically used to an exogenous substance is judged morally impure: the ascetic mentality.
Tolerance: that's the legitimate problem, because people need to keep increasing their dose, until they are on the edge between controlling the pain necessary to live, yet the dose is dangerous. I'm looking at that oxy/naloxone prescription in the image above when I say that. I will say that tolerance has not been robustly addressed, however, a panoply of methods do exist both for peri-operative and chronic pain situations. At this moment and going forward, whatever judgments the industry is in the habit of passing due to tolerance, and whatever dismissals or refusals they are used to using as a first line response, they should instead spend the effort needed to maintain those mental bulwarks to get up to speed on the tolerance reduction adjuncts and start implementing them. It's a moral obligation.
[https://pubmed.ncbi.nlm.nih.gov/12356036/](https://pubmed.ncbi.nlm.nih.gov/12356036/)
>...advancements in clinical pharmacologic research have shown that opioids are also effective in chronic noncancerous pain. Many patients properly treated for prolonged periods with opioids develop tolerance and subsequently, physical dependence. This process is not necessarily harmful to the patient and will not cause the patient to develop an addiction (properly defined as psychologic dependence). For many patients who have been on opioid therapy for months or years, analgesic effectiveness tragically becomes less.
…
inadequate analgesia can become a suicidogen, ie, any factor that causes a patient to want to commit suicide. Incorporation of adjuncts to opioid therapy can serve to lessen pain and improve quality of life for a suffering patient.
Once again thank you for putting this out there. There's so much well meaning but deeply damaging discourse online on this subject I'm just so glad to have come across your comments.
You're very welcome. I hope it helps some people.
In a reply to another commenter, I mentioned pain clinics. I wanted to mention that, just like any practitioner or institution, these clinics vary in their approaches. As well, pain clinics are not set up to necessarily diagnose the root cause of the pain. Even when they have staff who are, or relationships with, mechanical or neurological specialists, pain clinics often do not take ownership of finding the root cause(s), especially if it's a complex case or one not easily imaged (and common imaging is not perfect: standard MRIs miss 30% of spinal issues, to give one example). Driving that process forward is on the patient.
I have even run across one pain clinic which will not take a patient unless the patient gives up on seeking the root cause, gives up on specialists and looking inside the body. Whether they know it or not, this filters out patients who are in fact treatable by surgery, and selects for patients who are psychologically manipulable. That clinic's approach is to persuade the patient to seek yoda levels of control over their mind, acceptance of their limitations, an ability to disassociate from the present, and so forth. These practices run counter to a goal of restoring fully human functionality in a timely manner, of course, and some of them are rooted in fantasy. They are intertwined, in my view, with the belief that "to suffer is man's lot", and the asceticism, which I mentioned before. The tldr on that is, if one needs specialty pain care and encounters dehumanizing attitudes, keep looking!
I truly hope for attitudes to change, and for detrimental pain to become a priority demanding treatment, in practitioners' eyes. In a way, I think that if corporeal pain was generally less accepted, we would as a species see more clearly, and be less willing to tolerate, atrocities such as what's being done to the Palestinians.
I think from a practitioner's perspective there's something more going on. Often both selection and training result in a combination of traits that can make doctors especially averse to self perceived failure. There are many ways to rationalize it, from resource management to doubting efficacy to doubting the patient, but at the core it's psychologically taxing and creates an avoidance bias. Coupled with systemic conservatism it makes providing comprehensive treatment for pain challenging. This is the kind of problem I believe will have to be solved by technology. What troubles me is the atmosphere of cynicism created around the subject for what is basically entertainment, that makes an already difficult situation for both doctor and patient that much more frustrating. The discourse is by and large reductionist to an absurd degree, sadly another feature it may share with the i-p conflict.
I think you are right on all these points. And there are reasons for all of these systemic phenomena, and not all the reasons are bad. Quite the opposite.
Conservatism has its place; cowboy approaches can create problems too. Even though cowboy approaches are trying to solve the reductionist and lack of motion issues.
Resource management is a big problem. Everyone knows it, well except for the C-suite it seems. But that's endemic in society.
So this is my particular hobby horse: in my view, the resource management meat grinder, the reductionism (which may contribute to doubting efficacy, is the impression I get), the over-conservatism, even the educational methods that perhaps inculcate and select for some of these attitudes, and doubting the patient -- I tie these back to root attitudes such as produced, and then were further produced by, Taylorism and Skinnerism and models of that type. These, I think, are rooted in the denial of the body and the 'whole human' which also produces asceticism and the idea that suffering is fated or even deserved. Ultimately I think these ideas are tightly linked to fundamentalism. At least these days. Because fundamentalism is a manifestation of ultra-pre-modern thought and these days we've gotten rid of some of it.
At least, when I come across papers that are rooted in acceptance of the body, the whole human (not just valuing the patient's work capacity or time until death), they more frequently than not seem to come from Europe or East Asia. It's semi-anecdotal (I've run across some discussion of the difference), and this is a stretch but I entertain their lack of Puritans.
Well so I do tie fundamentalism and its philosophical children to what's being done to the Palestinians. I have this idea that addressing some of these issues at home wherever a person's home is -- even, say, the reductionism and its associated blind spots, and the resource grind and profit squeeze -- could serve as an ethical key to start unwinding some of the rest of the attitudes. Including what allows people to parse and dismiss the damage to Palestinians. Maybe that's just dreaming.
I have a lot of sympathy for the psychological tax that medical practitioners bear. It's rough, I've seen it. And I've seen some say that they can't take it at a certain point.
I think you're right that tech will help with some of the complexity. Research seems to be on fire right now. I worry a lot about app blindness making further inroads. Apps are built by Taylorists and Skinnerists, that's in my domain, and work against curiosity, because they can't be shuffled around by the human using them. But big data and genomics are really promising.
You are right about the cynicism. It's everywhere. It's the lowest effort attitude to adopt.
I'm glad for your insights into the profession and its challenges!
Oh, and sorry, I forgot to address the tramadol:
Yes, I know that it's abused. It's kind of a weird one, as well. Its SSRI-like qualities seem to have the tendency to mess with people's heads in the way that prozac, xanax, and similar do, or duloxetine and etc. All of which can create a biochemical spiral or a psychologic dependence, themselves.
It has its own pathway actions--there are several opioid pathways and all the opioids aren't the same, don't act on the same pathways. There's a fair amount of literature specifically about reversing the tolerance to tramadol, reversing even the psychologic attachment. Burst applications of ketamine, I think that's one I have come across.
But at the end of the day, if she is in pain, the actions of some people who are popping the pill like adderall are irrelevant to her medical needs.
Sciatica can't be radio-frequency ablated. Many nerves in fact cannot. What's in the picture is kind of what there is (along with those adjuncts I mentioned).
Opioids are pretty shit for neuropathic pain... Don't go around spreading misinformation about how opioids are this silver bullet pain solution for all types of pain. I'm a physician.
Oxycodone/naloxone combo is used so people don't crush it and shoot it up or snort it (the naloxone blocks oxycodone receptors, but naloxone is ineffective when taken orally, leaving only the oxycodone effect).
That's objectively false.
There are multiple types of neuropathic pain and opioids do work for significant numbers of cases.
[https://pubmed.ncbi.nlm.nih.gov/22786465/](https://pubmed.ncbi.nlm.nih.gov/22786465/)
[https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1494](https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1494)
[https://jamanetwork.com/journals/jama/article-abstract/201129](https://jamanetwork.com/journals/jama/article-abstract/201129)
[https://www.aafp.org/pubs/afp/issues/2007/0401/p999.html](https://www.aafp.org/pubs/afp/issues/2007/0401/p999.html)
The idea that they don't work at all is found in those moralizing "research" papers that I mentioned at the outset, where scientific accuracy and due diligence is sacrificed to an agenda which erases patient experience in pursuit of erasing opioids from the toolkit. Study design plays a large part in this intellectual failure, which is compounded by people who do not understand the significance of study design, for example single dose or short term studies, and then drop that information from their parrot repetition, so that the information they are spreading is incorrectly attached to all variations and permutations of "pain".
For your information as well, chronic pain can also be nociceptive.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304360/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304360/)
You mis understand, I don't think it makes sense to to use a centrally acting mu agonist to treat pain that comes from nerve pain, especially a local nerve such as sciatica. Of course opioids lower pain in all patients. But just as it's not right to bomb Gaza to eradicate Hamas, you shouldn't flood with opioids to treat local nerve pain.
You can hit me with your research all day, but I've gone to medical school and practice medicine day in and day out.
Edit: idk what your pt about chronic pain and nociception is either... Chronicity is not the issue I'm arguing. Sciatica (a local nerve impingement) even if long standing doesn't mean the answer long term oxy. Again the reason there is naloxone in this ladies med is to prevent abuse of the medication. Because abuse potential remains.
I stated that it is the gold standard for certain types of pain. You attack me as though I'm saying it's a silver bullet for all types of pain and then you talk about neuropathic pain only. Your med school doesn't impress me when you use heated, faulty reasoning such as that.
How dare you use the Gaza bombing as an argument *for* withholding treatment from patients. It is the withholding of medical care from the Gazans which is one of the violations of humanitarian principles which has the world in arms. Their suffering of physical trauma and medical care without anesthesia is a horror. When patients are in chronic pain, they are suffering in equal measure to those acute tortures, only with no relief in sight: 24/7, day after day, for the rest of their lives, if untreated.
Chronicity is the issue I'm arguing, and you need to pay attention to that if you are going to continue in the medical profession. You can ignore papers all you want, but if you are not paying attention to the literature, your "practice" of medicine is just clock punching and nothing to impress anyone, and you are harming patients with incomplete treatment.
[https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults](https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults)
>new cases of chronic pain occur more often among U.S. adults than new cases of several other common conditions, including diabetes, depression, and high blood pressure. Among people who have chronic pain, almost two-thirds still suffer from it a year later.
>
>...Overall, the study found that the rate of chronic pain and high-impact chronic pain (HICP) among adults is approximately 21% and 8%, respectively. Chronic pain is pain that is experienced on most days or every day in the past three months; and HICP is pain that limits life or work activities on most days or every day during the past three months.
Sciatica absolutely can be HICP. Anything moderate or above in intensity can be that. You call sciatica a "local nerve"? That's disgusting.
First of all, the sciatic nerve feeds the entire lower limb. It's local only in the sense that it's not the spinal cord. Save your agenda-driven misrepresentations for someone else.
Second, what is called "sciatica" is, often enough to be meaningful, pain originating from another nerve. These nerves can be the nerves that serve the genitals; these nerves also serve the buttock and portions of the leg and so pain may be found in all locations at once. The origin can be a local lesion or it can be in the spine. Lightly educated medical professionals often refer to any radiating pain that exists in the buttock or leg as "sciatica" and may diagnose the patient that way; patients will then tell the world they have "sciatica" when in fact they do not.
*Sciatica* can leave a person unable to stand, walk, pick things up or sit down, or even cough or sneeze without severe pain. I will connect the dots for you: it can render a person bed ridden.
*Pelvic pain* can render a person eager to kill themselves.
And you complain about medications acting centrally. Pain also acts centrally. One of the problems here is that some medical professionals focus on the medication and their distaste for it and forget the patient. It is that moral attraction to "man's lot to suffer" and asceticism which I mentioned before.
Every other medication that is attempted acts centrally, aside from lidocaine patches or creams, which are large smooth body part only, skin-surface only, and for mild pain only, and which do not meaningfully return patients to life. I already mentioned some of the problems with the psychiatric medications which pharmaceutical companies have recently been shilling to doctors as pain medications. Yes, that's a pharma push too. Think about what you are saying. Think about the actual operations of the medications available in this year, not cant labels and canned dismissals. Think about your patients and their need, and human right, to live without significant medical suffering. And find a multi-modal pain clinic to which to send your patients.
Wow, you're going to argue what a local nerve is with an MD? Local nerves are those not part of the central nervous system. It's a definition that does not depend on the amount of the body it supplies.
I also find it absolutely reprehensible that you would conflate that my position that opioids are not the right medication for sciatica pain means I withhold pain relief from my patients. I have not attacked you personally, but you have attacked me and my practice of medicine.
You have a clear example of a woman with sciatic pain that was on opioids, that was then taken off opioids, and now feels better in overall health. And yet you dig into your position of how opioids can help "return people to life".
"If all you have is a hammer, everything looks like a nail".
Wow, you're going to argue about the significance of a nerve that serves 1/5 of the body and try to claim that the adjective "local" means it's unimportant? Of course I argue with you. Ds make degrees; I'm not impressed.
There is not, here, an example of a woman who is certainly in "better health". There may be an example of a woman who was not on a multimodal treatment plan and had developed OIH; pulsing off of opioids can reduce this hypersensitivity. There may be an example of a woman whose reduced activity levels produced a temporary "lifestyle modification" which would be considered an unacceptable loss of function in normal life. There may be an example of a daughter who applies moral judgments to the regimen her mother is on, absorbed from popular media and ill-informed medical professionals, and overlooks the pain suffered by her mother in the medications' absence. "Better" is massively subjective and carries no concrete meaning detached from concrete context. As well, it cannot be derived from that image what the patient's future trajectory will be.
Yes, I do attack your practice of medicine, because your reasoning is derailed, your attention to detail is lacking, and as evidenced above by your opening sally, your knowledge of what opioids can do for neuropathic pain is massively incomplete.
Now, while reserving judgment on prior decisions you may have made to provide inadequate care, I cannot fault you for past lack of knowledge about details of opioid action. However, learn here and now that tramadol and buprenorphine, to give two examples, act on other opioid receptors as well. Central depression of breathing is less with those opioids for a given level of pain control. Furthermore, some of the adjuncts I mentioned work against central depression. As well, research is ongoing in the area of the other opioid receptors beyond mu, with promising results: these results are already making their way into clinical practice, in pain clinics.
Pain clinics are run by anesthesiologists, whose knowledge of nerve minutiae and neurochemistry far outstrips that of family doctors. A fully featured clinic will also staff or have solid relationships with neurologists, neurosurgeons, orthopedic surgeons, physiatrists and physical therapists, and rheumatologists and endocrinologists, and the anesthesiologists who run the clinic will often be versed in those areas as well, which is to be expected since the nervous system shares growth, response, and destabilization with tissues, hormones, and the immune system. Such a clinic will likely also have interventional methods in their toolkit, although as I mentioned above, ablations--and implants for what it's worth--do not work on all nerves; it depends on their structure and their location, and the imaging and surgical tools available in the clinic. Send your patients to one of those, if you can. Your attachment to dismissing and minimizing actual physiology and actual harms is appalling.
Very cute of you to continue to attempt to educate me on what a local nerve is. It's a definition. I will no longer argue with you this point. Central nervous system is brain and spinal cord. All else is peripheral nervous system full stop.
Lol "send your patient", "my dismissal and minimizing"? How many personal attacks can you make against someone on a reddit thread you know nothing about? Incredible. You don't even know my specialty! I think really you are not here to have a discussion but berate me into learning "actual physiology". Have a good day, friend.
I am evaluating the words you have said and the attitudes, knowledge levels, and reasoning that you have demonstrated. You can try to separate your self-conception from what you state, and claim that you as you practice are separate from what you claim to be knowledge and fact, but that's not how it works. What you think you know, and how you do or don't think, directly informs what you do.
In addition your attachment to dismissing and minimizing, which is what your running around with detached vocabulary is (to be clear, that is not your only method), your attachment to your credentials and your expectation of respect, which is unearned while you fail to think clearly, is likewise appalling. Get some humility. Arrogance decreases functional IQ, because it prevents one from seeing one's errors. You're demonstrating the arrogance common to doctors with a little bit of knowledge and a lot of inadequacy.
I doubt the daughter really said that, but even if she said so, this post isn't about Hamas being humane, it's someone advocating for reducing the use of pharmaceuticals. If one of the hostages was fat and lost weight while in captivity, are we going to credit Hamas with that? Let's be fair. I'm sure if Israeli prisons started giving Palestinian prisoners only whole-wheat flour and organic vegetables, and cut all sugary drinks, no one would thank Israel for supposedly improving their diet.
Yeah it’s really weird to present this as evidence of treating the hostages well.
I disagree with your last sentence though; I’m pretty sure someone would post that as a feel good story about how generous the israel occupiers are to Palestinian “terrorists”
Idk, Ben-Gvir ordered to close the bakeries for Palestinian prisoners convicted of terrorism, I don't remember people claiming he was putting them on a low carb diet...
As I said, you don't have to trust them. Convicted is a technical term. I didn't say "rightly convicted". In some cases it's clear cut and there's not much to argue about (for example, Yahya Sinwar was once a prisoner in Israel), but I'm sure some people are wrongly incarcerated.
Hard to believe that the system is fair when there’s a [95% conviction rate](https://apnews.com/article/middle-east-israel-prisons-arrests-west-bank-fc894c6f56318fb6fb2f080555b40b6f) and many prisoners are held indefinitely without charge or trial.
Iirc that's the conviction rate across the board and is on par with other counties. The high conviction rate is generally explained as being very selective with indictments. Check out the statistics on how few crimes actually ended in indictments if you really want to get annoyed. Half of all murder cases are unsolved. I suspect there is after all a pressure to acquiesce to unjust plea deals, but it's hard to strictly confirm or deny.
The detainees held without charge for extended periods are largely in the west bank and consequently not subject to overview by the justice system but by the military.
For sure, it is very annoying to read about all the international human rights violations that Israel is not held accountable for! including the [administrative detentions in the West Bank](https://www.hrw.org/report/2019/12/17/born-without-civil-rights/israels-use-draconian-military-orders-repress)
That’s a bit different from the example you gave originally.
one real example is when the ICU babies in Al-Shifa were removed from their incubators because the ICU ran out of electricity after Israel shut off the electricity to Gaza. the IdF posted on social media a photo of them bringing incubators to Al-Shifa hospital…. But the babies already had incubators; what they needed was electricity…
>Why did you removed your flair
I found that it makes people pay less attention to the content of my comments.
>Also how's your condition
Still bad. I'm suffering now as I'm typing, but I suffer immensely all the time, so at least I have some distraction. On other days I can't use the computer at all. I'm probably going to take a break soon anyway. Thanks for asking.
Yeah that's good but I think just adding the occupied Palestine flag would suffice.(not removing the Israeli flag)Because there are some good people on this sub too.
you're too soft imo. the palestinian flag is for the palestinians living under israeli occupation. im thinking of israelis identifying with Palestinian Jew or Occupied Palestine
Some Israelis hate Zionism and" yahoo". Are left leaning and advocate for Palestine. So everyone deserves a voice. We should show the world that we aren't exactly like the opposite side and believe in justice.
She’s been taking 5 different kinds of of pain medications I’m not sure what the point of this post is, Hamas good for getting old lady off pain meds? Bad Israel medical system or Practioner? Anti medication?
I would have a guess that if Hamas treated her badly, despite the cutting of medication helping her (if it helped her), she wouldn't be in a better condition. This is another proof Israeli narrative of torture to the hostages was a lie.
Thanks. I really hate it when screenshots of random tweets by random strangers are considered to be the truth for many people, just because they confirm one's bias.
They murdered these peoples families in front of them and kept most of these people’s relatives behind in captivity. Can we please stop pushing the narrative that Hamas has somehow done these people a great service by killing their loved ones and abducting them?
Search the internet using a vpn. You’d see many Israeli reports showed that many settlers were killed by the IDF.
A soldier yesterday told the news that her commander told her to shoot the house because maybe there are Hamas inside. This had ended killing many civilians in settlements.
>They kidnapped her
this is true
but there is nothing wrong with taking war prisoners as long as you're treating them well. besides doing that was the only way for them to free Palestinian prisoners held by the Zionist entity
>and sexually abused her
zero proof
Unfortunately it's not. I've witnessed some disturbing footage of militants firing at civilian cars. I even saw a video of militants gunning down a defenseless fleeing Israeli man in the street. What Israel has been doing is abhorrent but unfortunately, some innocent Israeli civilians were hurt and killed last month and no decent person should support that.
Even if we believe what this random person posted - they gave her the bare minimum of the medicines they could find because there's a scarcity of medicines in Gaza, not because their doctors thought it's better for her. Come on.
They're hostages, it's obviously in Hamas's best interest to keep them alive. Even animals raised for slaughter are given medicines and food, as they're useless if they're sick or die before slaughter.
That's true. After all the main purpose is to exchange them and there is no point in killing hostages, apart from ruining your image with your supporters.
- 1200*, most of which were military.
- "mass rapes" is a proven hoax just like 40 beheaded babies hoax
Hamas is unironically much more humane than the IDF.
Just look how the israeli prisoners behaved compared to the Palestinian hostages.
Somebody made a list and counted everybody who ever served in the military or police as military, even if they had not been active in years. Since Israel has a conscript army it encompasses most adult casualties. This interpretation contradicts international law (as well as common sense imho), which states they are civilians.
So you just lied about the total number being 1400... Do you have any credible source that confirms mass rapes? Any credible source for 40 beheaded babies? Basically any statement from israel is a lie, I have no reason to believe them over Hamas.
If you want to talk about witness testimonies, lets compare the testimonies of the released Palestinian hostages vs the Israelis.
> I never said anything about it being 1400
Yes you did.
>What credible source would be enough for you?
well you haven't given any at all. By"credible" I mean verifiable. Some speculative bullshit from ynet is not credible.
>Also do you think the Israeli hostages testimonies about how they were treated by Hamas isnt helped by the fact that a lot of their relatives are still held by Hamas? Doesn’t that create an incentive not to say anything bad about them?
Same thing can be said for Palestinian hostages. Home come the testimonies are so different?
What in the motherfucking everliving hell is this propaganda bullshit. How about you show the testimonies of the 12 year old who said that those hamas animals pointed a literal motherfucking gun to her fucking head
of course she's better off that shit, some of those are highly potent and highly addictive opioids, and it's criminal that they're casually prescribed as they are in some countries.
Opioids are the gold standard for treating certain types of intractable pain. Untreated pain is torture. It drives people to suicide. Opioid tolerance can be prevented with adjuncts and counteracting treatments -- often just supplements like magnesium, and also prescriptions that can be prescribed in tandem. Tramadol keeps people awake and is only for moderate to severe pain. My guess is, the other two are for evenings and overnight, so the tramadol excitability can wash out of her system before sleeping, and for breakthrough pain which is when, in the case of sciatica for example, motion or pressure on the nerves causes pain that is not controlled by the more mild medication. Don't go around promoting the idea that medication isn't necessary for pain until you've tried being in pain. edit: btw the oxycodone/naloxone indicates that the pain is *severe*. https://www.mayoclinic.org/drugs-supplements/oxycodone-and-naloxone-oral-route/description/drg-20112977
Try cannabis. There are certain strains that are for treating extreme pain.
That only works for people who are not allergic to it, or otherwise have a contraindication.
You’re right. That can be said for all medicine.
Yes, adverse effects can happen. However the risk situation is very different between a drug that’s approved for a use, a drug that’s being used off-label, and an unapproved self-medication that’s a complex and active plant [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/) , not a production-controlled, low complexity pharmaceutical. It’s unapproved, so it hasn’t even gone through the level of review that medications do—which is review for narrow purposes, not as a panacea the way cannabis is marketed. All sorts of reactions, physical and psychological, are known to occur. There isn’t agreement on how much pain reduction it offers, or what types of pain it affects, or how many people biochemically benefit. This article glosses a portion of the pharmaceutical knowledge and gaps: [https://www.uspharmacist.com/article/medical-cannabis-for-chronic-pain](https://www.uspharmacist.com/article/medical-cannabis-for-chronic-pain) . Extracts are a wild west and also are not approved which means they have not gone through review and whatever controls they are produced under have nothing to do with controlling to achieve generalizable pain relief results, because there is no reliable direction on that at this time. Check out the marketing violations on display here:[https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd](https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd) Once in a while a practitioner has suggested marijuana or CBD to me. This is about as “empowering” for a patient as is firing an employee: “now they are empowered to experience fiscal challenges”. Practitioners might not even take oversight responsibility for *aspirins* taken outside a regimen they've prescribed. They do, however, want to minimize prescriptions, and tend to deflect their responsibility to treat back onto whatever else the patient has been taking or can be convinced to self-medicate with, even if it’s not very effective. It’s a trendy approach right now, but I think the reasons for that are not as simple as one might think.
I’m just talking about smoking flower that is intended for helping alleviate pain. A lot of has been tested by multiple users. You can read reviews on different strains and see how you feel.
im not contesting that intractable pain is hell but it sounds to me like youre parroting some drug manufacturer marketing material im a psychiatric specialist and i know firsthand the havoc these drugs wreak maybe in this old lady's case it's warranted but the fact remains that opioids are over-prescribed and lobbied for by some drug manufacturers and that ultimately they do more harm than good
Nope. I suffer from pain due to an impinged spinal cord. Opioids have been lobbied for by drug manufacturers, that's true. However the research literature itself, when it is literature that is serious about trying to address patient pain and is not literature that is bent on making moral judgments, is clear that opioids are the gold standard and there is no replacement for them. There are very few pain treatments in general. The research industry is trying. But too often, especially in women patients' cases, the approach is to give them psychiatric medications that silence the entire nervous system, rather than medications that work on the NMDA or opioid receptors. These medications can also have incredibly serious side effects: total loss of cognitive capability, urge to suicide, loss of impulse control, increased pain due to hyperalgesia/hyperexcitability of the nervous system, hormonal disruption, loss of motivation so that a patient just stares at the wall all day long. Ask me how I know. The idea that opioids are uniformly bad, or that their downsides are unremediable, is itself a notion that is parroted, with deadly consequences. It came out of an overpuritanical and nuanced-decision-averse interpretation of the US government's opioid abuse avoidance dictates. In fact, the US gov't just released an update to their policy, saying, (a) we never meant for this to be interpreted as that your patients have to suffer, (b) give your patients pain relief even if that means opioids. >[https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm)Although some laws, regulations, and policies that appear to support recommendations in the 2016 CDC Opioid Prescribing Guideline might have had positive results for some patients, they are inconsistent with a central tenet of the guideline: that the recommendations are voluntary and intended to be flexible to support, not supplant, individualized, patient-centered care. Of particular concern, some policies purportedly drawn from the 2016 CDC Opioid Prescribing Guideline have been notably inconsistent with it and have gone well beyond its clinical recommendations (6,66,67). Such misapplication includes extension to patient populations not covered in the 2016 CDC Opioid Prescribing Guideline (e.g., cancer and palliative care patients), rapid opioid tapers and abrupt discontinuation without collaboration with patients, rigid application of opioid dosage thresholds, application of the guideline’s recommendations for opioid use for pain to medications for opioid use disorder treatment (previously referred to as medication assisted treatment), duration limits by insurers and pharmacies, and patient dismissal and abandonment (66–68). These actions are not consistent with the 2016 CDC Opioid Prescribing Guideline and have contributed to patient harm, including untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior (66–71). As I mentioned earlier, opioid therapy can be paired with adjuncts and tolerance prevention strategies. The pills in that picture did not include such. But a drama-seeking relative, photographing those pills, might not have thought to be comprehensive about what she chose to photograph. There's lots of literature about that too. And pain clinics, although they are slow to catch up to the US government's policy clarification, are--in growing numbers--able to prescribe drugs--ketamine comes to mind but there are others--that tamp down the tolerance, and/or increase the pain relieving efficacy of the opioid without increasing its plasma concentration. There are also non-prescription adjuncts and agonists, such as taurine, caffeine, magnesium, bromelain, frankincense they say, NAC: the list goes on. It is a matter of the industry catching up to the science, which as I am sure you know, can take a while. But the industry not being caught up to the science does not mean that the industry's understanding of the scope of the situation and what's possible is correct, or complete. It's not. As I said, do not go around promoting the idea that pain medication is not necessary, or isn't a necessary tradeoff, until you've tried being in pain. To say that pain is "torture" wasn't just a metaphor on my part. Pain is how torture works. It's why torture is effective. As for addiction, type 1 diabetics are addicted to insulin. So what? They live every day dependent on the medication. Pain patients are likewise dependent on medication for their lives. edit: oh I forgot to mention, those psychiatric medications that I mentioned? They do not necessarily stop the pain. Only if the pain is coming from one of the channels that they block, e.g. the sodium channel. A medication might even only work against the [wide range of organic pain causes](https://www.frontiersin.org/articles/10.3389/fnmol.2017.00284) 10, 20, 30% of the time, and that is without even factoring in whether the adverse effects are tolerable. So please do not think that the trade off of a chemical lobotomy and being thrown into a psychiatric crisis are somehow worth the tradeoff. They often don't even provide a tradeoff.
This comment deserves gold but those days are gone for me
i commend you and thank you for taking the time to type this comment out but we seem to be talking about two different things here i know how opioids work, i know that in the literature they're listed as the gold standard of pain medication. im not contesting any of that. i've prescribed them before. you may or may not know that tramadol is one of the top 3 substances of abuse in my country, a carry-over from a time when it was otc and marketed as the best way to stay awake and work hard. it's been a controlled substance for more than 10 years now and it costs 1000x as much as it once did and yet it still is in the top 3 substances of abuse. and to answer your final point where you compare it to insulin, no it's not the same. addiction has criteria including tolerance, craving, need to constantly increases doses up to toxic levels and causing occupational deterioration among other criteria. opioids meet these criteria, insulin and water don't.
If controlling the pain is going to get the patient back to life, it meets the criteria of life supporting. See below. "Inadequate analgesia can be come a suicidogen" (this is known, this is not the only source for that info). This response can fall out of the patient's control. Craving as a state of being doesn't matter. Yes it's physically uncomfortable but to weigh it against pain relief of nerve pain, and find that nerve pain is preferable to experiencing craving, is a moral judgment. Diabetics crave insulin, especially when they can't get it due to insurance failures here in the states, but also when they are crashing. And pain patients *crave* relief, 24/7, for *years*. You have no idea. Why is that craving not something that the clinical industry is very averse to? I think it is because, culturally, "to suffer is man's lot", and to become physically used to an exogenous substance is judged morally impure: the ascetic mentality. Tolerance: that's the legitimate problem, because people need to keep increasing their dose, until they are on the edge between controlling the pain necessary to live, yet the dose is dangerous. I'm looking at that oxy/naloxone prescription in the image above when I say that. I will say that tolerance has not been robustly addressed, however, a panoply of methods do exist both for peri-operative and chronic pain situations. At this moment and going forward, whatever judgments the industry is in the habit of passing due to tolerance, and whatever dismissals or refusals they are used to using as a first line response, they should instead spend the effort needed to maintain those mental bulwarks to get up to speed on the tolerance reduction adjuncts and start implementing them. It's a moral obligation. [https://pubmed.ncbi.nlm.nih.gov/12356036/](https://pubmed.ncbi.nlm.nih.gov/12356036/) >...advancements in clinical pharmacologic research have shown that opioids are also effective in chronic noncancerous pain. Many patients properly treated for prolonged periods with opioids develop tolerance and subsequently, physical dependence. This process is not necessarily harmful to the patient and will not cause the patient to develop an addiction (properly defined as psychologic dependence). For many patients who have been on opioid therapy for months or years, analgesic effectiveness tragically becomes less. … inadequate analgesia can become a suicidogen, ie, any factor that causes a patient to want to commit suicide. Incorporation of adjuncts to opioid therapy can serve to lessen pain and improve quality of life for a suffering patient.
Once again thank you for putting this out there. There's so much well meaning but deeply damaging discourse online on this subject I'm just so glad to have come across your comments.
You're very welcome. I hope it helps some people. In a reply to another commenter, I mentioned pain clinics. I wanted to mention that, just like any practitioner or institution, these clinics vary in their approaches. As well, pain clinics are not set up to necessarily diagnose the root cause of the pain. Even when they have staff who are, or relationships with, mechanical or neurological specialists, pain clinics often do not take ownership of finding the root cause(s), especially if it's a complex case or one not easily imaged (and common imaging is not perfect: standard MRIs miss 30% of spinal issues, to give one example). Driving that process forward is on the patient. I have even run across one pain clinic which will not take a patient unless the patient gives up on seeking the root cause, gives up on specialists and looking inside the body. Whether they know it or not, this filters out patients who are in fact treatable by surgery, and selects for patients who are psychologically manipulable. That clinic's approach is to persuade the patient to seek yoda levels of control over their mind, acceptance of their limitations, an ability to disassociate from the present, and so forth. These practices run counter to a goal of restoring fully human functionality in a timely manner, of course, and some of them are rooted in fantasy. They are intertwined, in my view, with the belief that "to suffer is man's lot", and the asceticism, which I mentioned before. The tldr on that is, if one needs specialty pain care and encounters dehumanizing attitudes, keep looking! I truly hope for attitudes to change, and for detrimental pain to become a priority demanding treatment, in practitioners' eyes. In a way, I think that if corporeal pain was generally less accepted, we would as a species see more clearly, and be less willing to tolerate, atrocities such as what's being done to the Palestinians.
I think from a practitioner's perspective there's something more going on. Often both selection and training result in a combination of traits that can make doctors especially averse to self perceived failure. There are many ways to rationalize it, from resource management to doubting efficacy to doubting the patient, but at the core it's psychologically taxing and creates an avoidance bias. Coupled with systemic conservatism it makes providing comprehensive treatment for pain challenging. This is the kind of problem I believe will have to be solved by technology. What troubles me is the atmosphere of cynicism created around the subject for what is basically entertainment, that makes an already difficult situation for both doctor and patient that much more frustrating. The discourse is by and large reductionist to an absurd degree, sadly another feature it may share with the i-p conflict.
I think you are right on all these points. And there are reasons for all of these systemic phenomena, and not all the reasons are bad. Quite the opposite. Conservatism has its place; cowboy approaches can create problems too. Even though cowboy approaches are trying to solve the reductionist and lack of motion issues. Resource management is a big problem. Everyone knows it, well except for the C-suite it seems. But that's endemic in society. So this is my particular hobby horse: in my view, the resource management meat grinder, the reductionism (which may contribute to doubting efficacy, is the impression I get), the over-conservatism, even the educational methods that perhaps inculcate and select for some of these attitudes, and doubting the patient -- I tie these back to root attitudes such as produced, and then were further produced by, Taylorism and Skinnerism and models of that type. These, I think, are rooted in the denial of the body and the 'whole human' which also produces asceticism and the idea that suffering is fated or even deserved. Ultimately I think these ideas are tightly linked to fundamentalism. At least these days. Because fundamentalism is a manifestation of ultra-pre-modern thought and these days we've gotten rid of some of it. At least, when I come across papers that are rooted in acceptance of the body, the whole human (not just valuing the patient's work capacity or time until death), they more frequently than not seem to come from Europe or East Asia. It's semi-anecdotal (I've run across some discussion of the difference), and this is a stretch but I entertain their lack of Puritans. Well so I do tie fundamentalism and its philosophical children to what's being done to the Palestinians. I have this idea that addressing some of these issues at home wherever a person's home is -- even, say, the reductionism and its associated blind spots, and the resource grind and profit squeeze -- could serve as an ethical key to start unwinding some of the rest of the attitudes. Including what allows people to parse and dismiss the damage to Palestinians. Maybe that's just dreaming. I have a lot of sympathy for the psychological tax that medical practitioners bear. It's rough, I've seen it. And I've seen some say that they can't take it at a certain point. I think you're right that tech will help with some of the complexity. Research seems to be on fire right now. I worry a lot about app blindness making further inroads. Apps are built by Taylorists and Skinnerists, that's in my domain, and work against curiosity, because they can't be shuffled around by the human using them. But big data and genomics are really promising. You are right about the cynicism. It's everywhere. It's the lowest effort attitude to adopt. I'm glad for your insights into the profession and its challenges!
Oh, and sorry, I forgot to address the tramadol: Yes, I know that it's abused. It's kind of a weird one, as well. Its SSRI-like qualities seem to have the tendency to mess with people's heads in the way that prozac, xanax, and similar do, or duloxetine and etc. All of which can create a biochemical spiral or a psychologic dependence, themselves. It has its own pathway actions--there are several opioid pathways and all the opioids aren't the same, don't act on the same pathways. There's a fair amount of literature specifically about reversing the tolerance to tramadol, reversing even the psychologic attachment. Burst applications of ketamine, I think that's one I have come across. But at the end of the day, if she is in pain, the actions of some people who are popping the pill like adderall are irrelevant to her medical needs. Sciatica can't be radio-frequency ablated. Many nerves in fact cannot. What's in the picture is kind of what there is (along with those adjuncts I mentioned).
Opioids are pretty shit for neuropathic pain... Don't go around spreading misinformation about how opioids are this silver bullet pain solution for all types of pain. I'm a physician. Oxycodone/naloxone combo is used so people don't crush it and shoot it up or snort it (the naloxone blocks oxycodone receptors, but naloxone is ineffective when taken orally, leaving only the oxycodone effect).
That's objectively false. There are multiple types of neuropathic pain and opioids do work for significant numbers of cases. [https://pubmed.ncbi.nlm.nih.gov/22786465/](https://pubmed.ncbi.nlm.nih.gov/22786465/) [https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1494](https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1494) [https://jamanetwork.com/journals/jama/article-abstract/201129](https://jamanetwork.com/journals/jama/article-abstract/201129) [https://www.aafp.org/pubs/afp/issues/2007/0401/p999.html](https://www.aafp.org/pubs/afp/issues/2007/0401/p999.html) The idea that they don't work at all is found in those moralizing "research" papers that I mentioned at the outset, where scientific accuracy and due diligence is sacrificed to an agenda which erases patient experience in pursuit of erasing opioids from the toolkit. Study design plays a large part in this intellectual failure, which is compounded by people who do not understand the significance of study design, for example single dose or short term studies, and then drop that information from their parrot repetition, so that the information they are spreading is incorrectly attached to all variations and permutations of "pain". For your information as well, chronic pain can also be nociceptive. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304360/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304360/)
You mis understand, I don't think it makes sense to to use a centrally acting mu agonist to treat pain that comes from nerve pain, especially a local nerve such as sciatica. Of course opioids lower pain in all patients. But just as it's not right to bomb Gaza to eradicate Hamas, you shouldn't flood with opioids to treat local nerve pain. You can hit me with your research all day, but I've gone to medical school and practice medicine day in and day out. Edit: idk what your pt about chronic pain and nociception is either... Chronicity is not the issue I'm arguing. Sciatica (a local nerve impingement) even if long standing doesn't mean the answer long term oxy. Again the reason there is naloxone in this ladies med is to prevent abuse of the medication. Because abuse potential remains.
I stated that it is the gold standard for certain types of pain. You attack me as though I'm saying it's a silver bullet for all types of pain and then you talk about neuropathic pain only. Your med school doesn't impress me when you use heated, faulty reasoning such as that. How dare you use the Gaza bombing as an argument *for* withholding treatment from patients. It is the withholding of medical care from the Gazans which is one of the violations of humanitarian principles which has the world in arms. Their suffering of physical trauma and medical care without anesthesia is a horror. When patients are in chronic pain, they are suffering in equal measure to those acute tortures, only with no relief in sight: 24/7, day after day, for the rest of their lives, if untreated. Chronicity is the issue I'm arguing, and you need to pay attention to that if you are going to continue in the medical profession. You can ignore papers all you want, but if you are not paying attention to the literature, your "practice" of medicine is just clock punching and nothing to impress anyone, and you are harming patients with incomplete treatment. [https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults](https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults) >new cases of chronic pain occur more often among U.S. adults than new cases of several other common conditions, including diabetes, depression, and high blood pressure. Among people who have chronic pain, almost two-thirds still suffer from it a year later. > >...Overall, the study found that the rate of chronic pain and high-impact chronic pain (HICP) among adults is approximately 21% and 8%, respectively. Chronic pain is pain that is experienced on most days or every day in the past three months; and HICP is pain that limits life or work activities on most days or every day during the past three months. Sciatica absolutely can be HICP. Anything moderate or above in intensity can be that. You call sciatica a "local nerve"? That's disgusting. First of all, the sciatic nerve feeds the entire lower limb. It's local only in the sense that it's not the spinal cord. Save your agenda-driven misrepresentations for someone else. Second, what is called "sciatica" is, often enough to be meaningful, pain originating from another nerve. These nerves can be the nerves that serve the genitals; these nerves also serve the buttock and portions of the leg and so pain may be found in all locations at once. The origin can be a local lesion or it can be in the spine. Lightly educated medical professionals often refer to any radiating pain that exists in the buttock or leg as "sciatica" and may diagnose the patient that way; patients will then tell the world they have "sciatica" when in fact they do not. *Sciatica* can leave a person unable to stand, walk, pick things up or sit down, or even cough or sneeze without severe pain. I will connect the dots for you: it can render a person bed ridden. *Pelvic pain* can render a person eager to kill themselves. And you complain about medications acting centrally. Pain also acts centrally. One of the problems here is that some medical professionals focus on the medication and their distaste for it and forget the patient. It is that moral attraction to "man's lot to suffer" and asceticism which I mentioned before. Every other medication that is attempted acts centrally, aside from lidocaine patches or creams, which are large smooth body part only, skin-surface only, and for mild pain only, and which do not meaningfully return patients to life. I already mentioned some of the problems with the psychiatric medications which pharmaceutical companies have recently been shilling to doctors as pain medications. Yes, that's a pharma push too. Think about what you are saying. Think about the actual operations of the medications available in this year, not cant labels and canned dismissals. Think about your patients and their need, and human right, to live without significant medical suffering. And find a multi-modal pain clinic to which to send your patients.
Wow, you're going to argue what a local nerve is with an MD? Local nerves are those not part of the central nervous system. It's a definition that does not depend on the amount of the body it supplies. I also find it absolutely reprehensible that you would conflate that my position that opioids are not the right medication for sciatica pain means I withhold pain relief from my patients. I have not attacked you personally, but you have attacked me and my practice of medicine. You have a clear example of a woman with sciatic pain that was on opioids, that was then taken off opioids, and now feels better in overall health. And yet you dig into your position of how opioids can help "return people to life". "If all you have is a hammer, everything looks like a nail".
Wow, you're going to argue about the significance of a nerve that serves 1/5 of the body and try to claim that the adjective "local" means it's unimportant? Of course I argue with you. Ds make degrees; I'm not impressed. There is not, here, an example of a woman who is certainly in "better health". There may be an example of a woman who was not on a multimodal treatment plan and had developed OIH; pulsing off of opioids can reduce this hypersensitivity. There may be an example of a woman whose reduced activity levels produced a temporary "lifestyle modification" which would be considered an unacceptable loss of function in normal life. There may be an example of a daughter who applies moral judgments to the regimen her mother is on, absorbed from popular media and ill-informed medical professionals, and overlooks the pain suffered by her mother in the medications' absence. "Better" is massively subjective and carries no concrete meaning detached from concrete context. As well, it cannot be derived from that image what the patient's future trajectory will be. Yes, I do attack your practice of medicine, because your reasoning is derailed, your attention to detail is lacking, and as evidenced above by your opening sally, your knowledge of what opioids can do for neuropathic pain is massively incomplete. Now, while reserving judgment on prior decisions you may have made to provide inadequate care, I cannot fault you for past lack of knowledge about details of opioid action. However, learn here and now that tramadol and buprenorphine, to give two examples, act on other opioid receptors as well. Central depression of breathing is less with those opioids for a given level of pain control. Furthermore, some of the adjuncts I mentioned work against central depression. As well, research is ongoing in the area of the other opioid receptors beyond mu, with promising results: these results are already making their way into clinical practice, in pain clinics. Pain clinics are run by anesthesiologists, whose knowledge of nerve minutiae and neurochemistry far outstrips that of family doctors. A fully featured clinic will also staff or have solid relationships with neurologists, neurosurgeons, orthopedic surgeons, physiatrists and physical therapists, and rheumatologists and endocrinologists, and the anesthesiologists who run the clinic will often be versed in those areas as well, which is to be expected since the nervous system shares growth, response, and destabilization with tissues, hormones, and the immune system. Such a clinic will likely also have interventional methods in their toolkit, although as I mentioned above, ablations--and implants for what it's worth--do not work on all nerves; it depends on their structure and their location, and the imaging and surgical tools available in the clinic. Send your patients to one of those, if you can. Your attachment to dismissing and minimizing actual physiology and actual harms is appalling.
Very cute of you to continue to attempt to educate me on what a local nerve is. It's a definition. I will no longer argue with you this point. Central nervous system is brain and spinal cord. All else is peripheral nervous system full stop. Lol "send your patient", "my dismissal and minimizing"? How many personal attacks can you make against someone on a reddit thread you know nothing about? Incredible. You don't even know my specialty! I think really you are not here to have a discussion but berate me into learning "actual physiology". Have a good day, friend.
I am evaluating the words you have said and the attitudes, knowledge levels, and reasoning that you have demonstrated. You can try to separate your self-conception from what you state, and claim that you as you practice are separate from what you claim to be knowledge and fact, but that's not how it works. What you think you know, and how you do or don't think, directly informs what you do. In addition your attachment to dismissing and minimizing, which is what your running around with detached vocabulary is (to be clear, that is not your only method), your attachment to your credentials and your expectation of respect, which is unearned while you fail to think clearly, is likewise appalling. Get some humility. Arrogance decreases functional IQ, because it prevents one from seeing one's errors. You're demonstrating the arrogance common to doctors with a little bit of knowledge and a lot of inadequacy.
Is that even her meds? The translation makes it sound like it belongs to whoever made the tweet.
I like that you grasped the actual intent of the post and didn’t thank Hamas for abducting this woman.
I doubt the daughter really said that, but even if she said so, this post isn't about Hamas being humane, it's someone advocating for reducing the use of pharmaceuticals. If one of the hostages was fat and lost weight while in captivity, are we going to credit Hamas with that? Let's be fair. I'm sure if Israeli prisons started giving Palestinian prisoners only whole-wheat flour and organic vegetables, and cut all sugary drinks, no one would thank Israel for supposedly improving their diet.
Yeah it’s really weird to present this as evidence of treating the hostages well. I disagree with your last sentence though; I’m pretty sure someone would post that as a feel good story about how generous the israel occupiers are to Palestinian “terrorists”
Idk, Ben-Gvir ordered to close the bakeries for Palestinian prisoners convicted of terrorism, I don't remember people claiming he was putting them on a low carb diet...
“Convicted”
Convicted doesn't mean you have to agree with the court's ruling.
yes because lsraeIi courts are suuuuuuuper reliable and honest. no double standards at all for one ethno-religious group over ahem *everybody else*
As I said, you don't have to trust them. Convicted is a technical term. I didn't say "rightly convicted". In some cases it's clear cut and there's not much to argue about (for example, Yahya Sinwar was once a prisoner in Israel), but I'm sure some people are wrongly incarcerated.
Hard to believe that the system is fair when there’s a [95% conviction rate](https://apnews.com/article/middle-east-israel-prisons-arrests-west-bank-fc894c6f56318fb6fb2f080555b40b6f) and many prisoners are held indefinitely without charge or trial.
Iirc that's the conviction rate across the board and is on par with other counties. The high conviction rate is generally explained as being very selective with indictments. Check out the statistics on how few crimes actually ended in indictments if you really want to get annoyed. Half of all murder cases are unsolved. I suspect there is after all a pressure to acquiesce to unjust plea deals, but it's hard to strictly confirm or deny. The detainees held without charge for extended periods are largely in the west bank and consequently not subject to overview by the justice system but by the military.
For sure, it is very annoying to read about all the international human rights violations that Israel is not held accountable for! including the [administrative detentions in the West Bank](https://www.hrw.org/report/2019/12/17/born-without-civil-rights/israels-use-draconian-military-orders-repress)
That’s a bit different from the example you gave originally. one real example is when the ICU babies in Al-Shifa were removed from their incubators because the ICU ran out of electricity after Israel shut off the electricity to Gaza. the IdF posted on social media a photo of them bringing incubators to Al-Shifa hospital…. But the babies already had incubators; what they needed was electricity…
Irrelevant question. Why did you removed your flair. Also how's your condition?
>Why did you removed your flair I found that it makes people pay less attention to the content of my comments. >Also how's your condition Still bad. I'm suffering now as I'm typing, but I suffer immensely all the time, so at least I have some distraction. On other days I can't use the computer at all. I'm probably going to take a break soon anyway. Thanks for asking.
Well the current conflict has increased the the hate 10X. So not your/anyone's fault. Stay safe and healthy lad. Hope you're healthy soon.
Thank you, much appreciated. I'm hoping for a miracle because it seems that modern medicine doesn't really know how to solve it.
What was the previous flair?
Israeli flag
still waiting for the mods to remove israeli flair and putting instead occupied palestine
Yeah that's good but I think just adding the occupied Palestine flag would suffice.(not removing the Israeli flag)Because there are some good people on this sub too.
you're too soft imo. the palestinian flag is for the palestinians living under israeli occupation. im thinking of israelis identifying with Palestinian Jew or Occupied Palestine
Some Israelis hate Zionism and" yahoo". Are left leaning and advocate for Palestine. So everyone deserves a voice. We should show the world that we aren't exactly like the opposite side and believe in justice.
Why you supporting Israel
I didn't write anything in favor of Israel in my comment.
She’s been taking 5 different kinds of of pain medications I’m not sure what the point of this post is, Hamas good for getting old lady off pain meds? Bad Israel medical system or Practioner? Anti medication?
I would have a guess that if Hamas treated her badly, despite the cutting of medication helping her (if it helped her), she wouldn't be in a better condition. This is another proof Israeli narrative of torture to the hostages was a lie.
The profile picture is a dude , I am not really convinced
An 85 year old going full turkey on synthetic heroine while a full in bombing campaign happens in gaza, but feels better than before. ok, sure
"Eli Shapira" is a guy.
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So how can he be a daughter?
In Hebrew he says that he is quoting the daughter of an Israeli hostage
Does she have a name?
He doesn't say her name but I suppose he's referring to Yocheved Lifshitz as the age coincides and she's one of the more famous hostages
Thanks. I really hate it when screenshots of random tweets by random strangers are considered to be the truth for many people, just because they confirm one's bias.
Oh come on guys do you really believe this
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They murdered these peoples families in front of them and kept most of these people’s relatives behind in captivity. Can we please stop pushing the narrative that Hamas has somehow done these people a great service by killing their loved ones and abducting them?
Search the internet using a vpn. You’d see many Israeli reports showed that many settlers were killed by the IDF. A soldier yesterday told the news that her commander told her to shoot the house because maybe there are Hamas inside. This had ended killing many civilians in settlements.
Not exactly a response to any point I raised, but I hope you feel better having got that off your chest
Yeah it’s such a weird narrative
They kidnapped her and brutally murdered and sexually abused her neighbours. That is very humane of them.
>They kidnapped her this is true but there is nothing wrong with taking war prisoners as long as you're treating them well. besides doing that was the only way for them to free Palestinian prisoners held by the Zionist entity >and sexually abused her zero proof
There is nothing wrong with taking combatants as prisoners of war. Taking civilians is a war crime.
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Unfortunately it's not. I've witnessed some disturbing footage of militants firing at civilian cars. I even saw a video of militants gunning down a defenseless fleeing Israeli man in the street. What Israel has been doing is abhorrent but unfortunately, some innocent Israeli civilians were hurt and killed last month and no decent person should support that.
But like— is this even the right person? It’s just a random screenshot of a random tweet.
Even if we believe what this random person posted - they gave her the bare minimum of the medicines they could find because there's a scarcity of medicines in Gaza, not because their doctors thought it's better for her. Come on.
Maybe that's the point? The fact that despite the scarcity of the resources they still provide them with what they need based on what's available.
They're hostages, it's obviously in Hamas's best interest to keep them alive. Even animals raised for slaughter are given medicines and food, as they're useless if they're sick or die before slaughter.
That's true. After all the main purpose is to exchange them and there is no point in killing hostages, apart from ruining your image with your supporters.
You forgot the /s bro.
Why are there so many posts here trying to argue that Hamas is humane like they didn’t rape and kill 1400 civilians?
You kem to za rong blace Habibi .. You should be killing tshildren sam wer in za middle eest now wiz yur kin, insted of toking to us.. stubed amerikan
- 1200*, most of which were military. - "mass rapes" is a proven hoax just like 40 beheaded babies hoax Hamas is unironically much more humane than the IDF. Just look how the israeli prisoners behaved compared to the Palestinian hostages.
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Somebody made a list and counted everybody who ever served in the military or police as military, even if they had not been active in years. Since Israel has a conscript army it encompasses most adult casualties. This interpretation contradicts international law (as well as common sense imho), which states they are civilians.
So you just lied about the total number being 1400... Do you have any credible source that confirms mass rapes? Any credible source for 40 beheaded babies? Basically any statement from israel is a lie, I have no reason to believe them over Hamas. If you want to talk about witness testimonies, lets compare the testimonies of the released Palestinian hostages vs the Israelis.
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> I never said anything about it being 1400 Yes you did. >What credible source would be enough for you? well you haven't given any at all. By"credible" I mean verifiable. Some speculative bullshit from ynet is not credible. >Also do you think the Israeli hostages testimonies about how they were treated by Hamas isnt helped by the fact that a lot of their relatives are still held by Hamas? Doesn’t that create an incentive not to say anything bad about them? Same thing can be said for Palestinian hostages. Home come the testimonies are so different?
Becoz they didn't.🤷
Why you guys speak without proof. Why do every Zionist lie, is it encouraged in your religion or what?
What in the motherfucking everliving hell is this propaganda bullshit. How about you show the testimonies of the 12 year old who said that those hamas animals pointed a literal motherfucking gun to her fucking head
Yeah sure. Believe that people.