Can I explain to doctors that weaker opiates don't seem to work for me?
September 29, 2020 10:24 PM Subscribe
I was recently in the hospital for a few days for gallstones. I have very little experience with opiates so I was really surprised/disappointed that I got no pain relief from them except for the really strong ones. But I also felt scared to actually express this since I thought it would sound like drug seeking. Surely there is some variation in how well people respond to opiates, but is there anyway to talk about that?
The pain was completely overwhelming from the time I was admitted until surgery the next day. The medical staff were all nice and responsive in giving me pain meds (tylenol, morphene, oxy-something, dilaudid, and fentanyl), but none of these had any noticeable affect on my pain except a very minor reduction from dilaudid, and then fentanyl actually decreased it to a manageable level. I also didn't get any "high" feeling, just a heavy slow drowsy feeling that was overall unpleasant. I wanted to say "can you just give me fentanyl? That's the only one that's worked so far" but I didn't want to sound like a drug seeker. I'm worried the way I acted already made me seem that way.
It's obvious to me that my body must process opiates a little differently, but surely there are lots of other people like me? Is there anyway to communicate that, or is it just the wrong time with the opiate epidemic? Are there non-opiate pain relievers (but stronger than tylenol) that I can ask for instead?
Hopefully I won't have another experience like this for a very long time, but I feel so apprehensive thinking about that night of pain. I want to be prepared.
The pain was completely overwhelming from the time I was admitted until surgery the next day. The medical staff were all nice and responsive in giving me pain meds (tylenol, morphene, oxy-something, dilaudid, and fentanyl), but none of these had any noticeable affect on my pain except a very minor reduction from dilaudid, and then fentanyl actually decreased it to a manageable level. I also didn't get any "high" feeling, just a heavy slow drowsy feeling that was overall unpleasant. I wanted to say "can you just give me fentanyl? That's the only one that's worked so far" but I didn't want to sound like a drug seeker. I'm worried the way I acted already made me seem that way.
It's obvious to me that my body must process opiates a little differently, but surely there are lots of other people like me? Is there anyway to communicate that, or is it just the wrong time with the opiate epidemic? Are there non-opiate pain relievers (but stronger than tylenol) that I can ask for instead?
Hopefully I won't have another experience like this for a very long time, but I feel so apprehensive thinking about that night of pain. I want to be prepared.
Are you a redhead?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/ - Anesthetic Requirement is Increased in Redheads
posted by sebastienbailard at 11:39 PM on September 29, 2020 [3 favorites]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/ - Anesthetic Requirement is Increased in Redheads
posted by sebastienbailard at 11:39 PM on September 29, 2020 [3 favorites]
And if you go down that path with the doctors, maybe ask if you can be tested for opiate resistance, rather than presenting it as a conclusion that has already been settled.
posted by rhizome at 11:54 PM on September 29, 2020 [17 favorites]
posted by rhizome at 11:54 PM on September 29, 2020 [17 favorites]
I'm like you and honestly, what's made doctors take me the most seriously about this is seeking Advil (ibuprofen). It genuinely works better for me in most pain-related situations than Tylenol or any of the the pill-based opiates I've tried. (It also doesn't make me vomit like opiates do.) The problem is that it's contraindicated with some surgeries due to increased bleeding risk, so it's not always an option, but I still find going in and Advil-seeking (or saying "look, if you put me on opiates, I'll probably vomit, so can you add Zofran if you have to do that" although it sounds like you didn't get that wrinkle) is much more successful as an approach.
If you anticipate needing pain relief again soon or frequently, I second the suggestion to ask about being tested for opiate resistance. But beyond that, I suggest being open about wanting non-opiate solutions. They may work better for you.
posted by pie ninja at 3:48 AM on September 30, 2020 [1 favorite]
If you anticipate needing pain relief again soon or frequently, I second the suggestion to ask about being tested for opiate resistance. But beyond that, I suggest being open about wanting non-opiate solutions. They may work better for you.
posted by pie ninja at 3:48 AM on September 30, 2020 [1 favorite]
I'm seconding what pie_ninja said above. When I was recovering from surgery a few years ago, I found (to my surprise) that Advil (generic name: ibuprofen) worked better than I expected. It didn't eliminate the pain, but it reduced it significantly. I was taking 800 mg.
posted by alex1965 at 6:26 AM on September 30, 2020
posted by alex1965 at 6:26 AM on September 30, 2020
When I tell my pain specialist that my current dose isn’t helping, she says, “Well, if it’s not helping, then I guess there’s no point in keeping you on it anymore, is there?”
posted by The Underpants Monster at 6:39 AM on September 30, 2020
posted by The Underpants Monster at 6:39 AM on September 30, 2020
You might have a mutation in the gene CYP2D6 that codes for an enzyme that metabolizes opioids. Gene mutations that lead to poor metabolization can translate to weak pain relief from opioids. Your PCP might order the test for you. Or there are commercially available genetic testing kits that will do it (at least there were a couple years ago). Approaching your healthcare provider from this angle, I think, will probably be the most helpful.
posted by teamnap at 6:59 AM on September 30, 2020 [3 favorites]
posted by teamnap at 6:59 AM on September 30, 2020 [3 favorites]
The technology is in its infancy, and not widely used in an official capacity but there are several genetic workups you can get done to see if you have uncommon genetic profiles that could potentially alter how medications ding you. It isn't really covered under insurance. I had the PGxOne test done; I don't know the cost, because it was waived due to financial circumstanes and the nature of the test. I was doing it for other reasons, but a wild byproduct found out that part of why dental work was so grueling for me was that I have a genetic profile that allows my body to absorb and process novocain and other similar drugs of that class almost twice as fast.
The documentation that I had was legit enough that it worked for the dentist I see; they now give me x2-x3 the regular amount of numbing agent, and dental work is now much easier to get through. If it would work for a provider of 'harder' medications, I don't really know, that would probably have to do with where you are in the country, what network you're in, and even the individual doctors and team members treating you.
Heavy documentation with your PCP might get you some traction? If it was serious I'd say getting a letter from a geneticist or other specialist may be important? But again, this kind of thing may be very doctor dependent.
posted by furnace.heart at 7:10 AM on September 30, 2020 [1 favorite]
The documentation that I had was legit enough that it worked for the dentist I see; they now give me x2-x3 the regular amount of numbing agent, and dental work is now much easier to get through. If it would work for a provider of 'harder' medications, I don't really know, that would probably have to do with where you are in the country, what network you're in, and even the individual doctors and team members treating you.
Heavy documentation with your PCP might get you some traction? If it was serious I'd say getting a letter from a geneticist or other specialist may be important? But again, this kind of thing may be very doctor dependent.
posted by furnace.heart at 7:10 AM on September 30, 2020 [1 favorite]
Is cannabis an option to supplement the opiates? Cannabis edibles allowed a family member of mine to cut her hydrocodone pain meds from 4+/day to 1/day.
posted by andythebean at 8:20 AM on September 30, 2020 [1 favorite]
posted by andythebean at 8:20 AM on September 30, 2020 [1 favorite]
Me too! It's a genetic thing for me. Morphine does nothing but make me nauseous (even via IV). Dilaudid works but god I would hate to have to ask for it upfront without being able to point to a test result.
posted by ananci at 10:20 AM on September 30, 2020
posted by ananci at 10:20 AM on September 30, 2020
Some people, in fact a majority of back pain sufferers in a recent study, actually produce anti-opioid antibodies which neutralize the drugs.
The back pain patients took opiates over a period of time, but if you have a history of allergies and sensitivities it's conceivable you developed such a response with less exposure, but that exposure would have to have taken place before your gall bladder problems since the opiates were ineffective from the start.
posted by jamjam at 11:20 AM on September 30, 2020
The back pain patients took opiates over a period of time, but if you have a history of allergies and sensitivities it's conceivable you developed such a response with less exposure, but that exposure would have to have taken place before your gall bladder problems since the opiates were ineffective from the start.
posted by jamjam at 11:20 AM on September 30, 2020
Seconding teamnap.
Morphine works for me, codeine doesn't. Polymorphisms in cytochrome P450 (CYP2D6) affects how quickly codeine is metabolized into the active morphine form.
posted by porpoise at 12:29 PM on September 30, 2020
Morphine works for me, codeine doesn't. Polymorphisms in cytochrome P450 (CYP2D6) affects how quickly codeine is metabolized into the active morphine form.
posted by porpoise at 12:29 PM on September 30, 2020
> I wanted to say "can you just give me fentanyl? That's the only one that's worked so far" but I didn't want to sound like a drug seeker.
I'm speaking with a lot of privilege here, so apologies if you're in a group that gets stereotyped as drug seeking, but in your situation I would just say that. I've had to ask for specific drugs sometimes and I've found that actually the medical people have been fine with it. If you're already in there for surgery or whatever it's been established that you really do have a medical issue.
posted by The corpse in the library at 12:48 PM on September 30, 2020
I'm speaking with a lot of privilege here, so apologies if you're in a group that gets stereotyped as drug seeking, but in your situation I would just say that. I've had to ask for specific drugs sometimes and I've found that actually the medical people have been fine with it. If you're already in there for surgery or whatever it's been established that you really do have a medical issue.
posted by The corpse in the library at 12:48 PM on September 30, 2020
A very good thing to do is establish this with your doctor/surgeon as close to the time of your surgical experience as possible. It helps diminish the appearance of drug-seeking if there's a note in your record saying, post-surgical experience was XYZ and should be considered prior to any future surgery.
But this is a supercharged issue for the medical community right now so please also be willing to be persistent and understanding of the reticence and suspicion you may have to deal with from practitioners. There is a LOT of just flat out drug seeking. It's so common that you will be in the undesirable position of differentiating yourself from the baseline exhaustion with this sort of thing that most/all prescribing physicians are dealing with.
posted by late afternoon dreaming hotel at 2:31 PM on September 30, 2020
But this is a supercharged issue for the medical community right now so please also be willing to be persistent and understanding of the reticence and suspicion you may have to deal with from practitioners. There is a LOT of just flat out drug seeking. It's so common that you will be in the undesirable position of differentiating yourself from the baseline exhaustion with this sort of thing that most/all prescribing physicians are dealing with.
posted by late afternoon dreaming hotel at 2:31 PM on September 30, 2020
I'm a redhead, and my lifelong fear of dentists was calmed by my beloved dentist - the only one I've ever trusted to keep me pain-free. He'd read an article about redhead's analgesia needs being greater than the typical patient and medicated me accordingly. Since then, being adequately anesthetized has not been an issue.
posted by citygirl at 5:29 PM on September 30, 2020
posted by citygirl at 5:29 PM on September 30, 2020
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