In residency, I had a patient who only wanted Toradol. We gave him Vicodin, tons of morphine, but he was obsessed with getting his toradol shot. For those of you who don't know, toradol is like a stronger form of motrin. I would love to give him as much toradol as he wants, but you can't give it for more than five days because it can cause bleeding.
My attending: "I've never seen a patient who wanted an NSAID that badly."
Me: "Yeah, I think he must think toradol is like demerol or something."
Attending: "Well, we can give him an oral NSAID. Which one do you want to give him?"
Me: "I don't know. Which one sounds the most fancy?"
Attending: "There's motrin, naprosyn, voltaren..."
Me: "Voltaren! Yes, that sounds good."
Cataflam
ReplyDeleteI have to admit I am one of those toradol folks but mostly because opiates make me vomit.
ReplyDeleteI usually prescribe Nabumatone for NSAID seekers... although I just learned about a very fancy NSAID Percogesic which I think I will be switching to now! (Perhaps we shouldn't be giving away our secrets on here!)
ReplyDeleteI worked with an ER doc that used to write scrips for Dolobid. He'd get gushing praise when he told the pts the name of the drug he was giving. I'd imagine they weren't nearly as happy when they actually got it filled.
ReplyDeleteFor my age, (29) I am relatively young for all the back problems I have had. It started at 25 and has progressed slowly but gotten worse during those times (I think its a rheum issue because of other issues, but they still haven't given me a definitive diagnosis) I can't tell you how many times the pain doctor or whatever specialist they sent me to gives me the side eye thinking I am a drug seeker because of my age. I never ask for any opiates and I don't want them either. All the NSAID's they have ever given me are really not that effective for me. They help minimally. I've tried voltaren, nabumatone, mobic...you name it. Toradol was the only thing that actually helped the pain. It worked better for me than even tramadol did. I guess I am one of those patients that have asked for toradol, but I knew it wasn't a narcotic/opiate. Maybe your patient was like me.....I know there are a ton of drug seekers from reading these blogs, but not everyone who is in a lot of chronic pain necessarily wants to have to take an opiate. I hate the feeling and nausea it causes. Maybe toradol was the lightest type prescription he could find that would help his pain?
ReplyDeleteI don't know how old he is, but I totally understand already being judged by certain doctors before they even read my file just due to my age. I hate it. AND i look young on top of that. I can understand how doctors get jaded, but some of us truly just want to be helped - I don't care what it is as long as makes my quality of life better! And I don't want to take something addicting. All I have found is that the doctors just want to keep doing cortisone injections over and over. None of them seem to have problems writing prescriptions for muscle relaxers, which I don't want either and never seemed to help too much. After 4 years, 12 injections, and a facet and SI rhizotomy, I don't feel much better. (Only some reduction from the SI one) Unless someone has experienced chronic pain first hand, it can feel really life altering and it sucks to feel judged and dismissed for it too. Especially, when during all those times I never asked for any painkiller in the 4 years, except right after the SI rhizotomy (which was really painful for me).
Am I wrong with thinking that an actual drug seeker wouldn't stick around for 4 years without trying to get heavy duty prescriptions? Nor would they go through the expense/time of at least 15 procedures (without asking/receiving narcotics?) Yet I still feel judged and not taken seriously. I totally understand the dilemma physicians have ( I am an non trad pre-med graduating in spring, so I do read a lot of med blogs) but there has to be a point where there needs to be less judgment coming from the physician and a better way to empathize with the true sufferers:( Too bad the drug seekers ruin it for those that really are suffering.
On my surgery rotation, my patients just LOVED IV Tylenol.
ReplyDeleteTana, IV Tylenol is quite effective. In Europe they've been giving it to people for a long time. I believe they said it's as strong as morphine, but without the respiratory effects.
ReplyDeleteWe have a pt who thinks Toradol is stronger than other drugs BECAUSE you can only have it for five days (whereas his Oxy he could take everyday). The power of the mind. He wants the strong stuff when he's admitted.
ReplyDeleteAnd I agree about IV Tylenol. I'm not sure it's as strong as morphine, but it sure does bring patient's morphine usage down. You can tell a big difference in pain control with it after surgery.