Nate, I really appreciate your comments, but it seems more complex to me as well. Leaving aside the diversion issue, there is no objective way to gauge another person's discomfort or function, whereas I can measure a blood pressure or a sedimentation rate or range of motion. I can ask "How much more do you get done with the medicine than without?", and I'll get an answer "without it I hurt too much to do anything" about 100% of the time. Granted, a lot of the time it seems that the patient is mostly frightened that they will have some pain, when in fact they are so tolerant that they are just treading water. But the fear is also real.
In one of the pain management classes I took, they said that it should be considered a success to reduce pain by two units, say from a 6 to a 4. When I had an epidural for back issues done, the clinic gave me a pain questionnaire, starting with the level of pain. I had no idea if it was a 3 or a 9. I mean, compared to what? Having my skin peeled off with hot irons? No one had done that to me. Maybe it was only a 2 if compared to that. Maybe it was a 9 if compared with pain I had experienced previously. Then it finished with " What level of discomfort do you hope to achieve after this treatment?" Now, of course, I knew they expected me as a good patient to say a 2 or 3 level of reduction. But, what a stupid question. I hope for the pain to bleeding go away, all of it, forever. So, if a patient just were to come in and say that "the pain used to be a 9 and now is a 6, please give me my Percodan", all is right with the world? The more educated I get about this, the more confusing it becomes.
Today I got a prescription back from a mail-order pharmacy that I had written for 60 Vicodin saying I now had to write "take so and so many tablets every so and so many hours for not more than so and so many days, not to exceed X tablets in 24 hours." And, by the way, did I want to write for 360 tablets like his last prescription? Wow. I'm sure that is really going to solve the overdose issue.
