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To Use or Not – Can Patients Answer the Question?
By Juliet Ugarte Hopkins
Posted on 1/21/2019 8:43 AM

Last week, I underwent a relatively minor surgery.  The podiatrist warned me on no less than three occasions – the original office appointment when decision to operate was made, in the pre-op suite, and post-op before discharge – that I would experience more pain than would be expected given the nature of the procedure.  But, I was still pretty surprised to find my prescription for Norco included 30 tablets.  Thirty!  For a simple laser excision of a less-than dime-sized lesion?


I’d also been told to take two tablets four hours after discharge and “not hesitate” to take it every four hours while awake for the next 24 hours, even if I wasn’t really having any pain.  Oh, and I could take Ibuprofen at the same time, too.  Hmmmmm…. 


Maybe the nerve block lasted unusually long, or maybe I’m just lucky.  But, after knocking myself out with that first dose of two Norco as directed, I didn’t feel the need to take it any longer because it just didn’t hurt that much.  Both my mother, a former oncology nurse, and my husband, who’s never worked in the medical profession, worried a great deal, and encouraged me to take the Norco at least every six hours.  “You don’t want the pain to get out of control!” they implored.  Have these two not paid attention to the news in the last five years, I thought?


The night of post-op day three, I woke to my wound throbbing and on fire.  I found myself faced with the situation I presume has led so many to get into trouble.  Start with the Ibuprofen and see if that takes care of it?  Or, go straight to the “big gun”?  I scooted to the bathroom (these knee scooter things are the bomb over crutches) and took some Ibuprofen.  But, I also brought the bottle of Norco and a glass of water back to my bedside table.  “I’ll give it 45 minutes,” I whimpered to my husband as he tucked me back into bed, “and if it still hurts this bad, I’ll take the pain pill.” 


Four hours later I woke up – rested, and practically pain-free.


It seems to me my experience thus far has covered a few of the bases of the opioid crisis.  (Mind you, I am completely aware there are other aspects not even close to being covered here):

  1. Liberal dosing by a well-meaning practitioner
  2. Encouragement to take it, even when not really needed, by my trusted practitioner
  3. Encouragement to take it, even when not really needed, by my concerned family members
  4. A moment where I had to make a decision about my pain control

If we don’t adequately prepare and educate our patients for base four, bases one through three will potentially bite them in the butt.  How much conversation is being had on how to choose?

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