Pain treatment...fiction or fact?

[buriedinbooks]

I posted these questions once before but they got lost on the House thread. While my queries center around situations presented on House, I am curious to know if these treatments hold truth and value in real life chronic pain situations.

Thank you. Low pain numbers everyone! Carly :)

Questions:
If the Ketamine treatment put House into pain remission for several shows, why can't he have another treatment?

Is House's pain supposed to stem from RSD?

What was his inital leg injury/ailment (that caused these awful pain)?

Also, does a hospital ever really put a person into a coma to supress extreme acute or chronic pain? (They have done that on a few shows.)

[oh_snap]

I can only address the issue of ketamine, as I don't have a high opinion of the Dr. House show (disclaimer: I have never watched the show, only coming to that conclusion via the short commercial "trailers")

I do know of some with neuropathic pain, of whatever cause or diagnosis are going down to Mexico for the ketamine coma, or lidocaine infusion (also over a week's time in a hospital or clinic setting). This is not just a treatment for those with CPRS/RSD. It would seem to be beneficial for any with long standing, neuropathies.

It does seem that it helps, although, may not be a cure for those who did not either get a quick diagnosis and/or treatment. Those whose neuropathic pain is long-standing/chronic may not be able to expect complete remission, but may find relief that lasts longer than a day (better than popping pills all day long, and chasing relief).

Again, those treatments are not usually covered by standard private insurance, although, perhaps those who are in litigation might be in a position to push for this kind of treatment and get it paid. Those who are cash only, may find that this treatment is too cost prohibitive.

As to this "House" character, I am not sure why people are drawn to the show. I don't know any doctor who would be that dedicated to someone with a disorder that is hardly a slam dunk. Most see a "complicated" patient as a "no-win", non-success black mark on their score card.

The show is a joke, and only serves to create more of an illusion that docs really care about any one individual, when in reality, for whatever reason, (including lousy insurance reimbursement), they have to work in a "volume" atmosphere, and those requiring more attention/thought, would certainly be set out in the hall, with the delusional old ladies. IMHO. With all due respect to the delusional old ladies.:D

You can google both "lidocaine infusions" as well as "ketamine infusions" and find that they target neuropathic pain, but usually of tumor, or cancer origin. This also leads back to that troubling distinction between pain of malignant vs. non-malignant origin, and those with "not malignant" cannot expect the same aggressive treatment and/or determination by the physician.

Here's one article: http://www.supportiveoncology.net/journal/articles/0201090.pdf

another, though about central pain, of non-malignant origin: http://www.anesthesia-analgesia.org/cgi/content/full/98/6/1581

Ketamine infusions:
http://www.rch.org.au/anaes/pain/index.cfm?doc_id=848

http://www.medicalnewstoday.com/medicalnews.php?newsid=13927


There's a lot more out there too...some of the issues is whether these treatments can be billed and covered by insurance. The Mexico clinics usually charge cash, and have obviously figured out that they have something and can make money out of offering it. They definitely must think the market (of patients) exists...

I don't mean to be disrespectful to those that "like" Dr. House, but I fear that many people develop unreal, and undeliverable expectations of the medical system, and/or doctors by what is being portrayed. I also don't bother with ER, Gray's Anatomy, (how many are there?)

My favorite doc show is SCRUBS, although I am not sure that the medicine portrayed there is any better than any other show that tries to create controversy and play off the fears of the public at large.

Perhaps, this wave of returning fear of opiods, and studies supporting their ineffectiveness, will result in loosening up the use of meds like ketamine and lidocaine for the treatment of neuropathic pain, the kind that gabapentin, lyrica, etc cannot control.

Best of luck.

[Mark N]

All I can say is that House doesn't do a good job of portraying chronic pain accurately. There are too many discreptancies with his pain and treatments along withthe way his associates deal with him.

[oh_snap]

Mark, think about it? Would the average patient be happy knowing their doc, or surgeon requires pain medications, especially with all the negative press they receive, as well as that need to believe that doctors are somehow different, better than the rest of us?

People can't just be smart, intelligent and caring in movies, TV; they have to be "troubled" somehow, and have some character flaw, and in today's media, opiate use, is that fashionable flaw. How interesting. Ugh.

Acute pain, and treating it, is heroic.

Chronic pain, and its treatment is at best, a necessary evil, at worst, those that require that treatment are branded, either openly, or in very subtle ways by our society.

The crap being shown on TV, movies, etc. only serves to reinforce the belief system that not being able to "shake off our pain" is inherently a weakness of character.

Remember, you were a jock. What were we told? "Get up, shake it off, and get back in the game."

If we couldn't [get up], we were replaced by someone who could.

Nothing has really changed, except that, for lack of understanding (of the real issue), we are the ones being pushed out of this game. :eek:

[buriedinbooks]

Hi Snap...

A million thanks for all the information you posted regarding ketamine treatments. Greatly appreciated.

While I have been a CPer (average pain level 6) since my dx of Rheumatoid Arthritis in 1987, the never-ending, highest pain levels 8 plus entered my world of what now? woe after an ACDF 5-6 done in 2003. With MCS and many allergies. I just haven't been able to follow the same course of chronic pain treatments as many others.

LOL You'd be surprised how many colleagues will use tidbits from an episode of any health show (fiction or otherwise) to inform me that there really is a cure for my chronic pain. I offer a small smile and give thanks. I am a functional CPer (walk, talk, smile) so I couldn't possibly have THAT much pain. LOL

IMO ... NO ONE ... can understand chronic pain until he/she has experienced the intensity of it day in/day out.

Health shows (fiction or fact) or OTC/BIG Pharma commercials never seem to end with ...there isn't anything we can REALLY do for some of you.

SOooo the general public seems to believe that all meds work, a doctor will have great devotion to your dx and rx, that family/friends will stick by you through it all and that the government will readily provide substitute care/finances in your darkest time of need. Sigh.

As for Dr. House...I can't get beyond him popping a pill, head back, minus any water. Just watching that gags me followed by instant heartburn. :eek:

Have a low pain day...Carly

[mforce00]

Ketamine infusion is a standard treatment in Canada I read. I think America is trying to force chronic pain sufferers to become canucks :P

[satchelle]

I do have an answer to one of your questions because it actually happened to me so I am living proof this does exist. Back in 2001 I had most of my pancreas removed due to some severe problems. A small portion was left in hopes it would prevent me from becoming diabetic. Because I had been on pain management for several years prior to this surgery, I had built up a significant tolerance to narcotic medication. I was given massive amounts of narcotic medication thru the IV after the surgery which did not have any effect on the post operative pain I was experincing. I was given an epideral to numb from the waist down (much like they give for cesarian sections) and this did not have any results what so ever. The anesthesiologist attempted to put me out using the mixture of gases they use to put people out for surgery. Unfortunatly, I stayed awake thru all these also. At this point they called in a pain management dr and he said the only option was to put me in a medication induced coma, complete with endotracheal tube, urinary catheter you name it an I had it. I am so glad I do not remember any of this. My family explained my behavior and boy was I embarraressed but I had no idea that I spent an entire week crying and screaming and thrashing and trying to get out of the ICU. They had to restrain me to keep me from hurting myself. Nine days after the surgery, I guess they started weaning the meds and machines off because I just picked up the phone and called my husband and said "how ya doing?" He was so suprised to hear my voice after the week of hell I put everyone thru. Because I had been bedridden for 9 days I had to learn to walk and bascically build up my strenghth again to function normally. So here note to the wise. I am scared to death that I will need another surgery or I will be injured in a car accident and because of my incredible tolerance to narcotics, I might die before they can treat me appropriately due to this tolerance. I would love to find out if there is a way to reduce my tolerance so that if any seroius thing happens in my future I will be able to manage better. Do any of you out there know of a way to reduce tolerance to narcotics and if si, how long would it take.......I just want to prepare for the future....


Thanks

Satch

[BrokenBladder]

Satch wow that's incredible!! I can understand your concerns about what if something happened to you now, that's plain scary!!
The only way I know to reduce your tolerance to narcotics is to wean yourself down from them, but then where would that leave you with the pain you suffer from now? Maybe you could discuss this with your doctor and see if he/she has any suggestions. Take Care!!

[erfan]

Gee, Ginger Snaps, you must be a real genius to be able to pass judgement about a tv series based on a 30 second trailer. I bet you could read the entire NY Times in 2 minutes.

As for House M.D., the show has plenty of flaws when it comes to chronic pain nad pain meds. For example, House was busted for posession because a cop noticed his eye were dilated while taking Vicodin. Most CP'ers know that opiates create the opposite effect-pinpoint puils as opiates constrict the pupils.

Nonetheless, the show is fun, entertaining and Hugh Laurie is amazing as House.

House's leg suffered a infarction after a blood clot. The story is that he was mis diagnosed for 4 days and after the infarction, he asked to be put in a coma. While in the cpma, he had muscle removed from the leg which left him in chronic pain.

Oh snap! I forgot that you probably already knew this from watching the trailer. I'd bet that you could write some great movie reviews after watching the trailers in the theater.

By the way, do you do everything in 30 seconds? :)

[Mark N]

erfan , like you, in spite of the misrepresenting of the realities of medicine I still like the show and find it intriguing. People that don't kike his character's attitude need to realize there are all kinds of attitudes in this world; some are good some are bad but to me it is the end result that matters most. You can be hard to get along with if your actions end up helping others. If you only are about yourself and in the end you don't help others then I have a problem with that.

[Kathi49]

I like the show too Mark, although I have only seen one full episode. :) And I find it intriguing as well. People may think I am crazy or dislike what I am saying..but he makes me laugh. It is just a show after all and no, our docs don't act like that. At least mine don't. And yes the guy has an attitude but some of his one liners make me laugh.

[BrokenBladder]

I've never watched the show, but I love a good laugh. Maybe I should check it out so that I can form an opinion on the show.

[jena1225]

I like the show too Mark, although I have only seen one full episode. :) And I find it intriguing as well. People may think I am crazy or dislike what I am saying..but he makes me laugh. It is just a show after all and no, our docs don't act like that. At least mine don't. And yes the guy has an attitude but some of his one liners make me laugh.

I don't think your crazy at all. DH and I have never missed an episode, and he cracks me up! He has such dry humor, which I love. And basically calls it as he sees it. It is definately NOT a show for the senstive though :eek:

[Jo6]

I've never watched the show, but I love a good laugh. Maybe I should check it out so that I can form an opinion on the show.

Lisa, same here. I've never watched the show. Didn't know what everybody was talking about for the longest time:D

I don't supose everybody here watches the History channel all the time either:eek: Well, Mr. Jo thinks he owns the remote.:p As soon as he walks out of the room I hunt something different, maybe I'll land on the House that Doc built next time. I am getting mighty curious:D

Chronic Pain, History channel constantly, what kinda life y'all think I have? Maybe I can get somebody put me in a medical induced coma:p

Kidding aside, my BIL had to be put into a coma for days. His lungs were going crazy and a whole bunch of other stuff I don't remember, but he was lucky. They didn't expect him to live. The coma allowed the meds to deal with the infection. Julia

[Kathi49]

Hey,

I watch the History Channel, Discovery Channel...you name it! LOL That is seriously what I normally watch. That is, until my dogs come in, they really do watch Animal Planet. :) I didn't know about House either until everyone kept talking about it.

[jimac]

What channel is House on?
I need a good laugh too. :D
Jim :)

[jena1225]

It is on Fox - Tuesday nights 9pm EST. I have to warn you he can be an acquired taste for some :D

[suede]

buriedinbooks,

I think this is what happened to your first thread!!


Linda

(I like the show too, I know it is only a show)

[jimac]

It is on Fox - Tuesday nights 9pm EST. I have to warn you he can be an acquired taste for some :D

Thanks Jena,
Yep... I take TV shows lightly and with a grain of salt.
I approach TV is similar manner as politics

But this is getting away from the subject of this thread.
Sorry about that.

I feel that pain treatment is a fact with some MD's and fiction with others.
Another way to look at it is some MD's have real compassion and others consider it a job $$$.

Or have I missed the premise of this thread? :confused:

Best to everyone,
Jim

[moi]

I went for a procedure that did not require a general aneasthetic just a twilight state. When the fentanly did not put me out, like Satch someone jumped in with ketamine, it was a horrible experience for me, I had the near death experience, didn't go to sleep but could not communicate, I've spent the last three months having flashbacks about this and am now am treated for post traumatic stress syndrome.

So although it might be a good drug for some, not for me, kindly, moi

[Mark N]

moi, It sounds like a terrible experience and I have heard of others that have had this happen with surgery. You are right that we don't al have the sme experiences with our meds and some of them are pleasant experiences. That is why I am satisfied with my combo of meds, I know what they will do to me and for me.

[moi]

Dear Mark, you are absolutely right. I'm treated at a pain clinic and my md there had actually told them how to put me out and what to give me by letter but they somehow did not follow his advice.

They use this alot in anaethesia, I didn't know this until I researched it, alot in third world countries and field hospitals and it is coming back into vogue in the west.

It is actually one of the three date rape drugs as it is supposed to put you in a trance like state. Sorry as you can see I'm still horrified.

My regular doctors are stunned. I know some places use this for pain but I for one think it has to be in pretty expert hands with the patient very well informed, I would have refused. kindly, moi

[Mark N]

moi, You are right about being well informed and being treated by the right doctors with this. I am sorry that they didn't let you know the impact of this treatment.

[buriedinbooks]

Thanks for all the input everyone...I gather that ketamine/coma induced CP treatment isn't a common treatment BUT does exist....with possible uncomfortable/bizarre side effects. They showed the hallucinations with Houses's experience. The pain-free results were limited.

(Linda/Suede) You are right! I enjoyed the epsiodes I saw the first season --- with each passing year the storylines become more extreme. I love that the docs have the time and permission to enter patient's houses looking for causes for the diseases. LOL

Exaggerated or not --- it is nice to have an escape from CP with the distraction of television drama.

Wishing everyone low pain numbers! Carly (buriedinbooks) :)