Placebo ethics.
Post Reply
 
Thread Rating:
  • 0 Votes - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
02-01-2013, 12:23 PM
RE: Placebo ethics.
(02-01-2013 09:38 AM)Anjele Wrote:  As for pain management, and as a sufferer of chronic pain, I say let them lie to me....if it works, they can tell me just about anything they want to. Opiods do not work on nerve pain, lucky me. I have tried Lyrica and Cymbalta which are supposed to work but with Cymbalta there was no relief at all. With Lyrica, they started me on a really low dose that wasn't working. So they said I could up the dosage...if I took a second one in a 24 hour period, I slept for hours and hours and was basically useless for anything else. I was told I could take up to EIGHTEEN times the dosage I was prescibed!

I suppose it could be possible to administer a placebo without technically lying to a patient. Say for example the doctor explains the treatment has efficacy for some patients, yet leaves out the details of what is in the treatment. Its a bit of a stretch but I have heard this argument from bioethicists before, or a derivative of this argument. Either way, chronic pain is such a challenging area of medicine for doctors and patients as I am sure you can attest. I have heard a number of physicians state they wouldn't want to work with chronic pain patients because these patients are often considered frustrating. I understand it in a way, doctors want to help their patients and patients expect them to be able to provide that help. However, with chronic pain the best that can be hoped for in most cases is to "manage" it.

On a related note, has your physician tried neurontin or its generic gabapentin? It has some efficacy with nerve pain as does botox injections, though that one is most often used in facial nerve pain. I worked at a pain clinic where these drugs were prescribed in conjunction with Lyrica or cymbalta.

Quote: I don't care what they say or do...if someone has something that works or that I think will work...I am in!

Thanks for the response. It is a complex topic with no easy answers.
Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 12:28 PM
RE: Placebo ethics.
(02-01-2013 12:16 PM)Bucky Ball Wrote:  
(02-01-2013 09:38 AM)Anjele Wrote:  If the intent is to lessen pain, which is the specific medical issue here in the OP, I think that is different from treating an infection or a presumed infection. Many people just don't want to hear that the doctor can't make them better because they have a virus and not an infection that can be treated with antibiotics. Patients get insistent, doctors give out a Zpac which is basically worthless and the patient "gets better", they would have anyway, in time. Everybody goes home happy even the bugs that are now more resistent to treatment.
As for pain management, and as a sufferer of chronic pain, I say let them lie to me....if it works, they can tell me just about anything they want to. Opiods do not work on nerve pain, lucky me. I have tried Lyrica and Cymbalta which are supposed to work but with Cymbalta there was no relief at all. With Lyrica, they started me on a really low dose that wasn't working. So they said I could up the dosage...if I took a second one in a 24 hour period, I slept for hours and hours and was basically useless for anything else. I was told I could take up to EIGHTEEN times the dosage I was prescibed! Hell's Bells, I would have been in the fetal position drooling on myself and needing a diaper. My oncologist said that Lyrica did the same thing to her...if she took two in a day, she was done.
It is mentally and physcially exhausting to trudge through every day in pain and I don't care what they say or do...if someone has something that works or that I think will work...I am in!
So I will butt out. However a "Z Pack" (Azithromycin), is incredibly effective, if one actually has an infection by a bug that is sensitive to it. All I can say, is, I would not want anyone, especially a practicioner, to lie to me. Eventually, the truth will out.
No need to butt out, you bring up some technically interesting points about how these things would be billed and the ethics involved in that aspect of the question. I may have oversimplified a very complex topic but I am interested in all the views related to it. Thanks for your opinion on the topic. Thumbsup
Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 01:12 PM (This post was last modified: 02-01-2013 01:16 PM by Bucky Ball.)
RE: Placebo ethics.
(02-01-2013 12:22 PM)Anjele Wrote:  I wasn't clear Bucky, sorry...it's worthless if you are treating a virus, but many patients don't feel like they got their money's worth of the doctor doesn't give them some kind of antibiotic.
I ran into so many half-truths with the medical profession (and that's a little generous) but after all this time, if someone could make the pain stop so I could sleep in a bed and not a recliner and sleep all night, I would take even a BIG lie.

(And happily pay for it.)
I get that. It's endlessly discussed in medical circles. How to make them think they got something for the visit, without a prescription. I hear many just call now, and demand it, on the phone, without even anyone even listening to their lungs, or taking their temperature. I suppose most people don't even know what a virus is, as opposed to a bacterial infection. Weeping

BTW, we need to ask NE Ohio atheist to weigh in here. Here probably has a lot to say on the subject. He has been screwed over by the government with respect to his chronic pain, which was acquired in the military.

Insufferable know-it-all.Einstein Certified Ancient Astronaut Theorist and Levitating yogi, CAAT-LY.
Yeah, for verily I say unto thee, and this we know : Jebus no likey that which doth tickle thee unto thy nether regions.

Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 05:17 PM
RE: Placebo ethics.
(02-01-2013 12:23 PM)BioPsychMS Wrote:  
(02-01-2013 09:38 AM)Anjele Wrote:  As for pain management, and as a sufferer of chronic pain, I say let them lie to me....if it works, they can tell me just about anything they want to. Opiods do not work on nerve pain, lucky me. I have tried Lyrica and Cymbalta which are supposed to work but with Cymbalta there was no relief at all. With Lyrica, they started me on a really low dose that wasn't working. So they said I could up the dosage...if I took a second one in a 24 hour period, I slept for hours and hours and was basically useless for anything else. I was told I could take up to EIGHTEEN times the dosage I was prescibed!

I suppose it could be possible to administer a placebo without technically lying to a patient. Say for example the doctor explains the treatment has efficacy for some patients, yet leaves out the details of what is in the treatment. Its a bit of a stretch but I have heard this argument from bioethicists before, or a derivative of this argument. Either way, chronic pain is such a challenging area of medicine for doctors and patients as I am sure you can attest. I have heard a number of physicians state they wouldn't want to work with chronic pain patients because these patients are often considered frustrating. I understand it in a way, doctors want to help their patients and patients expect them to be able to provide that help. However, with chronic pain the best that can be hoped for in most cases is to "manage" it.

On a related note, has your physician tried neurontin or its generic gabapentin? It has some efficacy with nerve pain as does botox injections, though that one is most often used in facial nerve pain. I worked at a pain clinic where these drugs were prescribed in conjunction with Lyrica or cymbalta.

Quote: I don't care what they say or do...if someone has something that works or that I think will work...I am in!

Thanks for the response. It is a complex topic with no easy answers.


I have dealt with many physicians and nurses who should not be allowed to treat people with chronic pain; they seem to think that opiates are evil.

Skepticism is not a position; it is an approach to claims.
Science is not a subject, but a method.
[Image: flagstiny%206.gif]
Visit this user's website Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 07:14 PM
RE: Placebo ethics.
(02-01-2013 05:17 PM)Chas Wrote:  I have dealt with many physicians and nurses who should not be allowed to treat people with chronic pain; they seem to think that opiates are evil.

Yes, that is indeed unfortunate. Chronic pain sufferers are dealing with enough issues that don't need to be compounded by ignorant asshats that know nothing about how to adequately deal with pain. It's as if they are saying to the patient "come on now, suck it up, we are going to take away one of the only real tools in our arsenal to deal with pain because its bad and you might become dependent".

To be fair though, its not only physicians and nurses. In the US last year the DEA became involved indirectly in pain management by telling pharmacies that they can only have so many opioid medications on hand in a given month. The restriction is only about the number of pills not about dosage or patient volume. So if you are a chronic pain patient seeking to get your prescription filled at a busy pharmacy that has many other pain patients the chances are good you will be told that your prescription can't be filled because the pharmacy is out and can't restock until next month.

In response, pharmacies have created what is being called a grey market in the industry. Where busy pharmacies are buying opioids from another pharmacy that has fewer pain patients. This in turn inflates the prices on already expensive medication and places a further burden on peoples suffering.
Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 07:21 PM
RE: Placebo ethics.
That's just wrong. I think it's a little different here in Oz but they still say 'we don't want you to be an addict!'

Well, let me think; would I rather have an addiction or would I rather be in excruciating pain all the time....uuuum Dodgy

Humankind Dodgy (a total misnomer)
Find all posts by this user
Like Post Quote this message in a reply
[+] 1 user Likes aurora's post
02-01-2013, 07:35 PM
RE: Placebo ethics.
As I came out of anesthesia from bilateral mastectomy and the placement of tissue expanders, the first thing I thought was "why does it feel like someone took a sledge hammer to both of my shoulder blades?"

After getting moved out of recovery a nurse finally came in with ONE HYDROCODONE tablet for pain. Nothing was being put into my IV they were just running the rest of the saline out. After an hour and I was gritting my teeth and trying to remember Lamaze breathing techniques from years ago, I realized that the pain pill hadn't done a thing and I could not mentally control the pain. I hurt so bad my teeth were chattering. I called the nurse and she said I had to wait three more hours before I could have another pain pill. I told her how bad I felt and she said my surgeon DIDN'T BELIEVE IN PAIN MEDS! I tried for another two hours to get a grip and mental control. I called her back in and said that I had read their mission statement and part of it was PAIN CONTROL and it wasn't happening and that either she figured something out or I would. She again said the doctor would not prescribe anything else. I told her she had 30 minutes and if I didn't have some relief I would call my plastic surgeon. She asked me not to do that because it would look like she wasn't doing her job. DUH! A few minutes later my husband walked out of the room and the nurse was on the phone, about 10 minutes later she came in with a shot of morphine, more pain pills, and the offer of a sleeping pill later if I wanted one. She had called the plastic surgeon herself.

I get not wanting to get someone addicted...but damn! It's not like I had gone in for some simple little procedure, they had restrung my whole chest. It was a horrifying display of the lack of common sense in treatment. And I think it was a bit sadistic.

I sure hope that pain management and common sense are the rule and that others don't go through what I did. My family doctor eventually kept me from jumping off a bridge as I told her if I could just get some sleep I could deal with the pain better...her response was that what I had been through was an appropriate use of pain meds. I will always be thankful that she would listen to me and help me.

See here they are, the bruises, some were self-inflicted and some showed up along the way. - JF
Find all posts by this user
Like Post Quote this message in a reply
[+] 1 user Likes Anjele's post
02-01-2013, 07:40 PM
RE: Placebo ethics.
(02-01-2013 07:35 PM)Anjele Wrote:  As I came out of anesthesia from bilateral mastectomy and the placement of tissue expanders, the first thing I thought was "why does it feel like someone took a sledge hammer to both of my shoulder blades?"

After getting moved out of recovery a nurse finally came in with ONE HYDROCODONE tablet for pain. Nothing was being put into my IV they were just running the rest of the saline out. After an hour and I was gritting my teeth and trying to remember Lamaze breathing techniques from years ago, I realized that the pain pill hadn't done a thing and I could not mentally control the pain. I hurt so bad my teeth were chattering. I called the nurse and she said I had to wait three more hours before I could have another pain pill. I told her how bad I felt and she said my surgeon DIDN'T BELIEVE IN PAIN MEDS! I tried for another two hours to get a grip and mental control. I called her back in and said that I had read their mission statement and part of it was PAIN CONTROL and it wasn't happening and that either she figured something out or I would. She again said the doctor would not prescribe anything else. I told her she had 30 minutes and if I didn't have some relief I would call my plastic surgeon. She asked me not to do that because it would look like she wasn't doing her job. DUH! A few minutes later my husband walked out of the room and the nurse was on the phone, about 10 minutes later she came in with a shot of morphine, more pain pills, and the offer of a sleeping pill later if I wanted one. She had called the plastic surgeon herself.

I get not wanting to get someone addicted...but damn! It's not like I had gone in for some simple little procedure, they had restrung my whole chest. It was a horrifying display of the lack of common sense in treatment. And I think it was a bit sadistic.

I sure hope that pain management and common sense are the rule and that others don't go through what I did. My family doctor eventually kept me from jumping off a bridge as I told her if I could just get some sleep I could deal with the pain better...her response was that what I had been through was an appropriate use of pain meds. I will always be thankful that she would listen to me and help me.


Yes, your surgeon was one of the pain Nazis. I have had to deal with these self-righteous, misguided, ignorant twits.

Fortunately, my orthopedic surgeon was not one of these.

Skepticism is not a position; it is an approach to claims.
Science is not a subject, but a method.
[Image: flagstiny%206.gif]
Visit this user's website Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 07:41 PM
RE: Placebo ethics.
(02-01-2013 07:35 PM)Anjele Wrote:  As I came out of anesthesia from bilateral mastectomy and the placement of tissue expanders, the first thing I thought was "why does it feel like someone took a sledge hammer to both of my shoulder blades?"

After getting moved out of recovery a nurse finally came in with ONE HYDROCODONE tablet for pain. Nothing was being put into my IV they were just running the rest of the saline out. After an hour and I was gritting my teeth and trying to remember Lamaze breathing techniques from years ago, I realized that the pain pill hadn't done a thing and I could not mentally control the pain. I hurt so bad my teeth were chattering. I called the nurse and she said I had to wait three more hours before I could have another pain pill. I told her how bad I felt and she said my surgeon DIDN'T BELIEVE IN PAIN MEDS! I tried for another two hours to get a grip and mental control. I called her back in and said that I had read their mission statement and part of it was PAIN CONTROL and it wasn't happening and that either she figured something out or I would. She again said the doctor would not prescribe anything else. I told her she had 30 minutes and if I didn't have some relief I would call my plastic surgeon. She asked me not to do that because it would look like she wasn't doing her job. DUH! A few minutes later my husband walked out of the room and the nurse was on the phone, about 10 minutes later she came in with a shot of morphine, more pain pills, and the offer of a sleeping pill later if I wanted one. She had called the plastic surgeon herself.

I get not wanting to get someone addicted...but damn! It's not like I had gone in for some simple little procedure, they had restrung my whole chest. It was a horrifying display of the lack of common sense in treatment. And I think it was a bit sadistic.

I sure hope that pain management and common sense are the rule and that others don't go through what I did. My family doctor eventually kept me from jumping off a bridge as I told her if I could just get some sleep I could deal with the pain better...her response was that what I had been through was an appropriate use of pain meds. I will always be thankful that she would listen to me and help me.
That's woeful and unethical, imo.

Humankind Dodgy (a total misnomer)
Find all posts by this user
Like Post Quote this message in a reply
02-01-2013, 07:45 PM
RE: Placebo ethics.
(02-01-2013 07:21 PM)aurora Wrote:  That's just wrong. I think it's a little different here in Oz but they still say 'we don't want you to be an addict!'

Well, let me think; would I rather have an addiction or would I rather be in excruciating pain all the time....uuuum Dodgy
I also think part of the problem is that pain is a subjective experience that others not experiencing it are skeptical of. For example, if I say I am sad, most people, including physicians are likely to believe me and offer support and comfort and practically throw medication at me. If I say I am anxious, same result. If I say I am happy...you get the idea.

However, if I say I am in pain then the response seems to be. "whoa, hang on a minute, you don't seem to be hurting as much as you claim" or the ever popular "I don't see any physical reason you should be in pain" and the conclusion is you are not. Either that, or you are faking or just being a big baby and need to suck it up. Don't get me wrong, people do fake injury to obtain drugs or to get attention but the numbers are low yet the critics persist. Just saying. Angry
Find all posts by this user
Like Post Quote this message in a reply
Post Reply
Forum Jump: