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Comment by nommm-nommm | Hacker News Reader

I said opioids are a good option for short term pain. They are also usually (not always) a bad option for long term pain.

Please go to a treatment facility (volunteer please) and talk to the patients there. It is beyond eye opening, I volunteered at one myself. I've seen pain medicine literary ruin lives, and it's so sad. These are people who have been through hell with their injuries, some of the worst I've ever seen, and then they go through hell again with the opiodes.

They can work on a long term basis for SOME (but not the majority) of patients.

Psychological treatments are also an important part of pain management.

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Yes, opiates can ruin lives. That is not the trump card you want it to be, sorry.

If anything, the pushback against opiate prescribing has resulted in a lot of dependent patients (and addicted abusers) looking at heroin as a more potent, widely available, cheaper alternative.

opiates have been around a long time for a good reason. they can give an unrivaled increase in the quality of life of those suffering.

there will ALWAYS be opiate abuse. taking prescription painkillers out of the picture doesn't even put a dent into it.

do you think it makes more sense to spend time and money demonizing prescription opiates and prosecuting those who prescribe them, or use that time and money to implement programs and services that can help those who have become dependent or addicted?

You're putting words in my mouth that I didn't say.

As someone who has chronic pain, tapentadol has been a godsend for me. Its an opioid which also has norepinephrine agonist effects to help reduce pain in a multi mechanistic way. It was developed as a 2nd generation version of Tramadol, which is also a very amazing drug. Tapentadol is brand name Nucynta and cost 1500 for a 30 day supply compared with morphine at <$50. But tapentadol is an engineered alkaloid..designed to be less addictivr, more selective for the mu opiod receptor and norepinephrine agonism for better medicinal use than morphine. I agree with other posters about prices necessarily harming those who are poor and more inclined to abuse drugs due to a dismal outlook on life. On the other hand, having taken various opiates and seen how effective and therepeutic Tapentadol is, makes me want to reward Depomed who researched and developed an improved version of their already very successful Tramadol. They took on an endeavor that needs to be justified by some type of risk rewarding lucrativity. Its not all carnal..

My energy levels and ability to be active during an entire day was borderline geriatric before I started taking tapentadol. Opiates are addictive but are also the gold standard for pain relief. Pain reduces energy levels, its fatiguing. I would sometimes want to just cry out of how weak I felt. No one should have to 'just deal with it' when it comes to nerve splitting pain.

To counter your anecdote, tapentadol (Nucynta) leaves me extremely foggy and out of it at doses below the required dose for pain relief -- far loopier than hydrocodone, oxycodone or oxymorphone.

I'm the same, as I was with straight SNRIs too. I think some people just can't tolerate SNRIs and SSRIs. But for those who can, they can make a big difference to pain levels

I feel more awake and stimulated from it. A laser focus. And the pain relief is far better than Tramadol or conventional opiates that lack an adrenal boost. I would guess you are right and it can definitely be a genetic variability. Its actually difficult for me to sleep on Tramadol or Nucynta .. so exactly the opposite of drowsy.

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