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I always get in a arguments with my EU acquaintances over pain management topics.

The idea that is a "good" to suffer with pain instead of taking pain killers is abhorrent to me.

There are definitely some people who view it as a kind of ascetic and/or natural-living thing where it's actively "good" not to take painkillers. But I don't think that's how most of the medical profession in Europe thinks of it. For doctors it's more of a pure risk/benefit type of thing, where how likely a doctor is to recommend or prescribe painkillers relates to both the type/severity of pain and the risk of the painkillers (e.g. ibuprofen is safer than vicodin, so there's a much lower bar for using it).

In addition, the things the doctors said was exactly right: pain can be a hugely important signal, especially when you're healing. It tells you of you're overexerting yourself, it tells you what you need to do to heal properly, it tells you when you're getting better. Dulling pain has a significant cost.

I don't think people should suffer pain "needlessly" either, but pain has a purpose. Long-term health consequences (whether they are risk of addiction, or a worse healing process) has to be part of the calculus when making decisions about pain management.

It's one thing to suffer with pain needlessly, it's another if the treatment of pain could have long term harmful effects, e.g., addition to opioids.

I had impacted wisdom teeth and needed dental surgery. The dentist gave me a couple of codeines to take home but I never took them. The day after the local anesthesia wore off was miserable, but it became easily manageable after that. I found a lot of times the fear of the pain was worse than the pain itself.

This is why my individualism, and Self Ownership come it to play as I feel that should be my choice if I want to take the risk, it should be up to me if the pain is server enough to warrant opioids or not as I am the one experiencing the pain.

Every person reacts differently to procedures and to pain, some people having their wisdom teeth removed may not be painful, others it might be terrible pain. It should be up to the individual as a adult to make those choices for themselves

I am sure that will be an unpopular opinion given the state of society is that no one should be treated as adults and that governments or "others" should tell people have to live ...

At multiple times in my life I have been given hydrocodone, I have almost never used the entire prescription, but when I needed them I would glad to have them. The idea that a 3rd party can tell me "ohh your pain is not that bad just live with it" when there is a easy solution to allow me not to live it it, well I find that morally reprehensible

If you're paying for it, I agree with you.

But that's not the case in Germany, as they have a single payer healthcare system. That "easy solution" costs other people money.

Which is why I also oppose single payer, but that is a whole other topic. The fact that Single Payer is used to make those justifications is one of my primary reasons to oppose it

Hows that? It's my understanding that in a single payer system you are still allowed to pay for whatever you want or buy supplemental insurance to cover types of care the baseline single payer system will not.

I don't think this is the popular understanding of "single payer" by its advocates in the USA. They think it means "I get any medical care I want, any time, with no waiting, for free."

This is a disingenuous characterization of single-payer advocacy in this country. Nobody-but-nobody claims scarcity doesn't exist; the single-payer argument is to deny that the fitness function for who-doesn't-die-from-preventable-disease should be the person with a bigger bank account.

That's a patently ridiculous straw man. No single payer system in the world operates that way.

Easy, once there is even a "baseline" of health services that becomes a platform to start restricting and taxing other things deemed to effect health. Things like smoking, Soft Drinks, high fat or high sugar foods, exercise mandates, and a variety of other public policies around "health" become justified because of public funding for healthcare.

Now I am sure most people including you are going to agree with these public policies but again I am an individualist and believe in personal choice and freedom rare in today world of Nanny State's and collectivism

Smoking is not illegal in most places, and realistically there is an argument that it should be (at least in public) because you don't have a right to expose other people to your habit.

I don't know a single country that has socialized medicine that has illegalized high fat/sugar products or has mandated exercise. If you could point me towards instances where single payer healthcare is being used to outlaw/force such things, I would much appreciate it.

Of course they do not make it illegal, they have learned their lesson from prohibitionist policies on drugs, I can not image the horrors of human rights abuse and violence making candy illegal would bring

They do however regulate and tax to the extreme, For example, how many restaurants in socialized care nations have free refills on soda? How many places in socialized care nations can you buy candy by the pound with just normal sales tax..

>>at least in public

What the hell lets open up another can of worms... That would depend on how you define "public". See in recent years in the US there have been many laws passed the prohibit smoking in businesses that allow general consumer access, incorrectly called "public" businesses. I disagree with these laws as it should be up to the owners of the establishment if they want to allow or disallow smoking in their place of business. For example if a Bar wants to have smoking and you do not like smoking you are free to no go to that bar. However many people in the US believe it is their right to tell that business owner what his policy is, and they have a right to assert their dominance and their view on smoking upon others.

> They do however regulate and tax to the extreme, For example, how many restaurants in socialized care nations have free refills on soda? How many places in socialized care nations can you buy candy by the pound with just normal sales tax..

This is some bizarre fantasy. There's no connection to reality in your post.

Slight correction: Germany does not have single-payer healthcare.

But the public health insurance system (which covers 90% of the population) makes joint decisions (through broad guidelines) on what is covered. An economic assessment is always part of the decision. Representatives of doctors are heavily involved in the process as well. Gemeinsamer Bundesausschuss is the name of that body.

Opioid painkillers aren’t necessarily particularly expensive. They are considerably more dangerous than NSAIDs, though, hence the reluctance to prescribe them where not absolutely necessary. It’s not a money thing.

On an individual basis, good for you that you can handle yourself. You are indeed a victim of the majority. However, making opiates freely available would be catastrophic for society to a point that would dwarf the current epidemic.

In other words, it is a shame that the system can't do better for you, but your point of view is selfish.

I disagree, having studied this topic for more than a decade most of the current epidemic problems, including the death toll can be more accurately attributed to prohibitionist policies as the "War on Drugs" than to any legal availability.

On the topic of Society in General, the US War on Drugs has lead to an inordinate amount of abuse, loss of freedom, and the elimination or reduction of most constitutional protection.

treating Addiction as a Crime is what is bad for society

> it should be up to me if the pain is server enough to warrant opioids

It is!

You do get the drugs you need. If you actually ARE in pain. But this woman, as predicted by her doctor, was not. If you read the article, she did not have the pain, it was only fear of it.

Society does have to pay the price in the end if people are given what they want. See the problem of over-subscription of anything from pain killers (in the US) to antibiotics.

Not least, those drugs show up in ground water and in drinking water supplies, and water companies can't really filter that stuff out.

https://www.scientificamerican.com/article/pharmaceuticals-i...

https://www.webmd.com/a-to-z-guides/features/drugs-in-our-dr...

If you think "the levels are low - that is save", there is no scientific basis for such a statement. We have no clue what low-level exposure to drug cocktails does.

Not to mention, there are plenty of safer viable alternatives. Is ibuprofen or acetaminophen as effective at preventing pain as oxycodone for most people? Probably not, but they're good enough for most wisdom teeth extractions, a common operation that unfortunately results in many opioid addictions. I had some particularly difficult extractions so I took some ibuprofen for a few weeks to make eating manageable, but avoided the oxycodone-acetaminophen I was prescribed once I left the doctor's office. When I reported this, the nurse who checked in on me was surprisingly taken aback, but to me, the potential consequences of opioid use to better mitigate temporary pain seem irresponsibly high.

Do dentists in the US actually give out opioid painkillers for wisdom teeth extraction?

10-12 years ago I would get small dose (5mg or less) Hydrocodone for an infected tooth or pre-root canal

Today it is just high dose ibuprofen, luckily I have pretty good dental insurance now (did not in my late teens and early 20s) so I do not need the dentist for anything more than cleanings but I do think my luck that I went through that pain back then instead of now, taking high does IB would not have let me sleep back in those days as I had to wait for the Antibiotics to kill the infection before they could remove or fill the tooth, that took anywhere from 2 to 7 days (had 2 infected teeth a couple years apart, I was hard on my teeth in youth, a lesson learned the hard way)

For what it's worth, I was prescribed the oxycodone-acetaminophen combination last month for an extraction of my four wisdom teeth in the US. My extractions were apparently some of the hardest in the surgeon's 30 years, so I'm not sure if this is the norm.

To offer the other perspective (though I guess you get that from your EU friends) - as one of those 'pain is a signal' people; I tend to avoid painkillers because when pain is tolerable, I'd rather use it as a guide for what is helping and what is delaying the recovery. Say you have a muscle spasm or something; isn't it better to feel exactly at which point it activates, so you can slowly stretch it out? A headache - well I behave differently when it is alleviated by reading a book, then when talking a walk outside makes it better, than when actually I'm just hungry and after eating a meal it goes away.

I don't know how I'd identify and distinguish those scenarios if I took painkillers every time.

Not sure how you manage to come up with such a comment after reading this particular article. Clearly she did not have the pain she feared she would have. She said she took two Ibuprofen - that she did not need!

So why would you think she would have been better off taking drugs against pain that she didn't have?

Real pain is treated here in Germany - of course!

But taking pills for mere fear of pain that isn't even there?

I had had four wisdom teeth removed all at once, that's when I got and took a few (a few!) Ibuprofen during the following week. Only because I actually lived and worked in the US at the time (but had the surgery done during a vacation in Germany), and had to go back to work, doing IT training for a few days. Otherwise I would have taken even less.

Later I had jaw surgery, lower jaw extension by 4 mm (no metal left inside me, by the way, it was a z-cut followed by the shift and half of a bone could reattach to the other half, just shifted lengthwise a bit), so a complete cut through the lower jaw. I did not need a single pain pill.

>>So why would you think she would have been better off taking drugs against pain that she didn't have?

Never said she should have or would have been better off. I am making the claim that choice should have been hers and hers alone after getting advice from professionals.

Doctors could have told her "You do not need them, here are the reasons why" that is fine. the legal prohibition is what I have a problem with

>Real pain is treated here in Germany

That is not my understanding and I have known a couple people that have come to the US for pain management because they were unable to get it in the EU, I dont know if they were in Germany or not however. My understanding is that many EU nations have very strict and subject definition as to what "real pain" is. This is evidenced by the personal stories being told here how people "went through X and did not need pain meds" that is fine for them, people have different tolerance levels for different types of pain, and a tooth extraction may be a minor pain for some people and excruciatingly painful for others, yet most of these nations treat pain based on the average response by type of procedure not in individualized reactions.

You've clearly misunderstood what's happening with pain management in Europe.

Firstly, it has nothing to do with cost. European pain management is expensive but available.

1) If you are in short term pain you will get pain relief. A wide range of options wil be available, from non-pharmacological options at one end (easing fear, for example) through non-opioids (paracetamol, ibuprofen, entonox) but using opioids when needed. Here's a guide form one of the English NHS Ambo trusts: https://www.swast.nhs.uk/Downloads/Clinical%20Guidelines%20S... You should be reassured that the entire document talks about properly treating pain, and reducing the pain the patient is in. There is no mention of cost in that document.

2) The reason they don't just go direct to opioids is because opioids have side effects. They have more side effects than other pain control meds. This causes harm to the patient.

3) If you are in long term pain things are more complex. People in long term pain fall into different groups. Some of them will be cured from their long term pain with lifestyle modification. Most, but not all, people with lower back pain will be cured if they lose weight and get exercise. It would be cheaper to give them opioids, but because diet and exercise are more effective and safer they get a package of care that includes access to a gym and physiotherapist, access to weight loss clubs, access to dieticians. Some people with long term pain will never be cured, but will be able to manage with access to a pain clinic. But some people with long term pain will always have that pain. There is no cure for it. We can't just give these people all the opioids they want because they develop a tolerance, and need an increased dose. At some point you have people taking very high -dangerous- levels of opioids but still not getting pain relief. These people need a package of bio-psycho-social care that includes access to specialist pain management clinics. Again, this is more expensive than just giving people opioids.

The psychology of pain is complex. “Pain” doesn't imply “suffer”. For example (https://jamanetwork.com/journals/jama/article-abstract/32309...):

”There was no dependable relation between the extent of a pathological wound and the pain experienced. No significant difference was found between the pain of sudden injury and that of chronic illness. The intensity of suffering is largely determined by what the pain means to the patient.”

On that front, I think there’s a large cultural difference between Americans and Europeans.

Some temporary pain won't kill you, but opioids might.

I have a non-addictive personality, and have taken opiods 3 different times in my life, never killed me nor did I have an issue stopping.

Opioids are only 30-40% addictive, meaning the vast majority of people taking them never develop an addiction. 30-40% is high no doubt, the highest of all pain killers, but the idea we should disallow people in pain from taking them simply because some people go on to abuse them is not rational IMO

I mostly avoid painkillers, not because I think that pain is "good" but because I think a little bit of pain is simply not worth taking drugs.

My advice is: Unless you're really suffering, try sucking it up for a few days.

As mentioned in the article, she was given a painkiller (ibuprofen, a NSAID). In much of Europe, doctors are far more reluctant to use opioid painkillers, granted.

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