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356518 tn?1322263642

What are some reasons you believe CP Pts can't get treatment?

According to a few different websites there 45 million people who suffer from chronic pain and only  half of them get treated seriously for their chronic pain.
In my opinion the number one reason for this is doctors are just not willing to put themselves and their practice on the line because of people who abuse them and lie to them to get drugs and the DEA.
The DEA's involment is because of the people who take advantage of the doctor by getting the prescibed medications and abusing them or selling them or even taking them with illegal drugs. When a doctor goes out on a limb for his pts to prescibe them medications they risk many things. Their freedom , license they worked long and hard for , their families well being and financial future.
Too many people do not realize this and respect these doctors. The doctors who go into pain management understand that pain is real and is a disease that needs to be treated.
What are some reasons you believe that chronic pain pts can not get the treatment they need and deserve?
20 Responses
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Avatar universal
I had that happen when I became ill one night within 20 minutes I could not stand & drove to the er where I sat for 12 hours on a bed, until I passed out from the pain, I woke up 4 times they kept moving me from one hospital to another trying to find out what was wrong with..SO COMPLEX! 4 hospitals and i awoke with each bump into a new ambulance. 48 hours later a surgeon is waking me up...& says we're putting u to sleep now do u know where u r or why?? NOPE!???
Your gallblatter needs to come out ur in the hospital. I was so sick & tired..I said I don't care what u take out! & was out. When i awoke all of my meds were gone, my $$ jewelry anything of slight value.even my fav channel lipstick was taken!!!
The pain clinic held it against me & made me sign a form saying meds were gone even though I had made a complaint at the hospital and the PA
at the PMC said to me, "It happens all the time, especially in a hospital if ur transported or arrive alone"   NICE! Then had me sign a form saying I had no meds when I should have had!!
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Avatar universal
I agree. I have never failed a drug screening..I don't drink, or smoke (I have enough problems!) & once you have had 21 surgeries and there is no where to go, u can not fix the problem without risk of killing the patient...Dr's need to be realistic.
Last year I had to have a Hysterectomy, I had mass on ovary & I am breast cancer survivor. So at 42 I said ok..Take this out of me when I found that it was double in size. NO one would touch me & straight out told me at the Women's hospital in Greensboro NC that they would call around. I waited for 3 months and finally a reconstructive surgeon from Wake forest agreed, but said it would be better if all was taken out of me. I agreed, no more surgeries 2-3 years when another mass grows. SO I finally had it done in Aug of last year. 13 hours of surgery because of all of the past damage to my stomach,adhesion's they said were like cob webs & I was covered when they opened me up again from just under breast bone ,down & around to left hip. I was opened like a book. I took me until October to get better & fully recover. In Dec. I had a mini stroke, and in June I had the fall and after I begged for MRI Dr discovered DDD, fracture in spine & bulging disks. I can't see a Dr for at 3 weeks as that is the time it takes. I am on a considerably high dose of morphine ER at 60 mg 2x's daily & 15 mg every 4 hours IR..I don't take it every 4 hours though...6 hours if & when I need. I am willing to try & get off this medication if someone will ween me ..I can't get in to see anyone who wants to help me though without going to a drug rehab which is not what I need. I don't abuse my meds & have not ever! Any suggestions would be welcomed. I would even change my primary care Dr if I thought someone would help me. I am using a walker now and I can not imagine the withdrawl I will go through?? I have spoke to Dr.'s in past asking if I could cut my meds or try to go off & use something else...They advised me that it would take 6 months to ween me off these meds & try it. I AM willing! Where do I turn?
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Avatar universal
You did exactly the right thing and you were also extremely lucky to have a doctor that treated your addiction as a medical risk of using essential medication. That allowed you to reach a successful conclusion of moving across to another medication.

Unfortunately too many doctors over-react to secondary addiction as a moral or criminal problem and then cut the patient off from all alternative medications. Stupid yes, hippocratic no.

On the related note of diversion of narcotics to the street: chronic pain patients cop the brunt of the blame for this happening but the numbers just don't add up. The significant diversions have to be along the path from pharmaceutical factory to the dispensary (both at hospitals and pharmacies). That implies a level of organised criminal activity may be a driver of diversion, yet we don't seem to hear much about. Much easier to lighten a shipping container at the wharf or airport warehouse, where the illicit profits could run to millions, than hope a few individuals will risk diversion. If I was lucky enough to be on a proper medication regime I certainly wouldn't further increase my suffering of pain by selling on some of my script.
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547368 tn?1440541785
What a good discussion. Hi all. Sorry I have been "out" for a bit.

You all make sense to me. In my opinion it matters if the physician can "see" the pain. If your leg is broken all you have to do is look and it's obvious you have pain. Fibro and other conditions (mine is SIJ Dysfunction) you cannot "see." If you can't see it, it isn't real.

I also think it depends how you "look" and how you function.I asked my PCP some years ago (who is my PMP) why no one would treat my pain before her. She responded, "Because you look good. You present yourself well. You are working in a full time career position; you walk in in a suit, heels and make up and no one would ever believe you had pain to look at you on the surface."  She said my pain was dismissed. She went on to explain that most physicians were programed to look at the patient that was crying with pain, usually unable to work and that looked pretty "tough", meaning wore out.  Initially I did not present with any of those on the surface. Yet I had horrible pain and went home at the end of the day and collapsed and cried. But I had to work and loved my career. I held on as long as I could. It took an exceptional physican to really see me and beleive I had pain.  

In my opinion another factor is age. The younger you are the least likely you are to be given narcotics long term. Physicians look at the years you will have to be on pain medications.

It takes the right kind of education,and an intelligent, kind caring physician to recognize, treat and understand CP and CP patients. Unfortunately there are not as many out there as their should be.

And yes Sandee is correct. Opiate prescribing physicians lay their liscense on the line for us. Behind those license's is years of hard work and sacrifice, thousands and thousands of dollars and in most cases a deep drive, dedication and love for the profession they have chosen. I believe that good physicians are "called", just like good ministers are "called."  They must be cautious and ever watchful over many of their opiate prescription patients. Who can blame them? Unfortunately the DEA is not a forgiving or understanding agency. All physicians are viewed as guilty until proven otherwise. Even well meaning physicians that made on error in judgement when prescribing are prosecuted mercilessly. Laws need to change, drastically! No other profession is held to this often unreasonable standard. Everyone makes mistakes but that is never acceptable in pain management prescribing. Some times these PMP are just hoodwinked by a very manipulative great acting skilled, drug seeker. How can they be right 100% of the time? We need to be as involved as possible to fight for a change in these unbending prescription laws that destroy well meaning, good physicians.    

So there's my two cents worth...sorry this is lengthy....now I'll get off my rant and shut up.  
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Avatar universal
unbelievable huh? being robbed in hospital. bloody hell. i only take what's in me to hosp.i think it is druggo's who take it tho (i've heard lots of stories of them being caught/kicked out of hospitals as they go ward to ward looking for scooby snacks). to dezdon - the patch is pretty good huh, made a big diff to my life too.
good drugs/good dr's and honesty go a long way.
Helpful - 0
Avatar universal
What Mollyrae said, made alot of sense, about patients not knowing thier Dr's or having a good relationship with them.
  I recently went through this with my own Dr and had a shocking experience and a pleasent one at the same time.
  I am a chronic pain patient, ampututated half feet. I was put on oxys about 6 months ago and hell broke out in my life. I had been on Vicoden for seven years and never had a problem, never once! Then, I had two operations on the end of my amputations and my pain levels rose as they got into some nerves. I was given percocets for awhile for break through, then evetualy onto 80mg of oxys a day.
  Everything went nuts. Something about that drug and I didnt get along.I literealy craved it. I was constantly coming up short and learned all about w/d's and even posted about it here and upset some folks (Im am truely sorry about those postings, this wasnt the place) I couldnt take it anymore, I was going nuts with the oxys. I so desperetly wanted to talk to my Dr about it, but was afraid I would be catorgorised and loose all pain coverage.
  I recently had a hospital stay becuse of a cellulits infection in my amputation and it came out my meds were all screwed up. My Dr. sat down with me in my hospital room and had a heart to heart talk with me. She asked what was up with my meds and I told her I having a huge problem with the oxys in my life. She went on to name like ten different problems people have with oxys and I told her, "I have all of them" I asked to be moved to the durigesic patch system. I needed to end the visciose cycle of having those little pills laying around calling me to be taken at will. She agreed and started me on the patch while I was in the hosptial. We had to do one adjustment on the dose due to breakthrough pain.
  What struck me the most was her knowledge of opiats and opiate theropy. I was blown away.We talked about it for a very long time and i finaly felt so at ease,like a weight had been lifeted off my shoulders. I also instantly grew to have so much respect for her. She knows her stuff. She wasnt just throwing pills out at people. You cant pull the wool over her eys.
  I have been on the patch for over two weeks now and my life has changed tramaticly. I no longer crave the oxys (took awhile), I dont obcess about pills or if I am going to run out of medicines anymore. My dose is exactly where it should be to date. There is no thoughts of even cheating on this stuff. Its like i am back to where I was eight months ago before the oxys's were introduced into my life and all hell broke loose. I dont think of meds constantly anymore. Im back to more myself with my pain covered kinda like automaticly. Im not in that euphoric haze anymore.
  And I do owe this all to my Dr. She wasnt judgemental, she listen to what I was saying and as long as i was honest, she returned that with her well educated advice on how we were going to continue to manage pain, but stop the negative behaviors.
   I also wanted to say, i am amzed how much I read about pain meds makeing it to the streets. After coming off the oxys, I know for a fact, I could have never even give one away to someone, let alone sell them. I HAD to have my little inventory and I kept a very close eye on them. They wernt going no where,but in me. I have never bought pills off the streets, so I dont know how it all works, but I have to guess, there must be alot of people lying about thier pain.
Helpful - 0
768044 tn?1294223436
hi there!

my grandpa isn't in chronic pain or anything like that... it's me and my mom who are... but! we did have to take my grandpa to the hospital once, and we took his pills with him... and yup, same thing happened to him... all of the pills that could be sold totally went "missing".
Helpful - 0
Avatar universal
WOW!!

okay as ya'll, I too agree with Sandee.  Also is the problem with Those whose pain problem can not be found/seen/diagnosed.  Naturally the first thought is 'drug seeking'  That is always the first place (I think) people look and think.  (did that make sense??)  Here's a ha ha!   I went to the ER for another problem and had my med bag with me.  The nurse took it with her to get the names and doses of all my meds.   Funny thing is...when I got home my oxycodone was missing.  GO FIGURE!!  I told my GP the next day and asked him what I should do.  He wrote me a new perscription (not being my PM) and said "NEVER take your meds to the hospital!!!"  They were probably sold to a dealer and on the streets before I left the Emergency Room.  I was shocked, appalled and mortified!!   These are the people that are suppose to be helping you not stealing your meds and making you look bad to your PM!!   I told him as well, and he basically said the same as my GP.  I still can not believe it!!
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Avatar universal
Upon reading my previous post, I would say I was rather crabby that day.

With regards to my comments concerning addiction and pain or related medication, I take it seriously. Addiction would most likely compound the stresses inherent in dealing with chronic pain. However, my opinion is that addiction is a risk, no different to other serious adverse side-effects, and therefore should be treated as a medical problem in the same way that chronic pain is a medical problem. To outright ban people from using opiates because they *might* become addicted is ridiculous - we don't ban alcohol or tobacco on those grounds, and they certainly have harmful individual and societal effects.

I have stuck with my current GP for a little over 2 years now since I moved here. I had my previous GP for 5-6 years. Unfortunately these days there are so many conflicting political, legal, economic and personal moral forces at work that the reason for prescribing pain medication - to relieve a patient's pain and increase quality of life and capability - trails at the end of the list of doctors' considerations, perhaps.

Unfortunately for chronic pain patients, the situation probably won't improve until such time as physical markers of chronic pain can be identified. Many diseases have been difficult to treat until the right technology and scientific advances have given a reliable platform for diagnosis. For chronic pain that may require a much more detailed understanding of the processes within the nervous system than we currently possess.
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Avatar universal
There's a belief that people with chronic pain will get addicted, which really isn't always true. You can become dependent on it, but you're not using it to get high, so it's different.

Problem is, a lot of people don't realize this and make you feel like a criminal when you tell them.

I've been to tons of doctors for an answer to my pain, and have never gotten a definitive answer. It's frustrating, but medical science doesn't seem to fully understand the nature of pain, and who knows if they ever will
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768044 tn?1294223436
I think it also has a lot to do with the type of doctor you go to...

It's like, if you go to a cancer specialist and they run tests to find out if you have cancer or not and you don't, then that's it... you don't have cancer so there is nothing left for them to do, you are not their patient anymore.

I think that more chronic pain patients actually need to get referred to chronic pain doctors. Of course, there are even some chronic pain doctors that can sometimes have a bad bedside manner that will make patients who are already dealing with a lot of physical pain and the emotional stress that goes along with that much physical pain... but, for the most part, pain specialists understand how to treat and manage chronic pain.

Now, you would think that a general practice doctor / family doctor would be able treat chronic pain... but, I agree with what people have said already here, I think that many worry about patients who are seeking pain medication not for pain but for illicit reasons. I don't think this would be such a problem if patients still really had FAMILY doctors.... general practice doctors who they formed relationships with.

In my country, Canada, especially in BC, I blame this on the decline of family doctors... post-secondary institutions in Canada are publicly funded (not free for students, medical school is still extremely expensive, but a huge percent is publicly funded) and in Canada medical schools and all medical programs (even nursing programs, pharmacy programs and technician programs) have caps on them set by the government as well as additional caps sometimes set by the schools. This seems ridiculous to many Canadians as we have a serious shortage of nurses and graduating doctors in many fields in Canada, especially general and family practice doctors. So, with the caps in place... there are a limited number of students entering medical school every year and a limited number of doctors graduating every year. General practice also isn't often thought of as the most "prestigious" career choice for medical students as well... and more and more my government is trying to change this unfortunate view-point that many students have when choosing a career path. You should hear how pretty much any citizen reacts when they hear a young person declare that they are going into family practice these days... they are treated like heroes, saints... because we really don't have ANY family doctors left here.

I have a family doctor. I am one of the lucky Canadians. Many Canadians now rely on walk-in clinics. Walk-in clinics do not, and cannot, supply anyone with pain medication. All walk-in clinics state this at the front counter and on the walls in-side exam rooms... and they say that a family doctor must be the one to prescribe such medicine. They also suggest that if you don't have a family doctor, you should find one. This often feels like a joke to many Canadians who don't have a family doctor.

When my family doctor retired we were lucky because the doctor who moved in to her office took us on as patients. A huge number of my friends whose family doctors have retired have not been able to find a new family doctor. In fact, I would say I am among the minority of the people I know who still have a family doctor.

Then there is also the issue of (again, this might be unique to BC) how many communities there are in BC that aren't near hospitals and do not have doctors in them at all. Some of these communities are lucky to have nurses stationed in them.

Without family doctors... how can a patient receive proper on-going medical care? Especially if that patient has a chronic health issue.

My city is a city of walk-in clinics... and from the country-wide media that is available to me (such as CBC radio, CBC television and McClean's News Magazine) I have a feeling that this is a country wide problem. I know that BC is trying to make it better... I don't know if it's working or how long it will take before everyone can get a family doctor if they want one again... but, until we have enough doctors that can take patients on as regular patients... a whole lot of people in chronic pain are going to keep suffering in my country.

Until that time... my suggestion to everyone I meet who suffers from chronic pain is to get themselves to the chronic pain clinic in their area, usually this is at a hospital. They'll have to get referred by a GP... which, again... is difficult... because, it means you have to HAVE a GP first.

Unless you get referred because you've gone to the ER. But, the ER has to believe that you're not there looking for drugs either... and no one who is in horrible pain needs to deal with the insult and stress of someone accusing them of lying in order to get "high". No ER has ever thought that about me, but, I've known people it has happened to who are suffering from terrible illnesses, illnesses which are NOT addiction... and so, my suggestion to them is to always always take someone with you to the ER and to NEVER let them leave your side.

You need an advocate there with you when you are at the ER and at all doctors appointments... especially if you are a young person (teenager), a woman, a senior citizen, or if you are currently on disability or welfare because of your illness... or even if you just look terrible because you're sick. But really, it's always good to have an advocate with you.... no matter who you are.
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Avatar universal
This concept of people getting high on pain medication is extremely frustrating. Aside from the intrinsic lack of evidence that this is the case for chronic pain patients, even if it was true it would be irrelevant. Euphoria is the only side-effect that GPs seem to get real concerned about, as though heart failure (lyrica, vioxx et al), blood disorders (just about any anticonvulsant), blood pressure increases (again, many non-opioid or non-opiate medications), extreme drowsiness (again anticonvulsants, many antidepressants, migraine medications, etc) and so on are of less concern. The balance of quality of life improvement against future physical health risks should be far more important a concern, than whether a chronic pain patient might *potentially* feel a little happy. The cynic in me now says that if a CP victimised person wants euphoria all they need do is get a bottle of wine or two and drink it - hypocritically this is acceptable for people who don't have chronic pain, in spite of the very well known risks of long term use of alcohol.

Here in Oz I have just discovered that management of drugs of dependence has been moved under the control of DASSA (South Australia's equivalent of DEA I suppose) and I've been told several times now that if lyrica doesn't work out it is the end of the road for me in so far as medications go. I have never *ever* been granted a proper trial of opiates for pain - always an excuse is found to fob me off.

The previous excuse was that we were waiting for me to see the Pain Clinic (12 month wait, roughly) - I dutifully used either nothing or panadeine forte (yeah, for CP). Then they decide that I am functional (not the DSM IV definition, but the "can do the shopping" type of functional - in spite of my parents having to do most of my household chores for me). Why o why would a pain clinic put "functional" in a report going to other medical specialists, without clarifying the term. The pain clinic also told the GP (but not me) that I have a schizioid personality - I had to look that one up - and not to use strong meds on me... No mention of the clinical depression my own psychiatrist had diagnosed a few months earlier though... The pain clinic doc politely told me that if I had terminal cancer they would recommend opiates, but since I have potentially another 40 years left, it isn't appropriate for me. Can anyone penetrate the logic behind that comment? I sure couldn't.

I cannot tolerate tramadol (hey, and that one did make me "high" in a bad kind of way - bad mood swings) and in any case my current use of Effexor rules that out. OTC medications are of minor impact but are dangerous for long term health. Opiates have a short list of managable side-effects compared to the mile long lists for tegretol, lyrica, mobic, vioxx (excluded now), tramadol, etc etc. I don't want to become addicted but I'm willing to risk it if opiates have a cleaner side-effect profile than my current medications.

Sorry all for the rant...but the irony is I moved back home from interstate in order to afford treatment of depression (work overload and chronic work stress caused this), and in so doing I've slowly lost control of pain undoing my physical health, my hobbies, and smashing whatever was left of my capacity for work. Not to mention the distress it causes my family.

My patience is running low today. Sorry again. My heart goes out to those who have endured even worse.

OtisDaMan.
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Avatar universal
This question has been one that I asked myself over and over as I was passed from doctor to doctor. The doctors could feel the huge knots in my muscles they could feel my shoulders pop out of the sockets every time I would move them even a small movement would case severe pain and yet they were unwilling to believe that I was in pain. I am fortunate now to have finally found a doctor who understands my pain issues but it took years. I felt at the time and still feel that my age was a factor since I was in my 20s at the time and the doctors I believe felt like I was looking to get "high". My mom went through the same thing though. She would go to doctors and tell them she had pain in her lower back but there was a very severe pain that was radiating through her leg. The doctors kept looking in her back but reused to even ackowledge the pain in her leg telling her it was from her back. After going to many specialists she finally went to her regular doctor and he actually did an MRI of her leg and found out that she had no cartlidge in her knee and the bones were rubbing together. had even one of the other doctors stopped to listen to her she would not have had to deal with almost two years of pain in her knee. Maybe part of the problem is the fact that doctors need to actually listen to their patients.
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356518 tn?1322263642
There are reasons people have pain and they do not always show up on the test that the doctors order but that does not mean the pain does not exsist. You could have some nerve damage or a number of things going on and I am blessed with a doctor that does understand that pain does exsist even though it may not show up on test.
maybe you should look into getting another docotrs views. Ask if she can refer you to a pain management doctor as they tend to understand that pain doesn;t always present itself in normal ways. At least thats been my experience.
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760862 tn?1243097304
I agree with everyone.  And it is aggrivating when the docs don't understand a person's pain issues.  I am kinda in that boat.  I know that I am almost 41/2 months past my injury and I know that the bones are healed but, I am still in pain, not as much as I was but,some parts of my body are still hurting to the point of interfering with my life in a big way.  I am a person, not a text book and sometimes I feel the doc needs to look outside the lines and words of the text and handheld palm.  Alot of people including myself are not textbook examples of patients.  I have pain that is ugly and makes me crazy and the docs seem to think that cause bones are healed than fine, I shouldn't hurt like I do.  But, how do you explain that to the doc?  I have told her that I understand everything she is telling me and I know that normal people, if they even exist, wouldn't hurt amost 5 months past a broken bone, but, I do.  Am I crazy, am I an exception to a normal human being.  I realize that my dependency on narcotic pain management has now lead me to be an addict in a round about way.  But, geez, can I have a little sympathy here.  The docs need to listen really good to their patients and understand what they are going through and not to always think you are a liar and a drug seeker or just making up the pain.  YIPES I am long winded.  sorry bout that, just got carried away, but, on the up and up does anyone else out there feel like that.  I would really like to hear your comments on the subject.
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535089 tn?1400673519
I also think that many Chronic Pain Patients do not know their Doctor well enough or have a good enough relationship for the Doctor to prescribe. There are many CP'ers out their who travel from one Doctor to the next looking for the quick fix to their pain like MontanaGurl has suggested and don't actually or necessarily want to spend the time or the money to possibly fix the problem. If one Doctor won't do the prescribing they go to the next. This makes it hard to get to know your Doctor as well as they should.

I know many CP patients who know their Doctor very well and have yet to see one that hasn't been satisfied. Most are. It's the CP's who don't have that relationship that suffer and that's sad too.
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Avatar universal
The DEA need to stop existing IMHO.  If you look at their decisions historically, they've done a lot of damage and seldom achieve their stated objectives.  I could go into more detail, but most people kind of tend to shut down when I start talking about average purity and the Columbian economy.  
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518031 tn?1295575374
i think both of you all have very valid points, but the use of illegal drugs and the abuse of drugs i beleive are the main reasons, and like sandee said the drs go to school for a long time spend hundreds of thousands of dollars to become a dr and they can loose everything
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356518 tn?1322263642
You have a great point. Doctors do want to fond the cause of the pain and attempt to fix the problem but when all else fails and medications are all that's left then they need to treat the pain.
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760862 tn?1243097304
I have gone over this question many times in my mind why docs think the way they do.  I think that they do not understand completely that pain for some take over their mind and body to a point where it does not go away.  Therefore, the pain becomes chronic and long term.  Most doctors do not like dishing out narcotics for pain because it does not help the problem only covers it up.  The doctor's want to find the cause of the pain and cure it, that is why most chronic pain patients do not get the help they need and feel like they get tossed around because the docs want to cure the problem to the pain not just throw in the towel and cover up the pain.  Some doctor's also believe in other types of pain control other than narcotics.  That is my thought in a nutshell.
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