I am going to take this advice

[james_davis_nicoll]

I got this from a friend I met this aft: if after major knee surgery the doctors strongly recommend pain killers, take them rather than assuming the current lack of pain will continue indefinitely. Apparently all the nerve blocks and such wore off at the same time.

Comments

[bastets-place.livejournal.com]

Yes - as someone who had massive (botched) abdominal surgery - once those nerve endings wake up and want to speak with you, getting them to shut up takes forever, if you ever manage it (I never did, until I reached the point where it was two weeks after they had removed all the staples and past the point where I was supposed to be able to return to work!)

[james-nicoll.livejournal.com]

A bit advice I learned from my father: if you've recently barely survived abdominal surgery and have bullied the doctors into letting you go home early, there's a reason the list of things you are permitted to do does not include "ride a tractor".

[aboutlikepleats.livejournal.com]

So the Nicoll effect is hereditary.

That's ... surprisingly counter-intuitive, if you'll forgive me saying so.

[neowolf2.livejournal.com]

Perhaps when they're injured they disperse large clouds of spores?

[fridgepunk.livejournal.com]

That's ... surprisingly counter-intuitive, if you'll forgive me saying so.

Oh not at all actually; A Nicoll Gene is certainly no more silly than a Teela Brown gene in general, as it ensures that dirty stinking luck leads to possessing experiencing survivable but quite impressive accidents, so most importantly and pertinent to natural selection, the gene clearly also ensures that the possessor ultimately survives to reproduce even in situations where they really shouldn't, even if the method by which it achieves this is painful for the gene's host in the short term. That it also frequently leads to sexy scarring (which increases fecundity and aids in sex selection for the gene), as well as giving the family a multigenerational wealth of knowledge about Things What Hurt Bad that other families wouldn't have, aiding in kin selection terms, is just a handy side effect that helps it to beat out competitors like the Teela Brown gene which tends to coddle its hosts and provide no net benefit for other nearby members of its species that do not possess that gene.

So tribes with a Nicoll will always have a competent herbalist/amateur EMT with a vast knowledge of poisons, venoms, anti-venoms, anti-toxins and first hand knowledge of most means to survive and treat physical injuries who is generally able to keep a clear head about them through sheer constant personal exposure to emergency situations. While the tribes with Teela Browns will of course have this nieve fool who's lucky when better people than they are not.

So to give a specific scenario when a Nicoll is evolutionarily better than a Teela Brown, say if two people from a Nicoll containing tribe are attacked by a bear, the Nicoll will be immediately but non-fatally mauled by the bear and thus allow the non-nicoll to escape, while the hunter who'd gone out with a Teela Brown will end up dying after the Teela Brown manages to run away or hide better than the non-teela brown.

[aboutlikepleats.livejournal.com]

OK, I'm now going to have to purge the combination of "James Nicoll" and "sexy scarring" from my consciousness (no offense, James). Otherwise, awesome analysis, I stand corrected.

[scott-sanford.livejournal.com]

I suggest the two gene complexes are not distinct, but rather variations on each other. The probability distortion long noted in the Nicolls suggests that the Nicoll Gene and the Teela Brown Gene are related to each other.

You make a cromulent argument about the evolutionary benefits of the two variations.

[mme-hardy.livejournal.com]

There's a thing called "kindling" where feeling a pain repeatedly increases the brain's sensitivity to pain. So, yeah, knocking the pain down and keeping it down beats letting it pop up, knocking it down, letting it pop up, and so on.

The long-term flip-side is medication-overuse rebound, as well as addiction. You can't win for losing. But in the short term, take the drugs, keep the pain under control, and then taper off.

[erikagillian.livejournal.com]

Mostly if you're only using opiates for pain, not for the mood lift, you won't get addicted. If you use them regularly long enough you will become physically dependent and need to withdraw slowly though.

Never heard of kindling, should look it up. I've had a migraine for 17 years now but it moves around, not sure if that counts for kindling. And I'm not sure if I believe in rebound, every time I've gone off to prove to another doctor that it's not rebound, it hasn't been rebound :)

My experience of cramps and back pain from my period really really showed me the point of taking the pain pills early and keep taking them, once they got their claws in me it could take a full day to get 'em under control again.

[mme-hardy.livejournal.com]

"And I'm not sure if I believe in rebound, every time I've gone off to prove to another doctor that it's not rebound, it hasn't been rebound "

I would have said that a year ago, after multiple specialists, until I visited a specialist researcher who explained what rebound (now known as "medication overuse headache") actually was. It's a complicated physical and chemical process. In any case, strictly limiting my use of *any* pain relief, including aspirin, did indeed reduce but not eliminate my migraines. Your migraines may vary. PM me if you want to know the name of the researcher.

> Mostly if you're only using opiates for pain, not for the mood lift, you won't get addicted.

This can be a mess. Opiates are not the Universally Awful Thing currently being promoted by the Federal government. On the other hand, people do become addicted because of opiate treatment for pain - this happened to a friend of mine after major back surgery, for instance. People with chronic pain respond differently to opiates than people with injury pain, but opiates remain a very mixed blessing, and opiates can be overused and misused (by the prescribers, not just the patient) even in chronic-pain situations.

[lostwanderfound.livejournal.com]

The work of Linda Watkins is worth a read if you're interested in the mechanisms of pain adaptation and opioid tolerance. See http://tinyurl.com/94rh8eq

[neowolf2.livejournal.com]

Interesting recent work suggests the mirror enantiomer of naloxone ((+)-naloxone), which does not act on opiod receptors, does act on non-neuron receptors in the brain to suppress the addictive effect of opiods. It's also claimed to have an effect on neuropathic pain.

[mme-hardy.livejournal.com]

Spiffy re: neuropathic pain!

[erikagillian.livejournal.com]

Oh yeah! My mom's having terrible trouble with oh, the one in the hands and feet, anything that'd help that would be amazing. Opiates don't touch it. Will have a look at the stuff. Thank you!

Not sure if my stuff is actually neuropathic pain or not, should look up a definition.

[(Anonymous)]

Has she ruled out Lyrica? Side effects can be vile, of course.

[erikagillian.livejournal.com]

Yeah, pretty much. It's complicated but yeah, not going to be taking it :(

[erikagillian.livejournal.com]

>People with chronic pain respond differently to opiates than people with injury pain,

This is so true and not something I take into account when I pontificate on opiates. Thanks for reminding me :)

Whenever the US gov't or the DEA starts whipping up a frenzy about opiates it leads to such trouble for people whose only pain relief is an opiate. And while they can be troublesome and if not treated with respect, horrible, we have been using them for so long and know so much about the effects, it drives me nuts! Washington state passed a law that caused most doctors to drop chronic pain patients and stop prescribing opiates except for cancer and the like. California has a pain patient's bill of rights, too bad other states don't *sigh*. And I swear the DEA does it when people start noticing that since the drug war started drugs have gotten cheaper, easier to find and better quality.

Enough ranting from me, a pm shall wing its way to you.

[glinda-w.livejournal.com]

Am one of those affected by the WA law. Doctor/clinic didn't drop me as a patient, but they won't prescribe opioids at all; was referred to the pain clinic at Swedish Hospital, where the verdict was "yes, you definitely need the meds, but we don't prescribe, we just recommend to your own doctor". I've been trying to find a prescriber for over a year now; have had chronic daily non-stop migraine since 2002. Also have CFS, fibromyalgia (one of those two turned the migraines from chronic to never ever stopping), a wrecked inoperable knee thing that's never below 8 on a 1-10 pain scale. Oh, and peripheral neuropathy, which is just hell.

Am not wimpy about pain, really; have had migraines since before kindergarten, just not daily. And the absence of pain control means it keeps getting worse, and I keep getting less and less functional. Had the baseline migraine level down to 6, with basically 45 vicos a month; now, the lowest it gets is 8, and I spend a lot of time in a quiet dark room with ice packs deployed.

*sigh*

[liveavatar.livejournal.com]

A friend of mine who just had both knees replaced (I love living in the future) seconds that advice. Her nerve blocks wore off suddenly, though slightly differently in each knee, and morphine was the only thing that even slowed it down.

[ruthless1.livejournal.com]

Pain management is a beautiful thing. After my last surgery (pilon fracture of my right leg/ankle) I went from codiene to ibuprofen as fast as I could and then tapered down from there. But I kept chugging them as long as I needed to because I never wanted to go back to the place where I could REALLy feel the pain.
I love your tractor story.

[pperiwinkle.livejournal.com]

I have degenerative joint disease in my right knee. I have found that taking anti-inflammatories at night so that I wake up in the morning with no pain or stiffness insures that I will have less pain the whole day than if I take it first thing in the morning. So, yeah, stopping pain before it starts is better than trying to control it afterwards.

[realinterrobang.livejournal.com]

Yes, this. The best time to take painkillers is before you (think you) need them. Afterward, it's probably too late to really be effective. (Now if only dglenn would learn that...)

[viktor-haag.livejournal.com]

Indeed. I have a friend who had surgery on a hand a few years back. The doctor gave him heavy meds, and said "you will want to start on these as soon as you get home". He, on the other hand, decided he'd put it off a bit, just out of curiosity. He discovered all too soon the cruel double-pronged truths of "this will hurt, you will want these meds and they take 30 minutes to start working" along with "pain is harder to control after it's already started hurting".

[aboutlikepleats.livejournal.com]

I have a friend who had a very similar experience with his vasectomy. His wife at least managed to convince him to
a) go home until the meds had worn off, rather than straight back to work to deal with Important Bidness, and
b) not to ride his bike home.

[glinda-w.livejournal.com]

Yes. That's what I had been doing, taking one pill at night so I wouldn't wake up crying from pain at 3 am, and could be somewhat functional the next day. The "extra" pills beyond the nightly one worked to knock the migraine level back down when they spiked to 9 or 10.

wait...

[(Anonymous)]

Does this not imply that you're going to be in a position to take the advice, and are thus at least contemplating major knee surgery?

-- Graydon

This deserves a place

[commodorified.livejournal.com]

right beside "if you have oral surgery and are told to ice it, do not refrain on the grounds that there's 'hardly any swelling', for if you do that you will wake up the next day with a red-hot golf-ball on your jaw"

[erikagillian.livejournal.com]

I ended up with the novocaine wearing off and not being able to actually touch the ice to my cheek. I had to run an errand or two! And I thought I should save the nifty chemical ice thing for emergencies as I was fine! And, for both me and my mom a couple weeks later, the ibuprofen worked and opiates didn't on that particular pain.

[commodorified.livejournal.com]

I am immune to novocaine (oi) and had mine done under general. I don't know if opioids would have worked for me as that was when we discovered that I am direly allergic to codeine. I don't recommend violent retching with a mouth full of fresh stitches, btw, especially if a) the clots are still sort of shaky and b) the pain-relief part of the equation hasn't had time to kick in yet.

Ibuprofin worked well for me, once we got me switched onto it, but MAN, that was NASTY.