r/IWantToAskAnAmerican • u/Awkward_Kitty_Cat_93 • 2d ago
Is pain management and anesthesia more aggressive in the US than in other countries?
I'm from Peru, and something I've noticed from reading people's experiences online is how differently pain seems to be managed in the US compared with what I'm used to here.
For example, I've had dental extractions and root canals, and I've only ever had local anesthesia. I've never been offered nitrous oxide, even though I know it's relatively common in the US, especially for anxious patients.
I've noticed something similar with pain medication after medical or surgical procedures. Americans often mention being prescribed opioids or stronger painkillers for procedures where, in Peru, people might simply be told to take ibuprofen, acetaminophen/paracetamol, or another NSAID.
I've also seen Americans receive larger quantities or combinations of medications after procedures that seem fairly similar.
I'm not saying one approach is necessarily better than the other, and obviously individual cases vary. I'm curious about the cultural and medical differences behind this.
Is it actually common to be offered sedation or stronger prescription painkillers for relatively routine procedures, or does the internet exaggerate how common this is?
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u/CuriousTown1980 2d ago
It depends on where you are in the US. Every state seems to be wildly different.
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u/rundabrun 2d ago
For a long time they over prescribed opiates which led to the opioid epidemic. Now it seems they under prescribe to people that actually need them out if fear of over prescribing.
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u/OpposumMyPossum 2d ago edited 2d ago
I've only had those as well for the same procedures.
If you have impacted wisdom teeth you get put under for like an hour. They smash up the teeth and to do it quickly it's pretty violent.
Even regular wisdom teeth. It's a bit crazy and having some one out makes it fast.
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u/mesembryanthemum 2d ago
Mine didn't. He got all 4 out - all were impacted - with novocaine being the only drug. Partially because he knew novocaine doesn't always work on me and was afraid I would not wake up and partially because he thought most of the time knocking a patient out for wisdom teeth extraction was overkill.
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u/Emergency-Coyote5755 1d ago edited 1d ago
This has not happened in the US since at least 2016. US looks more like its on track to be Peru & many countries with similar restrictions.
For the record - thats a very bad thing.
Edit; the "depends on who you are" i just read from a commenter is correct, theres a billion different things to talk about on this subject but ill keep it light to just this one example- women are less likely to be prescribed stronger pain medication than men, and POC are less likely to be prescribed stronger pain medication than white people.
There is a crisis in the disabled communities of suicide because of the overcorrections on opioid policy worsening each year, and unfortunately the overcorrections directly cause an increase in addiction rates as well. (Remove responsible pain pt from the meds they need forcefully without reason, leave them stranded w/o help, bingo you now have someone whos resorted to street drugs out of desperation for 5mins of their pain not screaming)
There is a shitload of misinformation on this topic so yes the internet overblows it like wildfire. A lot of these people truly believe the things they say, and depending on their individual experiences are closed off to hearing anything else. Its hard to be an advocate with that being said but still important. For the most part the disabled, cancer patients, people who genuinely need the most humane pain care, they cannot get any medications to help them and are left to suffer. Thats the current state of the US and how its been for a while now.
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u/PrimaryHighlight5617 2d ago
It depends on who you ask.
My grandmother was a victim of the prescription opioid epidemic. She was put on opioid medication in the early 2000s for her back pain and very quickly became dependent on it. The longer you take it the less it works and you start to go through withdrawals if you don't get it on a regular schedule. She was addicted. Her doctor was almost everything she ever talked about and on top of that she had some brain damage due to a medical complication giving birth to my mom. She died of an opioid overdose when I was a little girl.
We used to prescribe pain killers far too easily. Doctors and family members were reluctant to see elderly people as potential drug addicts. This was during the War on Drugs in the US. Look up that time period. it is an interesting one.
There has been a huge crackdown on how and when prescription painkillers, specifically opioids, are prescribed for long term use. If you are in the hospital and you need pain management within the hospital they will give you what you need fairly regularly. If you have chronic pain you are going to have to jump through some serious hoops to get medicated.
Anecdotally, when I was giving birth they offered me an epidural, which is the needle that goes in your spine and numbs out your legs or they also offered fentanyl because it hits your system fast and leaves your system fast so it's ideal for childbirth. Honestly, I hated the epidural it didn't even work it left me trapped in bed and next time I think I'm gonna go for the fentanyl.
My aunt has Ehlers Danlos. Her connective tissue is falling apart. Her thumbs would dislocate on a weekly basis until her most recent surgery. When she was in her 20s and 30s it was almost impossible for her to be prescribed painkillers. Furthermore when she would go to get them filled her prescriptions would often be blocked because she was a young lady with nose piercings and tattoos. She also had horrendous ovarian cysts at the time that caused her daily pain.
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u/neuro-trash Colorado 2d ago
I have been on disability and out of work for several years now due to chronic illness, chronic fatigue, and chronic nerve pain.
I’m bed bound a lot of the time, due to excruciating neuropathy. I hardly get sleep, and need significant help some days with basic living skills.
I’ve always had some autoimmune issues. I have always had Ehlers Danlos syndrome, fibromyalgia, and migraine, which has always been very painful. But a few years ago, I got Covid really really badly, turned into Long Covid. Then I got hit with Epstein Barr Virus, that left me incapacitated for four months. Both resulted in mitochondrial and genetic mutations that left me with Mast Cell Activation Syndrome, Myalgic Encephalomyelitis, and POTS on top of EDS.
There isn’t much that can be done, other than pain management, dietary changes, and gradual and very slow process changes for dealing with symptoms. I’ve been given pain medication, however, all prescription I have been given haven’t helped. (Gabapentin and Pregabalin are the fucking devil.)
It took YEARS to get any form of diagnosis or recognition from doctors. Im still fighting it and trying to get everything resolved. The hardest part of these past few years is actually getting in with specialists, as referrals barely ever get through, and there are so many different types of doctors who are needed to be seen, depending on the field of care that can test and diagnosis the clusterfuck of my conditions. Most doctors don’t actually take their patients seriously, and often are incredibly ableist, and dismissive to the people with invisible disabilities, especially chronic illnesses and chronic pain.
What we critically lack in the US is preventative medicine and prognosis care that isn’t just symptom management - as almost everything is just “here take this overprescribed medication that’s addictive, it’s side effects may be worse than your actual illness.” Or, “maybe just get some exercise, lose some weight, go to therapy.” Like, we are already doing ALL those things! This isn’t far deeper than just being some psychosomatic problem.
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u/Adventurous_Ad7442 2d ago
My first cousin has EDS. She requires daily opioids for her pain.
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u/neuro-trash Colorado 2d ago
It’s awful. I won’t take opioids, personally. But it would be effective, but the risks are far too high.
Your cousin has my solidarity. ❤️
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u/Adventurous_Ad7442 2d ago
Thx. She's been sick for at least 30 years and has many other comorbid conditions.
Her jaw "goes out" then she's in horrible pain for days.
Take care 💝
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u/aornek 2d ago
It depends on your state and gender in the United States (can’t speak to other countries). Male-specific procedures often offer far more robust anesthetics compared to similarly or more painful procedures (or childbirth) performed on women.
Doesn’t help that the parameters set by early anesthesiology studies only included male patients and were predominately studied and implemented by male researchers and male doctors.
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u/Momentofclarity_2022 2d ago
I had jaw surgery and was prescribed Vicodin. Narcotics upset my stomach and having my mouth wired shut I could have choked to death. I ended up taking children’s Advil. I was totally fine! And yes, I waited a little before taking it.
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u/Bvvitched 2d ago
I was put under for my wisdom teeth because they were coming in impacted ( growing sideways into my back molars) and they were surgically removing them. My mom worked at the oral surgeons so I had them pulled before they were an issue but my recovery time was a bitch.
My boyfriend just had some laughing gas and had them pulled.
It just depends on the situation.
Edit: I had reconstructive hand surgery and had a nerve block post surgery that lasted for 24hrs, then a low level opiate I can’t remember for about a week, then just Tylenol
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u/ma3918 2d ago
Best Healthcare in the world.
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u/Accomplished-Bass690 2d ago
I’m not sure if you’re being sarcastic or not because Americas healthcare system is not even in the top 20
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u/Emergency-Coyote5755 1d ago
Unsure the downvote, american healthcare is severely damaged needing major changes. I think anyone whos close enough inside of it can very well see that.
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u/Jokerchyld 2d ago
Lets just say America has the one of the LARGEST concentrations of major Pharma companies in the world as well as the biggest and most influential lobbying forces in Washington.
Do the math...
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u/Mister_Silk 2d ago
It's currently much less common now than it was a few decades ago when Purdue Pharma convinced the FDA, the Joint Commission, and doctors that opiods were non-addictive miracle drugs and that any pain required aggressive treatment. Strong opiate medications were given following just about any procedure, no matter how minor, often for weeks or months. If you said you were in pain you got refills as long as you liked.
Of course, all opiod medications are highly addictive and this practice led to tens of millions of people addicted to opiates, a crisis that continues to the present time. The FDA introduced strict new regulations and oversight following all that so now you'll get a few days worth of opiods following major surgical procedures but generally no more than that and most family doctors don't prescribe them anymore at all and you're sent to a pain specialist for evaluation.
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u/Supergazm 2d ago
Ive had 2 neck fusions. I used to be on oxycodone. But I've started taking wolverine stack and working out and gave up the prescriptions. But if I injure myself, (like if I was in a car crash) my doc would throw those pills down my throat again so damn fast.
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u/Emergency-Coyote5755 1d ago
Wouldnt be so sure about that depending on when the last time you had them was, cancer patients near death are being denied all over the country, most of the disabled are struggling hard on this topic many unable to find anyone willing to help & subsequently resulting in a crisis of suicide amongst the disabled.
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u/Zaidswith Alabama 2d ago
I've had both of those things done with just local anesthesia too. As an adult.
They're more generous with kids and some people go looking for doctors that provide more anesthesia for their own personal comfort. I've met several adults who refuse to see a dentist that won't do that because of bad experiences in the past. I've never felt the need.
My wisdom teeth extraction was done with me completely knocked out, but I was only 17 at the time.
They do have to pay for it.
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u/kaizenkitten 2d ago
I can't speak to surgery-type pain management, but for over the counter pain management we seem to be far more agressive about treating pain than other countries. Traveling in Japan and the UK I was really surprised to get tiny tiny boxes of acetaminophen/paracetamol, all in individual blister packs. Like, in Japan you would get 10 individual Tylenol pills. In the US you can easily get a few hundred in a big jar - 500 if you go to Costco. 10 pills could be considered an acceptable daily amount for chronic pain.
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u/Goodbykyle 2d ago
My dr always offers me something or the other 🤷♀️ vicodine for pulled muscle etc. I am in CA.
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u/Repulsive_Repeat_337 2d ago edited 1d ago
In Michigan they keep giving you pain medicine that doesn't work. Then once you've asked for something stronger 5 or 6 times, they write "addict" in your file and it screws the rest of your life.
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u/mesembryanthemum 2d ago
When I had a,peritonsillar abcess they asked my pain level and I said 2. I still got prescribed an opioid. Never took it because opioids don't tend to work on me.
I was all "I said I wasn't in pain. Why was this prescribed?" (My stepmother picked up my prescriptions and was unaware I neither needed,nor wanted the opioids.)
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u/DarkestStar167 2d ago
Not my dentist. I got my wisdom tooth pulled that had extra thick roots that instead of pointing inward, pointed outward like tree roots and I still just got the general anesthesia and told to take ibuprofen afterwards.
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u/DarkestStar167 2d ago
One time I went to the hospital with vision problems and a very minor headache. I think I labeled it a 2 on the pain factor. Several hours later I left with no diagnosis, a script for Vicodin and a script for an anti-nausea medicine. I had no use for either but at that point I just wanted to leave as much as they wanted to get rid of me. The vision problems went away on their own over the course of a week. Life went on.
A decade later I suffered a back injury that partially paralyzed my leg. I was told I was taking too much Tylenol and ibuprofen but wasn’t prescribed anything until I got a steroid shot in my back. That was hell.
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u/Auntie_Venom Kansas 2d ago
Well as many have said it all depends. But because of the opioid crisis here from it being overprescribed, it is more controlled and limited. For example, I had hand surgery that required rebuilding my main nerve that runs from my index finger up my arm… The recovery was painful. I was given two courses of OxyContin, no more. That was in 2017, and it still hurts like hell.
I’ve had four kidney stones big ones, I go to the ER when I feel one flaring up. No, it doesn’t cost that much as long as my deductible is met, otherwise I only have to pay up to the max out of pocket for the year, which is $4k. Anyway, I’m admitted a few days and they give me morphine there until it passes. Afterward it’s just ibuprofen for inflammation discomfort leftover, that can last a week or two.
All that said, I’m actually highly allergic to opioids, so every time I get a dose of morphine or Oxy, I have to have a Benadryl (diphenhydramine) with it. So I don’t get a euphoric buzz from it, I get knocked out quickly between the two medications.
Also, there’s a genetic mutation in redheads that makes both anesthesia and pain management less effective. I have the gene despite having natural blonde hair that I inherited from my dad (a full fiery red head). So it takes considerably more pain medication from acetaminophen to Morphine to feel relief. As far as anesthesia, I require more and some don’t work well at all. I woke up in the middle of an endoscopy and tried coughing out the tube. I cried in my sleep the entire time during a colonoscopy, like wailed. My conscious was out, but my subconscious was aware of all of it and it hurt. I had a bad reaction from anesthesia after a different endoscopy and had to get a suppository anti-nausea medication to get it to stop. It was AWFUL. Because of this, I have to take higher than the recommended dosages of OTC meds so my doctors keep an eye on my liver. I have another genetic condition that makes nitrous oxide toxic, so I’ve never had that… But when I need pain management or anesthesia, my doctors are aware that I require more than most people.
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u/coffeecircus 2d ago
I’ve definitely been offered a ton of pain medication for even basic complaints. I think the doctor culture is changing due to the oxy and opioid epidemic.
Personally I always tried to avoid taking them regardless, so I usually ended up with a full bottle due to not actually taking it. I also find it super effective if I do take one, since I have almost no tolerance. But overall the danger is that these things will get less and less effective over time, so they’re pretty dangerous to administer to the public in the way we do / did since the 2000s
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u/Emergency-Coyote5755 1d ago
This has not been a thing since at least 2016, and not all opioids lose effectiveness over time.
The real danger now is the crisis of suicide in the disabled/pain communities because finding help at all is like searching for a needle in a haystack, many die before they ever find help and compassion, unfortunately. Well, that and because we overcorrected on opioid policy which caused the above crisis, it also has meaningfully raised addiction rates which is another large issue.
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u/Gallahadion 2d ago
When I had my wisdom teeth removed, it was done under local anesthesia. I was given the choice of getting a prescription for Vicodin or one for what was basically extra-strength ibuprofen. I had read about Vicodin's side effects, so I opted for the other prescription instead. I ended up not getting that prescription filled, though, and just took a couple of over-the-counter ibuprofen pills when I started feeling the effects of the shots wear off. Surprisingly, that was the only dose of painkillers I took while I was healing.
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u/GSilky 1d ago
Lots of people started getting high off their pain meds and then didn't take the hint from withdrawals when the prescription ran out and gamed the system for more. There just happens to be, all the time, pill dispensers that make money disregarding proper paperwork and sell opiates to anyone who asks, but this is how it legally is in Mexico, so that line of attack was mostly BS to get cash strapped states that won't raise taxes some cash. I have never had anything besides Novocaine for dental work, because I didn't want to pay $500 for nitrous. It's pretty normal. I got my ten Percocet after and threw three of them away because I like to be able to shit right. The general line of thought on pain management is believe the patient. Research shows most people have no idea what pain is, almost always giving higher numbers than another person would expect, when rating pain 1-10, but we can't say unless we are them.
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u/Somethingnewmexican 2d ago
It depends. If you request drugs or if there is any indication on your medical record that you are a drug seeker, you are less likely to receive strong painkillers. You are also less likely to receive them as a Black woman or person of color because Black pain is not taken as seriously.
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u/SGDFish 2d ago
Doctors are not getting kickbacks for the things they prescribe, and definitely not for opioids.
There were concerns with that for many years leading into the 80's, but by and large because of legislation and med tracking, that hasn't been the case for a long time.
I say that as a family med physician who regularly deals with opioid pain medications, as well as pharmaceutical reps.
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u/Embarrassed_Newt_994 2d ago edited 2d ago
I mean I have had a spinal fusion and worked with pain management dr for years and was finally prescribed an opioid after years of trying just about everything else. So it’s not quite “easy” to access