…… How Long Can Surgery Patient Safely Take Narcotic Pain Killer? (Update post #68)

[Barry Natchitoches]

Lets just say that a friend recently had total knee replacement on both knees at the same time.

This guy has NO history of any kind of drug abuse or addiction. None whatsoever. Or alcohol use either, for that matter.

He would like to keep it that way.

He is now three weeks out of surgery. Everything went well as could be expected, but physical therapy is still exceptionally painful, even three weeks out.

How long can he expect therapy to be so painful?

The doc is still giving him narcotic meds, to use along with extra strength tylenol, aleve, and meloxicam. (And seno cot laxative, as narcotic meds can slow up the processing of stool).

He is also using PLENTY OF ICE.

At the moment, he considers ice to be his best friend.


Since his narcotic meds are now PRN, he has cut the dosage in half and even puts off his exercise for several hours at a time, to put more hours in between when he feels he must take a narcotic med dose.

But sometimes, putting lots of extra hours between doses is really huting him alot.

His wife still has a sister there to help her with her own health problems, and the sister has kindly taken to trying to help him out a bit too. But he needs to get himself fully independent of her assistance ASAP. Then, as soon as possible, he needs to take over his normal activities, including maintaining his own home, and taking care of the health needs of his wife.


He is concerned at this point, however, because he cannot do his exercises without alot of pain. His surgery was three weeks ago, tomorrow (making this day 20).


How long can he safely take aa strong narcotic pain killer PRN?

And is it better at this point to put off the exercise for several hours to prolong time between pain pills, or would it be better to take the pain pills sooner, to get his legs in better physical shape?

(Please note that he would NEVER exceed the recommended dosage, nor increase the time interval to less than the six hour interval that the doctor was giving it to him while he was in the Rehab Unit. This question is about how he can safely REDUCE his pain med load and still get in enough exercise for his long term recovery).

Any insights you might offer him will be considered just that — personal insights. Educated opinions. NOT any formal dispensing of medical advice.



Anyway, do you have any insights that you might be able to offer a guy that is in a bit of pain right now?




Asking for a friend, of course…

 

[joannita]

FWIW, my daughter the nurse says people like this will not become addicted. Just saying

 

[naegling62]

I had to take Percocet 7.5 when I had elbow replacement surgery. If someone can't quit cigarettes they should think twice about that pain killer.

 

[phloydius]

Some people will never become addicted, while others become addicted within a week or two -- and every where in between. Everyone has different tolerances and differences in how addictive substances work on the body.

 

[ShadowMan]

ONLY as long has he has REAL PAIN!! Remember that some pain is good in that it's "SELF LIMITING"....goes back to the old adage :"Doc, it hurts when I do this." Doctor's answer: "Then don't do THAT." Better to have a little self limiting pain than to have NO PAIN at all. Then you might be taking too much of a good thing and that's when addiction gets started.

The real purpose of pain medication is to take the "SHARP EDGE" off the pain....not to float you into euphoria. That's when people get into trouble.

 

[kittyknits]

I'm so sorry for the pain. I hope you feel better real soon. Take stool softener with the laxative or when you eventually go it will feel like you are pooping rocks. Opioids are hell on this issue.

 

[TedM1911]

I had a septic joint after knee surgery. I did not walk for 9 months. I took Dilaudid daily for 9 months. When the pain stopped I quit taking them.
Unfortunately here we are 14 years later and time for a replacement on the same knee.

 

[bev]

I would suggest that your “friend” talk to the PT as well as the surgeon about this. The rehab is important for many reasons, and he wouldn’t want his rehab/recovery to take longer or even stall because he is in so much pain.

If he is in inpatient rehab, where he’s required to be in therapy for so many hours per day, he could try to time the meds based on his therapy schedule. In other words, if the med is scheduled for 10 am and therapy starts at 9, he could ask the nurse to bring it at 8 instead. Nurses are generally very accommodating, especially in a rehab setting.

I am another nurse who was taught that the chance of someone becoming addicted/dependent on opioids, who takes them for acute/surgical pain, is slim to none. That said, phloydius is correct that everyone is different.

Hope your friend feels better soon.

 

[bev]

One more suggestion - have your friend take the ibuprofen or Tylenol between doses of the narcotic. For example, take the narcotic at 8 am, take ibuprofen at noon, then another narcotic at 4, if needed. If therapy is over by 4, he may not need the narcotic.

You don’t want to let the pain get so bad that the medication takes longer to work.

The surgeon is most likely still prescribing the narcotic because he feels it’s common for his patients to still need it at this point in recovery.

 

[colonel holman]

I would suggest that your “friend” talk to the PT as well as the surgeon about this. The rehab is important for many reasons, and he wouldn’t want his rehab/recovery to take longer or even stall because he is in so much pain.

If he is in inpatient rehab, where he’s required to be in therapy for so many hours per day, he could try to time the meds based on his therapy schedule. In other words, if the med is scheduled for 10 am and therapy starts at 9, he could ask the nurse to bring it at 8 instead. Nurses are generally very accommodating, especially in a rehab setting.

I am another nurse who was taught that the chance of someone becoming addicted/dependent on opioids, who takes them for acute/surgical pain, is slim to none. That said, phloydius is correct that everyone is different.

Hope your friend feels better soon.

As a DPT, I work on TKR patients all the time. His PT exercises should not hurt like that at this stage. I would suspect either the PT (or himself) is pushing him too hard, or there is a problem within the knee. That much pain makes the exercises counterproductive… could increase stiffness and weakness as a response to the ongoing irritation.

 

[kyrsyan]

My pathway, which may or may not work for your friend. Take alternating doses of NSAIDs period. If you're chasing the pain you end up needing more meds. Every 4 hours take either ibuprofen, acetaminophen, or aspirin in rotation.

Prescription narcotics are pain killers, not anti-inflammatories. So if needed, take one after the pain sessions. Don't take another if not needed. Check for interactions with the NSAIDS, and on days when narcotics are likely to be needed, plan dosing so there is a goodly amount of time between whatever NSAID that may have an interaction with the narcotic.

Depending on where things are in healing, there is arnica and other items which may help.

And... and this is the hardest one, stop pushing past the pain to try to heal faster. In truth, all you are doing is prolonging the time it takes for you to get healed.

Hi, pot. Meet kettle.

 

[Anti-Liberal]

I just had 5 molars and 1 eye tooth cut out and the surgeon could only give me 3 days of pain meds because of DEA regulations. When I had pneumonia last year and they had to cut one of my lungs open I had a Dilaudid button when I woke up from surgery, it's the best pain reliever EVER. But they took it away too soon and sent me home with crap.

 

[Knoxville's Joker]

When I had my orthoscopic knee surgery to fix my torn ACL I had to use narcotics for a month or two. Come to find out during things I was allergic to NSAIDs as they give me heart issues. Plus allergic to sulphur, benedryl as well.

It should not hurt like he is describing so something may have gotten messed up...

 

[Josie]

This is just from my experience with a hip replacement. I got off regular use of the narcotics ASAP, but after spending a year with bone on bone, I guess my tolerance for pain is pretty high. HOWEVER, and this was suggested by an MD friend, take the pain killer if needed a half hour or so before physical therapy, so you can participate to the fullest in that therapy. (Like most people, if it hurts too badly, I don't do it!) Without said therapy, a patient will not have the best outcome. So that's what I did. Half hour before my PT session, I took the lowest dose of pain killer. I went to therapy and tolerated most the exercises pretty well with little to no discomfort. I didn't push it at home beyond what my PT recommended, and I tried to do without any pain relief beyond over the counter stuff and only if I needed that.

If you're still in excruciating pain three weeks out, you need to talk to your PT. Things should be getting a little better by now.

 

[Barry Natchitoches]

As a DPT, I work on TKR patients all the time. His PT exercises should not hurt like that at this stage. I would suspect either the PT (or himself) is pushing him too hard, or there is a problem within the knee. That much pain makes the exercises counterproductive… could increase stiffness and weakness as a response to the ongoing irritation.

He is complaining of one spot on the left knee, on the outside just below the knee joint, that is really hurting him, especially when he walks or does exercise. It is about 3 inches long and a half of an inch wide.

You have picked up on something, Colonel, that he is concerned about.

He just got out of a residential rehab center, and went to an outpatient PT late last week.

The outpatient PT said he could do some things that TKR patients cannot do until five weeks after surgery.

The guy was so impressed that he went and got TWO POUND WEIGHTS to put on his legs, rather than starting him off with one pound weights.

The guy notice the pain below that left knee immediately upon doing exercise with his left leg using the two pound weights.

It was a new pain that he did not have before the PT put the two pound weights on him.

The PT quickly removed the two pound weights when the guy complained of the left knee strain, and replaced them with one pound weights. He could handle one pound weights much better.

He never did any exercise using his right leg, until after the two pound weighhts were removed.

But now hhe has that pain in his left knee that is aggravated by walking and by exercise.



He thinks he could tolerate the pain of walking without narcotic pain relief, if that one place on his left knee did not hurt so bad.


And yeah, he has not voiced it, but he does have a bit of silent fear within him, that he might have been somewhat injured when he did the exercise using the two pound weights that he was obviously not ready for. He only did 4 before the PT saw the problem and changed to the one pound weights. There is a bit of fear within the guy that he might be suffering an acute injury due to being given to heavy of a weight, too quickly.



Interesting that you picked up on that, Colonel.


But that IS a large part of why the guy is so concerned about his use of pain killers. That one place hurts really bad, and exercise makes it hurt more.

 

[maxduty]

I was on them for over two years 10mg hydrocodone 4x a day before back surgery and quit with no problems. I had a coworker who was on the same for 3 weeks and got addicted.

 

[WalknTrot]

Just say no, Barry. Get off two weeks ago.

In pain? Do ice and DO YOUR EXCERCISES! At home. They ease the pain! Do them every time you think the pain is getting bad. Take your NSAIDS (no narcs!) as prescribed and as needed. Stagger/time them so nothing ever completely wears off.

My shoulder surgeon (did two shoulder joint replacements with this guy, had one knee with another surgeon) told me the my practice of refusing post-surg opioids and just using OTC Tylenol after joint replacements avoids a LOT of problems. That through blind studies, Tylenol has proven to be just as effective (or not effective - haha) as the standard prescribed opiates for pain relief post replacement.

Adding: Have you had a check-in appointment/visit with your surgeon? IIRC, I had one at ten days and another at about three weeks. Tell the surgeon about that particular spot.

 

[dawgofwar10]

As said above everyone has a certain tolerance to pain meds. After years of surgery I had developed an addicted personality which means I had a high tolerance to pain meds. I was at the height of my medications of taking 1200 mg.s OxyContin everyday only to wean myself down in the summer to prepare for the cold of winter. He needs his doctor to wean him down with a less addictive pain reliever like Darvocet. BTW I have been pain reliever Free for 12 years now, just living with the pain…

 

[colonel holman]

He is complaining of one spot on the left knee, on the outside just below the knee joint, that is really hurting him, especially when he walks or does exercise. It is about 3 inches long and a half of an inch wide.

You have picked up on something, Colonel, that he is concerned about.

He just got out of a residential rehab center, and went to an outpatient PT late last week.

The outpatient PT said he could do some things that TKR patients cannot do until five weeks after surgery.

The guy was so impressed that he went and got TWO POUND WEIGHTS to put on his legs, rather than starting him off with one pound weights.

The guy notice the pain below that left knee immediately upon doing exercise with his left leg using the two pound weights.

It was a new pain that he did not have before the PT put the two pound weights on him.

The PT quickly removed the two pound weights when the guy complained of the left knee strain, and replaced them with one pound weights. He could handle one pound weights much better.

He never did any exercise using his right leg, until after the two pound weighhts were removed.

But now hhe has that pain in his left knee that is aggravated by walking and by exercise.



He thinks he could tolerate the pain of walking without narcotic pain relief, if that one place on his left knee did not hurt so bad.


And yeah, he has not voiced it, but he does have a bit of silent fear within him, that he might have been somewhat injured when he did the exercise using the two pound weights that he was obviously not ready for. He only did 4 before the PT saw the problem and changed to the one pound weights. There is a bit of fear within the guy that he might be suffering an acute injury due to being given to heavy of a weight, too quickly.



Interesting that you picked up on that, Colonel.


But that IS a large part of why the guy is so concerned about his use of pain killers. That one place hurts really bad, and exercise makes it hurt more.

That fear of pain can quickly become an established nerve pattern whereby the brain quickly learns that one particular action will cause pain. The underlying injury can heal but the brain often refuses to give up that learned reflex loop. That learned pain behavior (allodynia) usually eases up once the patient is educated about that process. The difference between one pound versus two pounds is actually insignificant (more or less) since the empty unwieghted lower leg places the equivalent of 10-12 pounds across the knee, but who knows. The one thing the PT might consider is gently manipulating the “proximal tibia-fibular joint“ located pretty much where you describe. Shifts in the tiny joint just outside the knee can create nasty pain issues like described

 

[Doughboy42]

We saw with my father that narcotic pain relievers compromised his ability to cope with pain. When we finally got him weaned off the opioids, acetaminophen and ibuprofen worked and reduced his reported pain level. He had become addicted to codeine and panicked when his supply was low, even doctor shopping for prescriptions. Just relating my experience, not advising or judging.

 

[bassgirl]

In reality it depends on the person.

Most people can take narcotics sparingly on and off for one month to 6 weeks before becoming even remotely addicted. Also it has been proven that people who actually take them for pain and not the high, have an easier time of coming off them.

Now those who enjoy the high are technically addicted from the start. They will always want more.

Two knee replacements at the same time is a very brave person. But they will be glad they got it over with.

Tell him to take the meds about one hour before therapy and alternate them like he has been doing, Maybe take one at bedtime so he can sleep. But take it with Ibuprofen, if it has Tylenol in it, which most do these days. However, I stress again everyone is different.

As long as he is not knocking down two pills every four hours around the clock for 30 days then he/she should be fine.

It's okay to be a one pill every 4 hours kind of guy, vs 4 pills every two hours like of guy.

 

[bassgirl]

As said above everyone has a certain tolerance to pain meds. After years of surgery I had developed an addicted personality which means I had a high tolerance to pain meds. I was at the height of my medications of taking 1200 mg.s OxyContin everyday only to wean myself down in the summer to prepare for the cold of winter. He needs his doctor to wean him down with a less addictive pain reliever like Darvocet. BTW I have been pain reliever Free for 12 years now, just living with the pain…

They do not make Darvocet any more. I think he lowest dose you can get is hydrocodone 5 mg.

Maybe 2.5 mg cough syrup.

 

[Milkweed Host]

Speaking of pain relievers, I broke some bones this past April in an accident.
I started out with Fentanyl injections, then morphine, then onto hydromorphone.
I was on pain killers for a month. I could have had more of that stuff, but that got
really old. My only issue is sleeping regular hours now.

Anyway, I felt no need to go back on that stuff.

 

[naegling62]

In my rehab the 1lbs weight was pink. Those bastards were using psywar on me.

 

[TedM1911]

Two knee replacements at the same time is a very brave person. But they will be glad they got it over with

I am doing just this later this month. Am done with the bone on bone.

 

[Barry Natchitoches]

Two knee replacements at the same time is a very brave person. But they will be glad they got it over with

I am doing just this later this month. Am done with the bone on bone.

The quality and experience of your surgeon - specifically when it comes to double knee replacement - makes all the difference.

I researched my surgeon extensively before I ever applied to be his patient.

In fact, I travel over 200 miles one way to see my surgeon, because he is so far superior to the best that my local Memphis area has to offer. He is on the faculty at Vanderbilt Medical School, works with Smith and Nephew in designing prostetic knees, and is one of only a few doctors in the state who regularly does “re-do’s” for other doctors, when they have a patient whose first knee replacement fails.


All this guy does is treat arthritic knees, hips and shoulders. But the good thing about him is that he will not push you into the operating room.

He waited seven years after my xrays proved I was bone on bone, and could easily qualify for surgery - because I did not want to do surgery yet. He supported me with occasional prescriptions for PT, plus rooster shots, plus braces to wear when I ran races. All the while, he was patiently waiting for the moment when I would tell him I was finally ready for surgery.

Double knee replacement is far more difficult than replacing only one knee at a time.

I pray your surgeon is as up to the task as mine was.

It makes that much difference.

 

[Dennis Olson]

Since I don’t know what PRN means, I can’t answer you. However, depending on the dose, one can take them a very long time as long as one doesn't take more than the recommended dose, or more often than the recommended frequency. But one will get physically dependent on the med, and go through withdrawals when trying to quit.

 

[colonel holman]

PRN… take as needed

 

[Dennis Olson]

Ah. I’d advise not more often than every 8 hours, or 1 pill 3x a day.

 

[Knoxville's Joker]

Since I don’t know what PRN means, I can’t answer you. However, depending on the dose, one can take them a very long time as long as one doesn't take more than the recommended dose, or more often than the recommended frequency. But one will get physically dependent on the med, and go through withdrawals when trying to quit.

PRN basically means as needed short for Periodic RN I think...

 

[Reasonable Rascal]

As has already been pointed out - but bears repeating - experiences differ. One PA once described a drug-seeking patient to me as "she got a taste of (Demerol) and decided she liked it." Years later all you could do was manage the addiction because there was no concerted effort to get her off of it. Lots more to the story but you get the picture.

Other folks like me - to use a concrete example - are opioid resistant. Unless I try very large doses - I can only imagine well beyond what I have ever had in my life - there is no euphoria, etc. They also have less of an effect at normal dosing. I tend to either stretch things a bit as far as a valid need for pain management peds, or get by with a couple doses and done. My shoulder repair last June was an example of that, and they did everything short of full replacement. A few Vicodin and done. The latest knee? I could only wish.

The resistance is a genetic thing. Some of us lack the usual number of opioid receptors in our brain, estimated at 10% of the population. My family has several members who share the trait, though. Easy addicts on the other hand may have more than typical, though I have never seen any studies regards that. On the other hand I am overly sensitive to NSAIDs (another genetic trait) taken over time. A very few people can be knocked right into kidney failure by a single dose, while others like me need very much to avoid regular use or chronic failure will ensue. Been there done that have the lab reports to prove it.

As far as Tylenol being equal to a narcotic, it isn't. Period. End of discussion. What HAS been shown to be approximately equal is a combination of Tylenol and Ibuprofen. IIRC the military showed that 1,000 mg of Acetaminophen (Tylenol) and 800 mg of Iburpofen taken together can have as much pain relieving effect as a 5 mg Hydrocodone (Vicodin, Norco, etc) without any narcotic side effects. Note this is in combination, not alternating.

Rather than worry about the meds and addiction I would worry more about what is causing the new pain and see the doc and let him know something has chanced. Might be time for an MRI if the PT can't determine what has likely happened. As the Col. pointed out, 2 lbs. vs. 1 lb isn't that significant overall but it *could* have been just enough to tear something lose that was already hanging by a thread so to speak.

RR

 

[dawgofwar10]

Since I don’t know what PRN means, I can’t answer you. However, depending on the dose, one can take then a very long time as long as one doesn't take more than the recommended dose, or more often than the recommended frequency. But one will get physically dependent on the med, and go through withdrawals when trying to quit.

Nothing worse then going thru withdrawal, been there and done many many times. First one is the easiest, last three days.. no sleep because of what I call crazy legs. Now add another three days to each additional withdrawal, it sucks even worst and the restless leg syndrome would make you go mad. Finally found a great pain mgmt doctor, put me on buprenorphine for the Narcotics, clonidine patch’s for heart rate and Ropinirole for what I called Crazy Legs. Ask me how I Know??

 

[Reasonable Rascal]

PRN basically means as needed short for Periodic RN I think...

Pro re nata, Latin for 'as needed.' Dates back to the days when Latin was still a required subject in nursing school becaus ethere were a lot of Latin terms used. Nowadays people just use the abbreviations without understanding the origination. NPO, for instance, means 'nils per os' or nothing by mouth.

RR

 

[TedM1911]

The quality and experience of your surgeon - specifically when it comes to double knee replacement - makes all the difference.

I researched my surgeon extensively before I ever applied to be his patient.

In fact, I travel over 200 miles one way to see my surgeon, because he is so far superior to the best that my local Memphis area has to offer. He is on the faculty at Vanderbilt Medical School, works with Smith and Nephew in designing prostetic knees, and is one of only a few doctors in the state who regularly does “re-do’s” for other doctors, when they have a patient whose first knee replacement fails.


All this guy does is treat arthritic knees, hips and shoulders. But the good thing about him is that he will not push you into the operating room.

He waited seven years after my xrays proved I was bone on bone, and could easily qualify for surgery - because I did not want to do surgery yet. He supported me with occasional prescriptions for PT, plus rooster shots, plus braces to wear when I ran races. All the while, he was patiently waiting for the moment when I would tell him I was finally ready for surgery.

Double knee replacement is far more difficult than replacing only one knee at a time.

I pray your surgeon is as up to the task as mine was.

It makes that much difference.

This surgeon is excellent. 4.8 reviews and I have 2 friends who used him as recently as this year. They loved him as a provider.

 

[Meemur]

Offering prayers for relief from the pain and rapid healing!

 

[WFK]

As a DPT, I work on TKR patients all the time. His PT exercises should not hurt like that at this stage. I would suspect either the PT (or himself) is pushing him too hard, or there is a problem within the knee. That much pain makes the exercises counterproductive… could increase stiffness and weakness as a response to the ongoing irritation.

^^^^
THIS! Have gone through that and have seen therapists torture patients by pushing them beyond the pain threshold.
Fortunately my own therapist did not do that and my outcome was very good without such pain during recovery.

 

[Kathy in FL]

Timing is everything. When they changed the bandage on the wound vac and/or wound alone my nurse said to take whatever level pain med that I needed approx half an hour before she got there. It didn't stop the pain, but it took the sharp edge off. Eventually I didn't need any hydrocodone (by law I could only be prescribed 10 at a time). I stabilized at half a pill once a day immediately prior to the wound change. From there I was able to only take Tylenol but I am still not to take anything else because of the blood thinning properties.

Yes, I still have a nurse once a week and all other times my husband, with my daughter an occasional stand in. But she nearly gakked last time as the wound still can be "messy" though the silver embedded felt that I use now on the wound is drying it up ... which can cause bleeding if they don't spray it before trying to remove it.

It is called "pain management" for a reason. Don't look for "pain relief" so much as managing your pain level. Now I am having a side effect from the diabetic meds (Levemir and Glyburide) which is causing bone and joint pain and backache from hell. It is approaching the point that I'm going to have to have a medication change because two hours of sleep a night is insufficient to my sanity.

What I'm trying to say, and perhaps poorly, is that everyone is different. You will need to find the timing and the med that works best for you. If you are truly in pain, you won't become addicted as your body is using it different. You pain receptors are being addressed rather than just your mental pathways being stroked. I may not have explained that very well but it is the best I was able to come up with as far as the gobbledy gook my doctor was telling me when I voiced the same concerns as your friend.

 

[dvo]

Been through a couple joint surgeries. Neither doctor would give more than three days opiate meds. I would have done more. longer pain than that indicates a problem. Get it checked out.

 

[Kennori]

Pharmaco-genetics are in play with any narcotic. For instance Arabs taking Codeine can OD because they metabolize opioids differently and it becomes Morphine in their bodies. If you have a substance use disorder with drugs, alcohol, even OTC meds you will be prone to abuse and addiction with any narcotic. Practitioners realized this a few years ago and stopped giving post-op patients 60 tablets of Oxycodone with 2 refills. This was a disaster for everyone and a lot of addicts were created. Once the Oxy stopped they went downtown for Heroin and now Fentanyl for relief. There is a role for post-op opioid use to alleviate the pain of the operation and then physical therapy. Adjuvant therapies should be used as soon as possible. Like someone pointed out ice packs, Tylenol, vibration, heated massage, and even guided imagery can be helpful. We are all different and what works for me may not help you. Be wary of the opioids but use them judiciously for immediate post-op pain and the first day or 2 of PT. Then go for the NSAID's and adjuvants.

 

[Telyn]

Rant: God gave us poppies. Pain meds at the pharmacy should be available to shoppers without a prescription, in measured doses, without resorting to street drugs made in shady manufacturing venues. Staying "on top" of pain after surgery shouldn't require begging a doctor, not being able to cross state lines to get your medicine if you opted to choose the best surgeon who happens to be in a different state, and other hoops to jump over. When laudanum was freely available at chemist's in the 1800s and 1900's our ancestors didn't turn into addicts. I've had my fair share of surgeries. My prescribed in hospital pain meds for back surgery were taken away by a Muslim doc on call, when my surgical team spent the day away, rebuilding a child's body, pure torture. (when the surgeon and his team returned, they stayed with me until the morphine drink they immediately ordered began to work). I used to follow a website named Bonesmart, there was lots of good advice on hip and knee replacement recovery, I haven't viewed it for some years. IMO requesting pain relief should not make you be labeled a drug seeker. This is a campaign issue. As a senior I never wanted to affect my brain power for years with drugs, but in my seventh decade, proper pain management means one can be a functioning citizen.