Comment by vanderZwan
7 hours ago
I feel like this is one of those things where Europe and the US are very different, culturally speaking - I've lived in the Netherlands, Germany and now Sweden, and the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
You're forgetting that when you're sick and hurt yourself in the US you very likely still have to go to work. Doing some quick research, roughly 25% of the US workers don't have any sick time whatsoever, so you gotta take some painkillers and get back to work. If you need to take time off to go to the doctor, you're no longer getting paid, so...a lot of people don't do that and instead hide the pain with painkillers.
Harder, faster, stronger, smarter
Reckon you've just summed up the US health care system to a tee.
Well for one thing, in America, you gotta get back to work.
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
Yeah I think this is the biggest difference. Here in Sweden if I get a headache that's bad enough I'll just take a sick day and there's not really much social stigma about that kind of behaviour unless it becomes a pattern that you don't seek medical help for.
I work in an office, but Swedish law protects blue- and white-collared jobs the same in this regard.
I've taken so much Advil/Ibuprofen in my life it would be impossible to count at this point.
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
Have you tried to have this diagnosed?
I have. Never really got anywhere.
Since none of them are actual migraines, most advice was the standard: drink more water, get enough sleep, are you stressed at work, etc.
I won't move back to my hometown because of it and it hasn't been as much of a problem. My grandmother said that I had a distant cousin who would get sick whenever he came to our hometown from Chicago as well. Said that his doctor thought it might have to do with the swampy air around the area. Pee Dee region of South Carolina, where Francis "Swamp Fox" Marion operated during the Revolutionary War.
This is talking about ibuprofen and acetaminophen, not prescription drugs. Also controlling inflamation and swelling is a very important part of an injury recovery plan; it's not all about Americans complaining about pain.
It is a cultural difference.
> In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.
So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.
> That's also healthier in the long run, no?
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
You rediscovered normal saline!
The plain water hurts because it's causing cells to swell or even burst as water rushes into them to equalize the osmotic pressure. Adding a little bit of salt to that helps remove that pressure because the environment inside and outside of the cells are both equally salt.
Maybe you took carprofen?
I don't think carprofen has been sold for human use in ages! Still available as a veterinary medicine though.
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As the more potent diclophenac? Might have been what was prescribed, I genuinely can't recall. I do know I didn't take it though ;)
AIUI one of the many quirks of the US health insurance system is that a lot of people have only minimal cover which doesn't include things like physiotherapy and rehabilitation treatment. That means that they often can't treat a painful condition at source so their only option is to mask the pain with painkillers.
It's worse than that - there is also no job protection. Hurt yourself and miss a few days of work and you are possibly unemployed on top of injured. And then you lose your health insurance, so you can no longer get/afford any treatment.
I'm convinced it's designed this way on purpose. Can't have people relaxing, ever. Must extract every ounce of productivity and blood while they're alive.
Yes, it's the combined outcome of both of those "features." Many Americans don't have access to healthcare and/or can't afford it even if they have access, AND they are not allowed to stop work to take care of their bodies, it's just a steady stream of painkillers to keep you numb and working until you retire or die.
This is so absurd to me. The expression "prevention is better than cure" isn't just folk wisdom, in just about any country with nationalized healthcare the studies also confirm that this costs less money. The only exception I ever heard was a Dutch study in the 2000s suggesting that people growing older due to smoking less was going to increase healthcare costs, because people were getting older putting pressure on the pension system, but let's not peer further into that can of worms.
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
Nationalized healthcare systems can reap the longterm savings from preventive care. I have had 4 different for profit insurance companies over the last 5 years because of job changes, my employer switching insurance providers and retirement. Such frequent changing of health insurance providers means that there is no guarantee that any insurance company will reap the benefit of providing me with better preventative care than required by law.
> unless they have ways to externalize the costs onto the rest of society
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
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Since we're talking about acetaminophen and ibuprofen, in France you're liable to end up with a medicine cabinet full of acetaminophen, because almost anytime you go to the doctor with any type of pain, they add it to the prescription.
Interesting, in the US they often do that too but I’ve personally never filled it because insurance doesn’t cover over the counter medications. So I’d have to pay cash for it.
I don't do it in France only because I don't need it. It won't cost me anything otherwise.
(It is worthwhile to note, because Americans don't realize this, but not all medicines that a doctor prescribes for you is free, although the overwhelming majority will be.)
You can sometimes get a prescription for a different form or different dosage than what's available OTC. These are most commonly administered in hospitals (and insurance will cover it there), when you're at home it's usually equal or cheaper to just buy the OTC version.
Does acetaminophen require a prescription in France?
No but you can get it for free with a prescription.
>Pain a warning signal from the body
Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.
> Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
Heat hot enough to kill diseases will have killed you long before. Fevers are really a pretty small temperature rise.
It does appear that fevers are an adaptive defense, but FWIW there's been basically no evidence that not taking medicine to bring down a fever will improve outcomes in practice. OTOH, evidence also shows that typical fevers won't themselves hurt you either, so they don't necessarily have to be treated.
Current medical guidance in kids and (non-pregnant) adults is to treat discomfort, usually the associated muscle aches, body chills, etc, but in general we shouldn't encourage people to suffer for no benefit. The fever isn't cleaning you out.
> the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Americans' relationship with painkillers is absolutely unhinged.
Might just be an artifact of the broken healthcare system. Painkillers are cheap and over the-counter. Going to a doctor is not.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work.
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
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Here in EU, in order to take official sick days, i would have visit doctor to get confirmation document. Which means that for simple cases i would rather take unofficial sick days (sometimes provided by employer, like in US) or just leave.
Well, yeah, but they do help. I had a bad case of bronchitis recently and the only way I was able to get to sleep was taking OTC ibuprofen.
If pain is a signal, then it's often a car alarm that won't shut up. Even if someone is actually trying to steal the car, I only need to be told once.
Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?
It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.
I feel better avoiding the causes of making me grumpy, I end up feeling less tired at the end of the day.
Of course, but once it happens, why not do what you can to mitigate it?
> home-made oral rehydration solution
water?
EDIT: I see it's a thing. Salt, water and sugar.
Apologies, I could have clarified that (then again my comment already was a wall of text).
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
However, that is in the context of oral rehydration therapy:
glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
The reason for doubling the amount of sugar is that the active absorption of water relies on glucose, while regular sugar is made out of sucrose. Sucrose breaks down into equal parts fructose and glucose (both have identical chemical formulas but a different arrangement of the atoms).
[0] https://en.wikipedia.org/wiki/Oral_rehydration_therapy
[1] https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote...
[2] https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1 page 12 of the linked on that page (labeled as page 3)
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
None of this is in disagreement with my argument and comes across as actively ignoring the part where I explain that I am not advocating to "walk it off".
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
Perdue Pharma/The Sacklers went on a huge campaign in the 90s convincing doctors and the general public that pain was bad and worth stopping at any cost and even though they were pushing opioids, I can imagine this also increased the cultural tendency to use NSAIDs as well.
Right, Purdue Pharma—the sleasebag Sacklers—were unethically pushing OxyContin (oxycodone) but the unethical tactics that Merck adopted in marketing its NSAID Vioxx seems to have been forgotten. Vioxx was withdrawn from the market and Merck paid out billions in law suits.
As I've mentioned elsewhere, the Vioxx scandal is every bit as big as the Purdue one. Check this Wiki (lawsuits): https://en.wikipedia.org/wiki/Rofecoxib
If you've time watch this YouTube video on Merck and the Vioxx scam (if you weren't aware of the facts you'd think you were in Palermo/Mafia territory): https://m.youtube.com/watch?v=K0GrFnOpJoU
I agree that Purdue Pharma was probably the most significant factor, maybe enhanced by the relative ease of granular lobbying of private doctors as compared to the challenges it may face in universal healthcare systems. However, I do suspect that the limited rights of most US workers to take sick leave served as one more cultural advantage in favour of Purdue's campaign.
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
Weren't the Perdue Pharma products sold in combination with Acetaminophen?
My assumption was this was always required to get regulatory approval to make abuse have harsher side effects. Liver toxicity of acetaminophen is pretty bad compared opioid abuse from what I understand
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
Sure, but how good are you at judging if a human mind is irrational or not without engaging in conversation with it? Why not extend that logic to your body.
All human minds are irrational, including mine. And yours.
> It's no more rational than the human mind
Neither is a car, but I still take it to get checked out when a warning light is on.
> Neither is a car, but I still take it to get checked out when a warning light is on.
I can't believe I need to say this, but cars did not evolve by natural selection. Cars are intelligently designed (by humans, not by God) to show a warning light when there is a problem you should get checked out. So cars are actually rational in that respect.
Hacker News comments never fail to depress me.
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Especially if a new one, pain is undoubtedly a 'warning signal from the body' which is a succinct metaphor we all understand and has a clear meaning. If you don't know why or from whence the pain, check it out. It may be one of those things or perhaps not.
The previous commenter appears to argue that you need to diagnose every headache, which sounds absurd to me.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
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