Posts Tagged Pain

Those Nortriptyline Blehs

Nortriptyline, according to Wikipedia,

is a second-generation tricyclic antidepressant (TCA) marketed as the hydrochloride salt under the trade names SensovalAventyl,PamelorNorpressAllegronNoritren and Nortrilen. It is used in the treatment of major depression and childhood nocturnal enuresis (bedwetting). In addition, it is sometimes used for chronic illnesses such as chronic fatigue syndromechronic pain and migraine, and labile affect in some neurological conditions.

A few weeks ago I had a fall (when it comes to falling down, I’m a Viking) which exacerbated an old injury from another fall — bottom line, was in a considerable amount of pain, and what was worse I couldn’t sleep becuase of the pain. So after about a week of sleeplessness and overdosing on AC & C, I finally gave up and went to  my GP. She prescribed some wicked bad-ass anti-inflammatories, and she also suggested I try nortriptyline. Besides being a rather dated anti-depressant, nortriptyline has some pretty nifty pain-control properties as well as the ability of  inducing sweet, restful sleep.

And, I must report, it worked amazingly well for the last couple of weeks. I’ve been sleeping like the dead, the pain is far, far better now, and I can function normally — sort of. Aside from a dry mouth, I’ve had no physical side effects at all.

Take two of these, and your ability to snark will vanish

But there’s this: nortriptyline, as I mentioned, is an antidepressant and mood stabilizer, and I guess I would describe my mood over the last week or so as tranquil, sedate, calm, unstressed, cool, placid, and serene to the point of having to check my pulse for a heart rate. Part of this new found attitude of repose is being completely demotivated to do anything creative at all, including any writing. For the last two weeks I have opened up the blog utility, fooled around a little, and after a half-hour, said, “Meh,” and went back to playing Words with Friends.

It’s plainly obvious, at least for me, having some emotional friction and turbulence feeds the creative daemon. It prods me to write, and I would guess this is true for most people who think of themselves as creative. So an interesting question: at what point would you sacrifice creativity for pain control — or relief of any condition, especially if it’s central to who you are as a human being? And on a larger scale, if everyone is medicated (it seems) for everything, what is it doing to culture as a whole?

Fortunately for me, I’ve finished the nortriptyline. It was a temporary thing. We now, as they say, return to our regularly scheduled moodiness. But here’s the thing: when I was on the drug, not only was I completely uninterested in writing, I didn’t care whether I was writing or not. The fact I could throw over something which I’ve done daily (in one way or another, even if I have written a couple of lines) for nearly three years is remarkable.


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Observations and Assessments

Notions to small for a blog post, all in one place.

You need to take your pain medication. Once upon a time, TorontoEmerg had some fairly significant surgery on a major joint. It was (theoretically) exceeding painful, but fortunately TorontoEmerg’s orthopod was very generous in supplying TorontoEmerg with Percocets and Tylenol 3s, and thusly TorontoEmerge experienced very little pain. Even when going to (really) painful physio, TorontoEmerg was kept more-or-less comfortable and at the end had a full recovery —- all because of adequate pain control.

TorontoEmerg was an RN, and knew how to take pain medication effectively.

So when five patients show up at Triage in one with poor pain control post operatively, even with adequate analgesia prescribed, TorontoEmerg begins to think some surgical nurses know squat about pain control and/or failing to teach adequately about analgesia when discharging patients. It isn’t about throwing a script for some opioid at patients and telling them to take the med “when the pain is really bad.” Is there is some deficit in our training which makes us reluctant to counsel patients on pain control?

You need to take your stool softener. Same topic. Different angle. I had several patients come to Triage yesterday for constipation related to opiate use post-operatively. None of them had any instructions about preventing or addressing what to do about the (inevitable) constipation. Again, why are we screwing up our discharge instructions?

Myth of the Queen Bee. Some research probably pertinent to nurses aspiring to leadership positions.

Drop Me a Postcard. This is kind of cool: internet postcards you can drag and drop to email, Facebook/Twitter messages, which pose some pertinent, challenging, difficult questions. From

How to deal with difficult colleagues. It seems too simple.

“Please do not let them breed.” Yep.

Size does matter. I thought this story was interesting because it exemplifies the anti-science, anti-intellectual climate we seem to be labouring under. Shorter version: right-wing web sites excoriate supposedly taxpayer-funded study of penis size and gay men’s health as trivial and frivolous, except, as it turns out, the study was not directly funded by the U.S. government and there is in fact an important correlation between sexual health and penis size, which in turn has implications for reducing HIV transmission.

Speaking of bad foodDeep fried butter. Really. Move over cheeseburger-on-a-glazed-doughnut. As Sean says, I’m speechless.

Dumb road signs



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