Cultural differences on the part of both physicians and their patients by region and by country are of great interest to me. It turns out that the British patients may be a little more stoic regarding pain than Americans or, alternatively, their treating physicians regard them as such (see: No painkillers please, we're British). Here are the details:
In Britain, the popular U.S. painkiller OxyContin is considered similar to morphine and used sparingly. Vicodin isn't even licensed. And at most shops, remedies like ibuprofen are sold only in 16-pill packs. To avoid risks including addiction, strong painkillers are often kept at arm's length from patients — even if that means some people will be left suffering. Many British doctors say the country has a more conservative approach to doling out painkillers than in the U.S., where overdose deaths from powerful drugs including OxyContin and Vicodin, tripled over a decade, according to a government report there earlier this month....Prescriptions for opioid drugs must be written on a special pink pad — and even those from private doctors get cross-referenced with the country's national health service so that patients' primary doctors know what their patients are getting from others. [A physician] also said British doctors may be less inclined to automatically do what their patients want. "In the U.S., doctors might wish to please their patients and prescribe them something because they're clients," he said. "But in the U.K., the patient doesn't pay the doctor directly so I can choose not to prescribe painkillers without the fear of suffering financially myself."....[Kyle] Hultgren, [managing director of the Center for Medication Safety Advancement at Purdue University,] said aggressive pharmaceutical advertising puts more pressure on American doctors. "Patients sometimes openly ask for medications because they've seen them advertised," he said. "Physicians need to be very disciplined and explain to patients why a certain medication may not be right for them."
Distilling all of this information, I think that, for me, the key factors highlighted in this article are the following: (1) U.S. doctors are more anxious to please their patients; (2) U.S. patients are more inclined to push back on physician advice and may tend to be more knowledgeable about drugs; and (3) British physicians are more conservative across the board about writing analgesic prescriptions. Understanding that these drugs are highly subject to misuse, I come down on the side of making the patient as comfortable as possible. However, this can lead to problems. I have a number of friends who have been supplied with too generous a supply of OxyContin or Vicodin by their surgeon after surgical procedures. They tend not to consume all of the pills supplied at discharge and then don't know how to get rid of the excess. There is no place to return them and, appropriately, they can't flush the pills away. So they sit in a drawer.