I consulted an ENT doctor for a painful swelling of the ear canal. The pain increased over night considerably, and even more between the time I got up and the mid-afternoon ENT appointment. Eating was almost out of the question as the pain with each chew was so strong.

After examination and explanation of treatment, she mentioned providing me with a pain killer. I explained my belief and concern that Thai patients are more sensitive to pain killers and that we farang seem to need a more potent dosage to actually cover up pain. I specifically asked for a STRONG pain killer.

She nodded understandably and said she would give me something strong: 120 Mg Arcoxia, taken once daily.

Well, I took the first one a little over two hours ago, and the pain amelioration is *minor.* It's a *little* better, but eating is still daunting due to the pain.

In my mind analgesic pain killers should cover up the pain, just not ratchet down the level from 8 to level 7 on a medieval torture scale. For the medical professionals here, what's your take on that? Should a patient be able to be medicated sufficiently so they no longer notice a pain such as from a swollen ear canal, or is it adequate to just take the edge of the pain, leaving the patient to still agonize in pain? I'm not talking a morphine drip, but surely with adequate warnings about not driving, etc, a substantial dose of codeine or something similar?

She predicted that my swelling should be substantially reduced by tomorrow, and if not by tomorrow then the next day, and with it the pain. Why not let me sleep in peace tonight?

I don't think Arcoxia is really a painkiller- I think it is an anti-inflammatory (anti-swelling) agent that is to reduce the swelling that may be causing the pain.

Googling "arcoxia" and eliminating the more technical, chemical documents, I find such things as:

"Arcoxia is used for the following:

relief of acute pain"

"It is mainly used in relieving pain and other symptoms of inflammatory diseases as it acts on certain enzymes that play an important role in inflammatory diseases."

Even the prescription plastic bag label I got says: "For pain (Anti-inflammatory-take after meal immediately)"

It seems like it is (supposedly) anti-imflammatory and pain killing?

I got five of them. It's *tempting* to increase the dosage, as the doctor indicated the pain should be more manageable by tomorrow, or the day after...

It is both an analgesic and an anti-inflammatory, it achieves it's analgesic effect both by reducing inflammation and by blocking the action of some of the chemicals involved in transmitting pain signals. It is not as effective as opiates are in relieving severe pain.

You are already at a maximum dosage. Don't increase it, not safe. In fact, can cause serious kidney and liver damage...not to mention tearing up the lining of your stomach and quite possibly causing a GI bleed.

If the pain has not improved within 24-48 hours, go back to the doctor as something is wrong.

In answer to your original question, I think most docs in the West would have been comfortable giving you a 1-2 doses of an opiate to get you through the night pain free, but that is just not the practice in Thailand. Unless you have just had surgery or have terminal cancer, they virtually never provide opiates.

Thanks, Sheryl, for the stern warning about dosage! When under stress it's sometimes hard to discipline oneself, but in this case, I'll heed your warning.

I do have a follow-up appointment tomorrow afternoon to have the cotton in my ear replaced, so depending on the pain level, there may be a discussion. My treating physician today is off tomorrow, so I might find a more sympathetic pair of ears. I *am* hoping, of course, that the swelling (and hence the pain) will have abated a bit by tomorrow.

I would also add, if the pain does not improve get yourself to Emergency at the local hospital. May be a bit late for OP but an option for any one else in the future.