Ha Ha, I don't really need more than one or two needles but they weigh absolutely nothing on my gram scale so they get to stay for various reasons. We do a lot of bushwhacking and both catclaw acacia and slot canyons are hard on clothing and gear so not a bad idea. I tend to look back over the years and decide on what I take by what I have needed.
as for pain meds, haven't taken any for decades at home or during trips so why have them?
It is just a personal light weight kit that covers any of my needs without going overboard with what might happen...
I don't know what mine weighs but it's pretty simple. Emergency blanket, 1 roll medical tape, 5 small strip band aids, 5 medium strip band aids, 3 4x4 gauze, small vial super glue, ibuprofen.
Ironically I used to carry a lot more in a first aid kit until getting on the street as a firefighter. Most issues can be fixed with some gauze, water, and medical tape/coban. If it requires more than that your hiking trip is most certainly over and you've got bigger issues. Hopefully qualified help is on the way or else your likely screwed.
Like anything else it boils down to packing for what's likely and packing for your fears. If I packed for "what ifs" I'd have at least a 20 lb med kit with Sam splints, coban, gauze, airways, bvm etc... But we all know the likelihood of having to ventilate someone on the trail is practically zilch.
After doing the research and realizing how dangerous falling was in the backcountry, and then watching helplessly as a passing hiker pulled ankle wrap out of his first aid kit when my wife broke her ankle in New Zealand, I now carry ankle wrap.
I now always carry a CAT Tourniquet. If someone's bleeding out, instead of using direct pressure I will toss a Tourniquet first and then start treating the wound. Since it slows the bleeding its easier to treat the wound. I have three hours to get someone or myself to help before it has to come off. I still carry Quickclot or Celox as its low volume but the Tourniquet im going to link is very easy to use and effective.