Challenges of Treating Chronic Pain in People with Opioid Dependence

As headlines about opioids focus on misuse of the drugs, physicians who treat patients with chronic pain are grappling with how to deal with opioid dependence. At the recent American Psychiatric Association meeting, pain specialists said that treating patients in pain who are dependent on opioids involves a delicate balance between managing pain relief and risk of drug abuse.

“One of the challenges is that we don’t have good estimates of how common it is for chronic pain patients to develop problematic opioid use” says Jennifer Potter, PhD, MPH, in the Department of Psychiatry at the University of Texas Health Science Center in San Antonio. “The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse to be denying access to all people in pain who can benefit from opioids. We need to build our understanding so we can manage our risk of drug abuse effectively.”

Rates for co-existing chronic pain and opioid addiction vary depending on where you look, Dr. Potter says. “For patients in a pain clinic, addiction rates are relatively low, but in a methadone or buprenorphine population, between 34 to 40 percent will have a chronic pain complaint,” she says.

A doctor treating a person for pain needs to look for potential risk factors for substance abuse, such as a personal or family history of other types of substance abuse or psychiatric disorders, Dr. Potter says. “If a person has one of these risk factors, they shouldn’t automatically be denied opioids, but they should be informed of the risk of dependence and be monitored for potential abuse.”

For some people with chronic pain, medication isn’t always the answer, says Dr. Potter, who is studying the treatment of opioid dependence and chronic pain through a grant from the National Institute on Drug Abuse. “There’s a false assumption that giving medicine makes pain go away, but in chronic situations that doesn’t always work,” she says. “Many people only get some reduction in pain.”

Non-Opioid Pain Treatments

Patients with substance abuse issues can be treated for pain in a variety of ways that don’t involve opioids, says Sean Mackey, MD, PhD, Chief of the Pain Management Division at Stanford University and Associate Professor of Anesthesia and Pain Management. “A multidisciplinary approach is needed to treat patients in pain who have substance abuse issues,” he says.

There are non-opioid drugs such as anti-epileptic drugs, antidepressants and anti-arrthythmic drugs, which can be effective in treating pain, Dr. Mackey says.

Patients can also be treated with psychological therapies, as well as physical and occupational therapy, he says. Many patients, however, do not receive a multidisciplinary approach to treating chronic pain because it generally requires the resources of an academic medical center. “Doctors who are treating patients without these resources need to collaborate with others who have the knowledge they don’t, either in addiction medicine or pain medicine,” Dr. Mackey advises.

If a doctor weighs all the options and determines that opioid treatment will work best for an opioid-dependent patient in pain, buprenorphine or methadone may be good options, he says. “Buprenorphine and methadone have strong analgesic benefits, and we commonly use them in this situation,” he says.

For a patient using methadone, one approach is to use a “blinded pain cocktail” in which methadone is ground up and mixed in with baclofen as a binding agent, with cherry syrup as a base. “We tell the patient what’s in it, but not how much,” Dr. Mackey says. “We closely track their quality of life measurements, and we can go up or down on the methadone accordingly. If we have a patient with clear control issues we only give out small doses at a time, or we hand it over to a trusted family member.” Mackey does acknowledge that the use of this tool is time and staff intensive and may be more than a small community practice can handle.

When treating patients with both chronic pain and a substance abuse disorder, Dr. Mackey advises making sure that they are receiving psychological counseling, either in a group or individually. “Many treatments we use in substance abuse overlap with chronic pain treatment—the psychological and behavioral skills are the same,” he says.

He also suggests an opioid contract for some patients, which establishes an understanding between patient and doctor that the patient will only receive opioids from that doctor, and from only one pharmacy. The patient may be asked to submit to urine drug screening, and is told that if their medication is lost it will not be replaced, and stolen medication will only be replaced if the person brings a police report.

“While even the most careful clinical pain management cannot eliminate risk of opioid misuse in patients with a history of addiction, good communication, knowledge of non-opioid treatment alternatives and appropriate monitoring and care in structuring opioid management can reduce risk significantly,” Dr. Mackey says.

48 Responses to Challenges of Treating Chronic Pain in People with Opioid Dependence

  1. Valli Genevieve | June 24, 2011 at 2:07 pm

    I am curious about Dr. Potter’s statement on Opiate addiction. She says: “One of the challenges is that we don’t have good estimates of how common it is for chronic pain patients to develop problematic opioid use” but then she goes on to say the “vast majority of people with chronic pain do not go on to develop an opioid addiction.” How do you know? People seeking treatment for opiate addiction has exploded over the last decade, in Maine, going from 28 people per 100,000 to 338 people per 100,000. Most physicians use the 2009 AAPM/APS guidelines for prescribing but a close reading of those guidelines reveals that 16 out of the 21 experts are on the payroll one or more pharmacy company and their own guidelines, they rate as having very low evidence. So we are blithely prescribing highly addictive substances that can destroy whole communities based on little evidence and put forth by experts whose recommendations are tainted.

    There is no evidence that people with non-cancer chronic pain can be safely and effectively treated with opiates over the long run. We have medically induced epidemic on our hands – we need to rethink our approach.

    • jerome ennis | June 24, 2011 at 2:53 pm

      Great and accurate comments Valli Genevieve. All too many decisions to prescribe drugs is dependent on whether or not the prescribing individual has a vested interest as in, Stocks In Said Pharmaceutical Company. Ritalin is one of the most highly prescribed drugs on the market and is also a drug that is prescribed, in about 90 percent of the cases, where there is no evidence that it should be prescribed, and this is especially true in the incidence of this deadly drug being prescribed to children. The prescription rates on all pharmaceutical drugs are way up and I hate to be the one to say it, but I honestly do believe that doctors over-medicate and over-prescribe drugs, especially addictive drugs. Thanks, M. Jerome Ennis, MA/Addiction Therapist

    • Bill Lapadat | June 24, 2011 at 6:26 pm

      @ Valli Genevieve…
      Have you ever lived with chronic pain? I’m not talking about a creaky, arthritic knee. I’m talking about “can’t walk without the Fentanyl patch.” Or, had your second-grade daughter say to you, “Daddy, don’t use the cane today” as you walk them into school after their dental check-up?

      • jmurcko | January 25, 2013 at 9:32 pm

        your message made my day!! Someone actually gets me and what i’m going through..god bless

    • Diana | March 25, 2013 at 7:46 pm

      There is as much, if not more, evidence that patients with chronic non-malignant pain can be treated long term with opiates without risk of becoming addicted. This is a great review of the literature from a very well respected pain researcher and clinician, Howard Fields…http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073133/

      • Sharon | July 2, 2013 at 4:24 pm

        Hi Diana,
        Until I was 31 years old, I would have agreed with you about people taking med’s correctly do not all become addicts until it happened to me!! I’ve never had anything control my life, until I Vicodin starting taking over. I am so frustrated at how Doctors can feed you all the narc’s they want to prescribe, but when it comes to me taking suboxone (opiate blocker) and then because of freaking POLITICS, my Dr. can only have 100 people under her taking the medicine that we need to come off and be clean. I have never been broken down, weak type of person, but when it comes to withdraws I only want the pain to stop. I want my life back, and I took my med’s right so I hate to tell you that NO ONE can help but become an addict because it is your body that starts having to have the medications. I did NOT chose to want this to happen, and by all means when it comes to it being a choice for anyone….DRUGS ARE NOT PREJUDICE. I wish they were then my life would not be in the shape it is in now. I was you at one time because I thought my friends could just “STOP”. I told them it was only up to them not realizing what they were going through. Unfortunately it is too late by the time you understand what they have been telling you because you are now in the same shoes you told them they were weak for being in and I would say it is all a choice. Little to late by the time I fully understood they were right along. It is soooo hard to admit this too because I have never been weak until it came to becoming an addict. I just want to feel normal, no pain, and be happy just because my brain is producing my natural ability to be happy without having to take a chemical to just feel OK. To be an addict feels like being in a jail cell, you and only you can get yourself out of this place, even having the key to unlock that cell doesn’t help because the withdraws are so bad you will be calling that cell home again real soon. I am sorry for sounding angry, but I was you saying the same thing until I had to be on pain killers and I just wish I could have seen a slight picture or feel a tiny withdrawl before listening & trusting my Dr. because I would have cancelled that appointment never looking back that is a promise. I just pray one day after coming down few milligrams at a time I can be free even though the odds are against me I’ve never wanted anything more, yet can’t wait to take the medication just to feel OK, not high as a kite on it just function-able in society like I was once upon a time… I’m sorry for my frustration, but I have been where you are and I was wrong. The only way to stop it is NEVER start or take a drug that has a high potential rate for addiction. You can take a couple of scripts and be OK, but long term pain management will never work!!!

        • L-1 ~ Sacrum | August 20, 2013 at 1:58 pm

          I am so sorry for your anger, BUT you can be admitted to a hospital & taken off of drugs. Many of my friends had to do this in the 60s & 70s. I believe highly in opiate pain control. What difference does it make if you are dependent on opiates or anti depressants? You cannot just STOP anti depressants either. I have 7…SEVEN…Ruptured discs in my spine, Scoliosis that is degenerative. There is NO CUSHIONING left in between the Vertebra from L 1 to the Sacrum….That is 5 Ruptured discs Impinging on Nerves. There is also 1 in my neck, and 1 in the thoracic region of my mid back. I am not a candidate for surgery as the neurosurgeon said I would lose too much flexibility. I am in Constant, Intense Pain 24 hrs of the day, because when there is no cushioning between vertebra what do you have? Nerve Impingement. LOTS of Pinched Nerves. I have been at the point of going to one of the states that allows Dr. assisted suicide, you do not know the pain I feel, I am an invalid in my own home. I am only 60 yrs old, and cannot stand, sit, or walk for longer than 5 minutes. My Dr. is very stingy with the pain meds & I don’t like them either. BUT, I would like to be able to walk around again, and if it takes being dependent on opiates to attain mobility, then so be it. My GREATEST fear is losing the Dr. that I am about to put my faith in. I am seeing a new one that is an anesthesiologist & board certified in pain medicine. The Dr. I have been seeing is nothing more than an MD with a certification in physical therapy. He has had me on a rollercoaster with the pain meds. On one, then he changes it, on another & then he does it again. I have been seeing him for 10 yrs, when the pain started I was not educated in WHAT type of Dr to see…But now I see I have not been in good care. GOD made the Poppy, he put pain relief in the world, but these Drs are so afraid of addiction, they hesitate to use it, yet they freely prescribe anti depressants that they mostly “don’t know exactly how it works” (from the PDR) and you have to be weaned off of them, so they are ADDICTING…your body is dependent on them. MY FEAR is the Dr. Dies, or Moves out of state, and once again you find yourself in intense Constant Pain. I do NOT like taking pills, But if it comes down to being bedridden (as I am now, from bed to chair, then because of sciatic pain in my butt I have to move to the bed, different position) I am eating ALL frozen dinners, cannot stand long enough to prepare a meal. And YOU say you wish you never saw the Dr. that relieved your pain? Well..I guess you don’t really know what REAL PAIN IS…..should people just STAY in pain, or go out of state to die…What is your answer? NO ONE TALKS ABOUT THE DEPENDENCE ON ANTI DEPRESSENTS yet you cannot stop taking them either. A Diabetic is dependent on Insulin, would you deny them that? Then Why Deny Someone in CHRONIC Pain, pain medication? This really kills me about what people think, what Drs. think….All the While, There are the PILES of MRI’S & CATSCANS showing you are suffering to the maximum. What do you suggest we do?

          • Lynda | November 9, 2013 at 4:21 pm

            We must be identical twins. Exact same problems and no pain relief in over 3 yrs now. I pray to die each and every day. Are there any states where dr assisted death is approved? This is NO WAY TO LIVE. It is pure torture and suffering. I feel you my sister… God help us please.

          • Gata | December 4, 2013 at 7:23 pm

            Well i hate when ppl tell me what i can and can’t take. It’s not the drugs that are the problem its obtaining the dam drugs that cause ppl to lie cheat and do whatever to talk to a doc for 5 min and hope he believes u enough to give u expensive dam meds. Ppl can function perfectly fine on opiates, no violent behavior or slurred talking even work on ladders and rooftops all day. Ppl need opiates wether for pain or just because they are addicted and for the latter category its like taking meds from a bipolar patient same dam thing. The drugs should be legal in the first place. But we have to tale matters in our own hands as a supposedly free ppl. I will never rely on doctors to tell me im in pain and hope to god that some judgemental doc who i see for ahalf hour will write me a script or worry that big brother is checking up on me. Remember heroin tho stigmatised and highly taboo doesnt need to be injected and it is exactly the same as opiate pain killers and cheaper to buy on the street. Also u can grow opium yourself its laughably easy to grow in almost any climate as well as indoors. Now while you all cringe and say im crazy uderstand this whats crazy is that a lot of ppl even have to resort to a street drug because our gov says we cant have it and docs like gods wield the power to choose wether we deserve relief. I say screw them all take care of yourself either live in excrutiating pain hoping a dr will give enough of a dam to help u or do something taboo and be pain free. Unforunately for some this is how things have to be until drug proabition ends and we are free to choose to put whatever we want into our bodys for better or worse.

        • Trainy | September 9, 2013 at 1:25 am

          Sharon,
          I share your pain and understand your frustration! BUT you are not alone. I’ve been struggling with addiction since my first back surgery at 15yrs old. Now 4 surgeries and 1 C- section later Im 33 and still can’t figure out a way to manage my pain for long periods with out meds. I was also on suboxone but my dr. kept me on way to long and now Im 4 days in with out it, after a long taper, the withdrawals are not that bad. Of course im tired and in some pain but as you know the poison has to leave the body. Did it help me get off Norco, YES ABSOLUTELY! But I feel that people think this a miracle drug and that it will solve all their pain and addiction problems. Thats not really the case. The pain is still there its just you brain is covering it up. For me it was just an easy way out, because physical therapy and working out and going to 12 step meetings, is a lot of work!! Im really on your side though Im just sharing my experience and trying to give you another look at things. I may have to return medication at some point but I hope thats not the case. Trying other things and relying on a power greater than yourself may be the answer. I know it was for me in the past. I was sober going to meetings, working out, and was out of all pain. I know that was not me, there was a higher power working in my life, i just turned my back on it.
          I never abused my suboxone but while i was on it i was just maintaing. For me Ive been on both side of recovery with chronic pain and life without drugs if POSSIBLE for me is really living, not just maintaing. i never read all the stuff that suboxone can do to you if you are on it for a long period, so if you do not have a good dr he is not going to guild you through each phase as he is suppose to. Mine didn’t and 2 years later i was just dependent on suboxone. well best of luck to you. just do your research before you succumb to another drug. Ive been in that jail you speak of and its no fun! but there are ways out and you dont have to do it alone. this is just my experience.

        • Tammy | January 31, 2014 at 10:10 pm

          It is so very frustrating to me when I hear people call themselves an addict when, they were very likely only dependent on opiates. Withdraw sucks whether you are an addict or not. Dependency happens to almost anyone who spends a length of time on narcotics. If you are not weaned off the opiates slowly enough or if you are still suffering from the painful condition that you were originally rx’ed opiates for- then there’s a good chance you are only dependent. Even if you had some symptoms of addiction. Then you could be going through pseudo- addiction. I truly believe the spread of misinformation just like in your post is a big part of why the general public just doesn’t get it. There are so many people out there still suffering from untreated chronic pain because someone convinced them that they became addicted when it was only a dependency on the narcotic. Suffering withdraw isn’t a pleasant experience for anyone!! Whether you are an addict or dependent on narcotics. Please get some further evaluation before giving in to someone giving you the tag of an addict.

    • Connie | October 26, 2013 at 10:48 am

      I sm one of those “addicted” persons dependent on opiates for pain relief and from my perspective, I am grateful for the trade. I LIKE being able to walk and bend without screaming out in pain. It makes all the difference. The steroid cortisone shots have a lot more side effects. I don’t abuse my pills. but I do depend on them. Now, how to stop the PROBLEM users?

  2. John Bancroft | June 24, 2011 at 2:20 pm

    There has to be a recognition not just lips service to the fact the opioid based pain meds result in tolerance.
    The pain and treatment communities need to recognize that part of the treatment can and should include a process of reducing tolerance so that meds can be kept at a steady state and therefor the risk of addiction managed as well.

    • D.J. Amick | January 4, 2014 at 3:41 pm

      Kudos to John Bancroft for understanding the basics of pharcokinetics in long term pain med use. Tolerance is inevitable but manageable if the practitioner cares. Switching meds on a quarterly basis along with adjunct therapy to potentiate meds such as Ketamine, and others under investigation

  3. Rocky | June 24, 2011 at 4:46 pm

    bUPRENORPHINE MAKES A TREMENDOUS ANALGAESIC FOR CHRONIC PAIN CONDITIONS THAT INCLUDE PROPENSITY TO OPIOID ADDICTION. THERE IS NO TOLERANCE INCREASE TO WORRY ABOUT, NO CONCERN FOR OVERDOSE (IF NOT MIXED WITH OTHER DRUGS) AND THE PATIENT IS LEFT WITH A SENSE OF EMOTIONAL NORMALCY. SINCE THERE IS A CEILING AFFECT TO GETTING “HIGH”, THERE IS NO POTENTIAL FOR ABUSE. TOO MANY ADDICTION PROFESSIONALS ARE MISINFORMED AND THINK THAT BUPRENORPHINE IS THE SAME AS METHADONE. THEY NEED TO BE EDUCATED.

    • Midknight | April 30, 2013 at 1:15 pm

      AMEN ! Now that should be made into law.

  4. Stewart B. Leavitt, MA, PhD | June 24, 2011 at 4:50 pm

    I wonder if opinions and attitudes toward opioid analgesics would be different if healthcare providers as a part of their training, as well as government officials or other policymakers, had to endure several months of chronic pain. At that, it would be an unfair exercise because, unlike actual patients, the others would know there is an end in sight to their pain and suffering. Patients do not have that luxury and often worse than the pain itself is the lost hope of relief or lasting recovery from their daily agony.

    While all of the concerns about opioid analgesic safety and the impact on public health are valid — to some extent — have the fears been elevated out of proportion with reality; considering there are more than 76 million chronic pain sufferers and an extremely small percentage of the population is misusing and abusing the medications.

  5. Bill Lapadat | June 24, 2011 at 6:28 pm

    Tolerance and addiction are not the same thing. I appreciate the comments by John Bancroft.

  6. Ben House | June 24, 2011 at 7:48 pm

    Recent publication of data showing the close proximity of emotional and physical pain receptor systems in the brain offer valuable insights. These are hinted at in this article, but not well addressed. Clearly assessing the role of the emotional pain and especially the incidence of fear seem a reasonable standard that might offer insights in treatment planning.

  7. Brinna Nanda | June 24, 2011 at 9:13 pm

    Hate to bring up the obvious, but in the US Pharmacopeia prior to 1942, cannabis was used as a very effective method to reduce opiate addiction. So, we already have a tool in our arsenal that has been shown to potentiate opiates so that smaller amounts can be used for the same analgesic effect, but because of our hair brained approach to public health, we don’t use it. Sad, really.

  8. Brinna Nanda | June 24, 2011 at 9:37 pm

    Funny, I looked through the whole article and I do not see any mention of the alternative analgesic that has the least side-effects, the safest profile, and the greatest potential for reducing the need for opiates. Yes, cannabis. The fact that it was not even mentioned in this discussion shows how completely distorted our public discourse is on this subject.

  9. Steve Westen | June 27, 2011 at 8:22 am

    How about instead of over-relying on opioids, how about using, non-physically addicting, fewer side-effects, no death, safer alternantive cannabis. Proven to assist with pain related illness. We over prescribe and over-rely on opioid medications and though the tide could change from over use of opioids for pain to overuse of cannabis for pain, at the least, cannabis won’t kill you or cause over-whelming withdrawls and phsyical dependence. Whether you personally think cannabis should be legal or not, for whatever level of freedom, the bottom line is that it is a safer alternative to opioid pain management.

    • robinladda | September 5, 2013 at 3:44 pm

      For all you out there, wanting it used for chronic pain, I’ll have you know as a child of the HIP generation, 60s/70s I smoked a lot of marijuana, partially because it Hightened all of my senses. I tried it for my Ruptured vertebrae (7) and guess what? It hightens the pain also. So WHY would I want to take something that makes the Pain Worse? It also gives me and not only me, Panic attacks. It is very mild when used for pain, alcohol deadens the nerves way better than pot, it’s what they used in the early times, thru the cival war when there was no morphine to be had. Marijuana also has long term side effects. My brother is a walking example of them all. He smoked pot on a daily basis, thru out the day, every day since 1964…he got busted, he went from a mild marijuana to the hydrophonic stuff, and now because of the law, he cannot smoke or carry any, and guess what? He has constant panic attacks, Major Depression, Shakes constantly…and 5 anti depressants took it’s place. Now he can’t get off of those. He made it last almost a lifetime, and he is a MESS. A lot of people have heightened sensation when smoking it, as I do, panic attacks while smoking (as I do)…and it is a weak opiod for chronic pain. So just because it’s good for you, doesn’t mean it’s good for everyone. Man…I’d hate to have a tooth pulled with just marijuana for the pain. THINK before you post. You’re not in much pain if you could have a tooth pulled with just marijuana, and I mean a tooth that has a toothache, you couldn’t kill the toothache pain, much less the pulling of the tooth with only POT.

  10. Doug | August 16, 2011 at 5:51 pm

    What are you all smoking? Doctors and Big Pharma can’t get rich off a plant! Have some pity for their suffering, would you? I know not all doctors are motivated by profit, but it is disappointing how many “need” to be subsidized by drug companies because their 6-figure income just won’t cut it without a little “boost”.

  11. Jolene | August 11, 2012 at 6:07 am

    What about puffer fish, bee, spider, and cobra venom based “drugs ” to name a few?
    I read several articles of cobra venom in patches so it’s all day relief. ..which if you have chronic pain the biggest problem is the up and down of pain…. and abuse starts with relating livable pain with meds and bad pain as NEEDING meds… I also read these venom based meds are widely used with great success in Asia,Europe and Canada. ..plus they are cheap.

    I think we need to investigate these drugs… its natural and non addictive.

  12. Matt Paperplanes | September 28, 2012 at 1:46 pm

    20 years daily opiod prescribed. last 10 sick on buprenorphine. Recently diagnosis ankylosing spondylitis and in now it’s “sorry we thought you were faking your poison and pill seeking, but you’ll have to live with it.” I should not suffer, I am an honest single parent. I just want to go on duragesic but no one will help I am easy to die

    • Tammy | January 31, 2014 at 10:25 pm

      I realize that this post was made in 2013 so, maybe my words are too late to help the OP. I still wanted to try in case someone else comes along and feels similar. Why in the world would anyone suffer withdraw needlessly? There ARE methadone clinics out there that would at least help with w/d’s. Then talking about checking out? Of course your life is rough. I too live with-untreated chronic pain. I would not and could not ever give up. I have two kids (one teen and one now “grown”) who would spend the rest of their lives wondering why they were not good enough to make me want to stay. I would leave behind too many people (and even if it’s ONE that IS one too many) wondering Why? Yes, I suffer daily now and I know what that is like. Why in the world would I choose to check out early and leave my loved ones in daily pain because of it? Please!! As horrid as the pain and possibly withdraws might be- THINK about the sentence you would be giving your loved ones who you leave behind. You sentence them to the lifelong question of Why. They will forever wonder if they could have done something to stop it. How can anyone think that is fair? Keep trying to change things. Have faith in God (or whatever higher power you hopefully believe in). Hug your family and keep em close. This life is a heck of a lot shorter than you realize.

  13. ER45flatback | January 7, 2013 at 5:11 am

    I have a damaged steell rod on my entire spine. Back,arm and legpain. I went from codiene to oxy to fentanyl to booze.
    I no longer drink at all but the back pain coupled with severe withdrawals leaves me with nowhere to go cgo but in a coffin.

  14. Dr Bill Belfar, MD | March 17, 2013 at 10:39 am

    Nobody was born with chronic pain or drug addiction. They learned it. Opiate dependence is based on tolerance and withdrawal. If you have these, you are dependent or addicted. The best way to treat pain is with carefully monitored pain medication, being opiate or non-opiate and good education for substance abuse. If you are abusing any drugs or medication, there is a reason you are doing so. Substituting marijuana for opiates is substituting one addiction for another. It is not any better. Don’t kid yourselves.

  15. Kari | March 17, 2013 at 6:26 pm

    If someone has sever chronic pain and has been an opiate addict and now refuses opioids is there an alternative? I have read through everything but monitoring an opiate is not even an option for me. I am poverty stricken and do not have the resources to pay for extensive studies and pain clinics. Please help

  16. Mike | April 21, 2013 at 4:18 pm

    I suffer from chronic pain, I have most of my life. In the last half dozen years it’s become so bad that I have had to take daily pain medication.

    I’ve had surgeries, steel in my back, spinal fusion etc. …twisted spine, deterioration etc..
    In addition I’m fortunate enough to have decent insurance that would cover a spinal cord stimulator implant. I can’t imagine the amount of pain medication I would need without it. Even with it my pain level is substantial.
    I also do other things DAILY. Heating pad and/or ice pack every morning when I take my medication and use heat/cold in afternoon or evenings as well. I have an inversion table to help decompress my spine. NOBODY can say I am not trying multiple things to help relieve my pain. I only have a few vertebrae left that aren’t fused at the bottom of my back and I really don’t want to lose that tiny bit of mobility that I have left until/unless it’s unavoidable. …not that a single doctor I’ve seen can guarantee that fusing (fill in procedure here) will remove the pain and not lock it in or make it worse.

    Now the *Pain Management Center* I go to, a large one, is basically telling me that the state of Texas is craping on them and saying that the patients have to be stepped down / off pain meds if it isn’t *fixable* and only treated as chronic. Insanity. I’m at a total loss as to what I’m going to do or where I should look next.

    For 1 to 2 years I’ve had my pain managed and been able to function and at least do part time jobs. Now after only one month of this ‘stepping down’ of Morphine and other medications I’m using a cane quite frequently just to get around. Even laying in bed and trying to sleep more than a few hours without waking up in pain is out of reach.
    This foolish ‘war on drugs’ and ATTACK ON THE DOCTORS has to stop. It’s killing the actual patients that NEED help. It’s causing people to suffer NEEDLESSLY because doctors are afraid that their license will be pulled or they will be hauled off in cuffs because SOMEONE ELSE is abusing the system.
    Doctors shouldn’t be punished for doing their job or having compassion. The state/gov should concentrate on real drug problems and let the medical field do it’s job.
    Attacking the medical industry will only cause more suffering of patients, INCREASE illegal drug traffic and cause MORE people to be UNABLE to work and pay TAXES because they can’t manage their pain.
    I’ve worked mostly 12 hour shifts all my life and now I can barely get out of bed in the morning and make it to my heating pad in the living room because MY DOCTORS are paying the price for a BROKEN system that can’t do it’s job.

    • Mike | April 21, 2013 at 4:23 pm

      Small edit for above message: “only treated as chronic” should have been “only treated as Acute”, or ‘occasionally’ treated, like it was a flare up of some kind.

  17. Midknight | April 30, 2013 at 12:58 pm

    Something I have always found very strange is all the people I have witnessed firsthand who are absolutely against the use of opiates in pain management except in extreme cases e.g. at deaths door from cancer etc. UNTIL they are for whatever reason dealing with severe pain, THEN it’s ugh ah cough,scratch head……well THIS is different I HAVE TO HAVE THEM. LMAO Ohhhh aint that sweet? THEY are “special”.

  18. dave | May 1, 2013 at 11:17 pm

    i have lived with cronice pain for 4years i had a 14 hour back surgery with rods and pins i will be in so much pain i will be in tears at night when i wake up it takes me 2 hours to move i live with my pain at all time 5 and night 8 9 my doc stoped my pain meds i can hardley get out of bed all you people who are out there never living with pain i mean every day and night i have6 grand children i can only may be hold for a few min go to park with them i sit on bench with my pain meds i can atleast walk with them a little bit my wife is disabled i can not get dis becouse she will loose here ssi here med is over 2000 a month so i get 0 but over qualfy for it so not only do they take my pain med away but screw me i worked all my life im 48 years old but you doc had to live with this for 1 hour you would do the same i hat the pain med but takes my pain down so i still can have some life but would rather make me feal like a druggie when im in tears asking for reliefe i think a lot of it is wor on drugs i hope thoes people go thrue the hell there putting me thru or want you to go see a shrink just becouse they can not fix you or they are the one who messed you up in the first place

    • Sashi | June 25, 2013 at 5:52 pm

      I truly understand what you are going through. I’m only 39 years old and already had three major back surgeries. I have a 7 year old daughter who doesn’t understand why mommy can’t bike ride, run, walk fast if at all sometimes. I try my hardest not to complain and keep my tears for when I’m alone. My knees are now going and I have arthritis in my hips and knees and might need double knee surgery. My husband just recently got laid off so I once agin have no health insurance. Thank god workers comp is paying for my meds for my back. Trying to get them to understand that my knees gave out because of my back. This has been going on for three years now and the pain is at its worse. My pain dr basically told me if I don’t get my knees fixed that I will need a knee replacement. I can’t imagine going through another surgery. But back to the point. No one will ever understand the pain we people are in, nor do they care. God forbid I tell anyone in my family that I’m on pain meds because they would think I’m an addict. People really don’t get it. I don’t abuse my medicine. I go to the same doctor and pharmacist every month. Never failed a urine test. I would be a cripple if it wasn’t for the pain medicine. Part of me wishes that the people who judge us could walk in our shoes for just one month and see how they would feel then. Now without no health insurance I have no chance to save my knees. The sad thing is I’ve been working on the books since I was 15. Been paying taxes since then and I can’t even get insurance from the government. People who are really in pain rely on these medicines just to get though the day. Like you I have tried everything before I went to narcotics. There are days when I feel like its just not worth it anymore. If it wasn’t for my child and husband I don’t think I would be here anymore. This is the first time I have ever wrote anything on these sites but sometimes you need to vent and lord knows no one else want to hear me complain, because they just don’t understand. I wish you well, I wish all of us who are in chronic pain to get through each day. I would do anything to get my life back but this is what it is. I guess that’s all I have to say. Wish everyone well and good luck with this horrible government crap.

  19. carl | July 16, 2013 at 9:48 am

    It’s a shame when we try to be honest with the doctors and yet we are still stigmatized because of our disease. Then they wonder why patients lie to them. As far as I’m concerned letting people with addiction suffer with constant pain is sub standard care, period.

  20. carl | July 16, 2013 at 10:07 am

    The runaround that some of these Drs. put us through is outrageous. First, let me say that my Dr. put me on the Fentanyl patches last year for my arthritis in my knee, hip shoulder, and both hands. I’m also a diabetic and suffer from severe neuropathy. After about 3 months I took myself off of the patches because I was somewhat controlling the pain with anti inflammatory meds. I went back to taking my Subutex as well. Now a year later the pain has worsened to the point of now needing the stronger meds. And now the dance begins. They know my pain is real, they know that I’m not drug seeking (or at least they should) yet they still play this game of giving me meds that do nothing for the pain, and still cost me a fortune. I should have just shut my mouth a year ago and kept getting the Fentanyl. But I thought that if I was being deceitful, then it could hurt me down the road. So I decided to be honest and for my honesty I can’t even get out of bed in the morning. I’m so tired of this constant bickering with Drs. to prescribe the proper pain relieving meds so that I may to at least get some measure of relief. I’m only 54 and I walk like I’m 80 years old. There are some days that I wish that God would just take me so I don’t have to deal with this constant agony. It’s a terrible way to live.

  21. Dave | August 23, 2013 at 9:48 am

    I do not agree that people who have chronic pain will not become addicted to opiate painkillers!!! I have seen cancer patients who are in severe pain become addicted!!! Many of these drugs are close cousins to heroin!! This ‘excuse’ that only people who are not in a lot of pain would likely become addicted against someone who was in a great deal of pain, is nothing more than pure spin from drug companies and even some doctors!! Anyone prescribed opiates will run the risk of their body (and mind) becoming addicted!!!

  22. conspiracy | September 17, 2013 at 1:03 pm

    I know that a lot of the opioid pain med issue is a result of our government’s domestic war on civilians labeled “War on Drugs” The U.S Government has no business meddling in the patient doctor relationship. All doctors take an oath “to do no harm” how can they honor this oath if the DEA is scaring the doctors. The DEA has no concern for the patient their concern is the pharmaceutical companies are selling opioid’s they are manufacturing therefore keeping the government’s profits out of the picture. America’s G.O.D is Guns, Oil, Drugs. Why did we fight a war in Korea and Vietnam? Could it be to control the opium trade in the far east? Which is why win or lose the “War” the U.S. still wins in regards to the opium trade and arms sales. Why did we fight a war in Iraq? Could it be for Oil? Why are we still in Afghanistan? Could it be to control the opium trade in the middle east. Afghanistan is in a very strategic location between Europe Asia and the middle east which is why the USSR tried to control this country. The US gets to control the opium trade and sell missile defense to allied countries and install the defense system in one of the most strategic locations on the planet. The last war we fought for the good of man kind was WWII, but yet we still fight wars and sell arms to allied countries. Our Government knows that there is far more money keeping “drugs” illegal. In the big picture our Government controls the drug trade on the seas they allow the drugs they control to pass while ceasing the drugs they don’t control, and they get to sell arms to the foreign Governments trying to stop the non approved drug organizations. The U.S. wins both ways and looks like hero’s in the process.

  23. Becky | September 17, 2013 at 9:06 pm

    I have read most comments but my question is, I have been on vicodin for 15yrs, in the last 2 years I have been abusing it. I need to take it because of my pain but not abuse it. If I take Suboxone will this help?

  24. Amy | February 4, 2014 at 4:32 pm

    Yes, buprenorphine will help tremendously with getting off the narcotics! Just remember, 8 mg per day is all that is needed! Some people take 16-24, but any dose over 24 is wasted sue to the ceiling effect of the drug. My problem is that I saw a buprenorphine doc on my own decision 3yrs ago. Began tapering down and 2 wks ago find out that I have necrosis of the femur. My primary doc is aware of all my meds and now that I am in extreme pain, he is very reluctant to prescribe ANYTHING. feel like I shouldn’t have been so truthful. Now I am screwed. Need hip replacement and a doc who understands my situation!

  25. Jennifer Russell | February 7, 2014 at 2:53 pm

    Stopping opiods for pain due to “fear of addiction” WILL NOT make the pain one takes them for magically disappear. I hear this common idea all over. If your spine is badly degenerated, for example & take opiate pain killers for it, stopping them WILL NOT stop that condition or pain from existing. Where some are getting these ideas is beyond me. All that’s really going on is people suffering needlessly, while those just wanting to get high find their fix easily! Something very screwed up here!

  26. BRIAN | February 8, 2014 at 1:49 am

    the thing is if you have to put your hand on a bible in court with three professional doctors on brachial plexus and three lawers and all deem you as having a non-repairable injury and cronic pain and say you will have this for life and for a person addicited check there eyes for being dielated?????????????

  27. terripin99 | February 18, 2014 at 11:41 am

    Was prescribed fentanyl patches- for severe back pain which has destroyed my quality of life for the past 2 yrs. Finally Ive decided to have surgery(this Thursday is the date.).- The doctors in thier infinite wisdom,discontinued the patches after prescribing them for 3 months. They were the only drug that worked.,and I was prescribed them all..along with every kind of silly therapy known.
    Now ,as wrong and as illegal as it may be..I found a source for the same patches that I was being prescribed. Its a damn shame that I was pushed to such a thing,,but when you cant even get out of bed,,or walk the dog without pain that is so disabling you feel like jumping off the roof–this is what I resorted too.Doctors tell me that they were afraid of getting me addicted..I think they are much more afraid for themselves if they keep prescribing this drug. I dont care about the addicting part- Hell, Im 58 yrs old…so if I need to live with a patch ..who cares?
    Now the question is ,after this spinal fusion surgery , am I going to have a hard time with post operative pain meds?- I think so..God..I hope Im wrong… Ideally the surgery is unbelievably successful and I walk out a new man. More likely I am going to need pain medication. Now because I had to illegally find patches (because they didnt want to prescribe then more then 2 months),,how much will they hold that against me?- Will I be looked at as a common addict with drug seeking behavior?
    I have to tell them that Ive been using then after they stopped prescribing them and just hope someone has a little compassion. I can not live in this much pain day after day ,day after day ,day after day

  28. Amy Maretsky | March 8, 2014 at 12:36 pm

    On methadone and still can feel chronic pain / fibermialga. Looking for pain management clinic the dose Dual actually I can’t remember diagnosis -mental, ex-drug abuse 6yrs clean, chronic pain, fibermialga, thyroid disease, oxygen, wheelchair, & starting a pain management clinic. HELP!! I’m sick of being tethered to 7 days a week 5AM EVERYDAY FOR 7yrs. For six years I’ve had clean urines. I’ve bent over backwards to comply they know I won’t leave because recently had pneumonia & the docs @ the hospital dropped my dose to 40mg after being on 115mg for 7 yrs! When got out of the clinic they are making me run around in circles to get put back up not to 115mg but so I’m not in severe pain CONSTANTLY!!!!
    Maymi119

  29. Debra Welch | March 12, 2014 at 10:13 pm

    Ok, so what do I do about the pain if my doctor takes me off opiods? Surgery, that I may or may not need? Whatever they put me on, can not interact with the meds for my ADHD and Bi-Polar depressive disorder. Am I supposed to live with my leg feeling like it is on fire, and swollen from the knee down to my ankle? Is that normal? What about sitting on my hip and butt on my couch, in a chair, in my car and feeling my leg go numb. I could go on and on, like all the rest of you. The DEA, media and people without chronic pain keep talking about getting rid of these drugs. What do you plan on replacing them with, that doesn’t interact with my medication so that I don’t commit suicide?

  30. Stephanie | March 22, 2014 at 11:38 am

    How does the pain clinic know if you’re getting opiates from another doc?

  31. Kristy | March 31, 2014 at 6:20 pm

    I was an RN for 10 years before my license was suspended because I had to treat my medical conditions with “controlled” substances. I have been on these medications for over 25 years; years before I ever went and graduated from nursing school. I never abused these medications nor got “high” from them. My Doctor prescribed these medications because he knew they were the best course of treatment for my diagnosis. I have been diagnosed with polyarthritis in multiple joints, lumbar spinal stenosis, degenerative disc disease of lumbosacral-
    spine with associated radiculopathy, chronic leg pain due to narrowing of the arteries, anemia and severe anxiety disorder (the anxiety started at the age of 11 years old). I placed quotes around “controlled” substances, because they are poorly controlled and controlled by entirely the wrong agency. The medications that I was placed on were Oxycodone for the severe chronic athritis and leg pain, Neurontin for the nerve and back pain, and Ativan for my chronic anxiety. These medications that I took every day for 25 years, never interfered with my ability to work as a nurse. I had been on them for so long that all they did was help me
    function as a “normal” human being. It was not right
    that my hard earned RN license was suspended because of my medical conditions; I had a valid RX
    for each medication; none of that mattered. I was told that I could get back my Nursing license back if I stopped taking all of these medications. I loved Nursing; it was who I was and meant the world to me, but I didn’t even have to think twice about my answer. My answer was NO! I had to weigh the quality of life that I would have if I stopped taking my medications, and frankly it would suck! I would rather work at a job that pays less and is not what I would have originally chosen, than be in pain every day of my life, and be so anxious that I could not leave the house. The whole system is wrong. I know that drug abuse is prevalent in the medical field, but not by everyone who works in that profession. These type of situations should be evaluated by a professional on a case by case basis. The entire Government agencies, for example the FDA need to
    rethink how they evaluate “controlled” substance use, as compared with abuse and change many of their policies. I am not holding my breath however, as it has been 25 years for me.

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