Dr. Phil Goode

Say a person has a chronic pain of some kind, say from a back injury and operation. They take some anti-pain meds for the bones/tissue grinding on each other. Doesn’t the persons body become acclimated to the regular dose? What do you do then?

“What do you do then?”You explore other options – steroids, NSAIDs, drugs like Neurontin or Topamax, etc. You try some targeted exercise and PT to build back strength and mobility. Only as a last resort should you consider chronic narcotic analgesic use, and God forbid you should keep upping the dose as you build a tolerance. There is an endpoint you will reach where nothing works.Legitimate pain management clinics provide a valuable service to their patients, but there are far too many who just pass out candy on the slightest pretext.Case in point – a pretty boy comes in the other night doped to the eyeballs. Everything hurts, yet he can point to no legitimate reason for his pain, other than an old “back injury.” Our hospital has no such records, he cannot produce the name of the doctor who diagnosed him with this injury, or even elaborate on exactly what the injury is.He obviously works out and lays out in a tanning bed, yet he has a back injury that tortures him, and the ER mattress is too tough on his back, while a tanning bed obviously isn’t. And yet, he has prescriptions from one of these Pill Mills for boatloads of narcotics.And did I mention that he has so many DUI convictions that he has a court-ordered breathalyzer lockout on his car?If you have been in the ER a dozen times over the past few months, medicated to the point where you need emergency treatment to manage your airway and breathing support, and drugs to reverse your overdose, you are no longer managing your pain. You are taking the drugs to get high, period.This kid was an addict, plain and simple, and he got these drugs on false pretenses. And MANY more just like him in southwest Louisiana travel across the border to get their candy at these Pill Mills. It’s a travesty.

Okay, thank you AD for the generalized advice on what to do with chronic pain.RE:the addict kidGetting dirty drugs or AIDS on the street would be better?I assume the kid knows what he is doing to himself? or does someone have to smack him alongside the head and tell him he is addicted?

“RE:the addict kidGetting dirty drugs or AIDS on the street would be better?”Most addicts I encounter know they are addicted. The reason is, by the time they encounter me in the ER or on an ambulance, they are already on their downward spiral. They may not want to admit it aloud, but yeah, I’d say they realize they have a problem. The problem with addiction to prescription drugs (this kid has been addicted to pretty much everything) is that the addict often truly believes he or she needs the medication. When you’re a crack or meth user, you KNOW it’s wrong. It runs against every social more. However, with prescription sedatives and painkillers, they think of it as their MEDICINE. They doctor wouldn’t have prescribed it if they didn’t need it, right? Recognizing their problem is much more difficult.

You like that, do you? How about pharmacies that receive blatantly-changed scripts that add a scheduled narcotic in a 90-day heavy dosage, who call the doctor and verify that it’s not legit, but then fill the original scrip and NEVER call the cops to report the forgery? I, uh, know a guy who’s dealing with one of those.. . .

Ha ha ha! Love that Houston Coctail!Actually, they had me high for a couple days after my maxillectomy on a couple strong narcotics. Most of the time I was just out of it, and thankfully didn’t feel the pain. But when I got to push the green button every hour, I felt about 2 minutes of narcotic bliss.Now that I am healthy again, would I ever chase that high? NO! A two minute high isn’t worth all the drama and potential damage to my body! But I do, sadly, have a problem with that damned alcohol!

AD:Love your blog. Would like to be sure you understand the difference between “dependence” and “addiction.”I’m 41 and have some serious problems with my knee from an accident 5 yrs ago. Shatzker Type VI fracture of the tibial plateau, compartment syndrome. They were talking amputation, I ended up with a quad-compartment fasciotomy, followed by a skin graft when they couldn’t close the incisions. 3 of 5 ligaments were torn completely, the other 2 were 2/3 and 3/4 torn. Meniscus was in 7 pieces. My knee is bone-to-bone.The pain is constant, 24 hours a day. 10 minutes of sitting still and movement is agony, every step is almost as bad.Ever wake up in the night to the sound of someone screaming, and realize it is YOU? I told you all that so I could tell you this: without pain management I’d literally have shot myself before now. The only solution is (obviously) a TKA, however at 41 noone is willing to do it. Add to that the poor success rate of TKA in Tibial Plateau Fx cases, and I could well end up going from bad to worse.I took myself off the Morphine, ended up in ER twice with what I thought was a heart attack. Having never experienced acute narcotic withdrawals, I thought I was dying.Once we figured out what was happening, I switched to a titrated dose and weaned myself off in half the time the doc had scheduled. I did this because I realized that I LIKED THE STUFF and thus didn’t want any more of it.My docs, in their wisdom, decided if I didn’t need 180 Mg of Morphine a day, tylenol should be enough. Needless to say, I was soon wishing I’d died in the accident. My GP sent me to a PM specialist.NSaids weren’t enough, and as I also have some problems with varicose veins and purpura pigmentosa, they caused subcutaneous bleeding and actually caused my knee to swell even more than usual. At one point the doc “drained” my knee. He accidentally separated the needle from the syringe, and the bloody, smelly mess that shot out all over his floor led him to say “no more NSAIDS for you, young man.”I started on a 25 McG/hr Fentanyl patch. This was like a miracle for me — I was able to sleep again, and my recovery accellerated when my pain was controlled. As I became tolerant, doc had to increase the dose. I’m now up to 75. Doc won’t write me the 10mg oxycontin scrip, which would let me sleep all night. He’ll happily give me 15mg/day of oxyCODONE, which means on particularly bad nights I’m up every 2-3 hours popping another 5mg pill, ending up taking MORE meds than I need because the doc is scared to write a scrip for something with “contin” in the name.Bear in mind that on multiple occasions I’ve told him not to write the oxy scrip for that month — “I’ve got plenty” and don’t want them laying around my house.Further, the patches SUCK. I can’t get a scrip filled a day early, which means when I sweat one of them off, or my skin gets twisted when I stick it on, I’ve got to suffer through withdrawals and pain for a day or two until it is time for a new patch. Originally, the PM doc would write me 3 months worth of scrips, with each marked “do not fill before…” the proper date in the future. This date would be a couple of days before I was “out” so I could get it filled before running out. If I’d managed to sweat one off, or otherwise screw it up, I was OK.A year or so ago, he stopped this, and will now not allow me to pick up a scrip even one day early. Got a problem? TOUGH. Both of the pharmacies in town are sold out on the day you get your scrip? Sucks to be you. They get a new shipment next Tuesday. While some people apparently abuse Fentanyl, I cannot understand why. It makes me nauseous, kills my appetite to the point that I’m dropping several pounds a month, and constipates me so badly that normal, daily bodily functions have become a weekly, bloody torture-fest.Still, with the patch I am able to hold a job, and uphold my responsibilities to my family, church and my community.I do this in spite of the fact that for a few days nearly every month I am suffering from withdrawals — the sweats, cramps, runny nose and “junky-twitch” that I go through when I manage to screw up one of my patches or the pharmacy screws me over AGAIN.As a patient who has clearly demonstrated that I can be trusted — that I’ll take no more meds than I need, etc, what kind of sense does it make for me to have to suffer like this?Dependence is part of the treatment — a known, and calculated risk that goes along with the benefit of the pain relief. Nothing in life is free.Still, I find myself thinking like a junky to survive. I’ve taken to cutting my patches in thirds, and changing 1/3 of it each day instead of the whole thing every three days. This way if I sweat it off I only lose 1 day’s worth instead of three. I recently started cutting it into quarters, in order to lower my dose a bit and allow me to build up some reserve to avoid the monthly hell. In sum, the system is causing me to think like a junky. It’s not right.If I were you, I’d want to smack Mr. “Pretty Boy” too, but just be sure that you don’t swipe everyone on narcotic meds with the same brush. Some of us literally can’t function without them, and prefer the life of a productive person with a dependence on narcotic analgesics to a life of disability payments.I’ve never gone to the ER seeking meds, but have been desperate enough to consider it. Unlike those you describe, I’d tell them flat out that I was in withdrawal hell and needed some help to get through until my scrip came in.Judging by some of your comments I’d be better off seeing the local dealer…There must be a middle ground between a “pill mill” and the SS dictator I have to deal with.Where is it?Respectfully, A regular poster who feels he must keep this one anonymous.

Anonymous wrote:“Love your blog. Would like to be sure you understand the difference between “dependence” and “addiction.”"Anonymous, I do indeed understand the difference. When I’m on the ambulance, I’m quick to administer pain relief. I firmly believe that no one should be in pain if I have the means to do something about it. In the ER, I’ll advocate strongly for those people with the ER doc.Some people have to live with pain every single day. I’m one of them. Yours is obviously worse than mine, and it’s for people like yourself that pain management clinics are a Godsend. My beef is with people that have a history FAR less impressive than yours (often no history at all) who are taking these meds to feed their addictions.These Pill Mills are the ones that are going to provoke draconian regulations on pain management, which will eventually wind up hurting legitimate pain management clinics and patients like yourself.Your doctor’s reluctance to prescribe anything with “contin” in the name is a case in point. He fears unwarranted prosecution or harassment by the DEA, and it is abuse of prescription narcotics by addicts and the Dr. Phil Goodes who profit from their addiction who foster that suspicion. You have my sympathies.