Stanford Outpatient Psychiatric Clinic is now handling my medication management, with the insistence that I receive psychotherapy somewhere local, and also that county mental health does "case management," which I'm not sure what that means.
The doctors at Stanford on my last visit shared two concerns with me: one, obviously my caffeine intake, which they explained was unusually high (although I don't drink near the coffee or soda that my mother does), and two, the potential prospect of me abusing or becoming addicted to opiates. You would think that being on morphine for a year, and other opiates before and after that, when I titrated down off of the opioids, that they would be comfortable with the idea that I didn't become an addict.
"How are you going to manage your pain after the surgery?" The attending physician asked me.
I shrugged. What I didn't say: I was out of the dead dog's tramadol, and was essentially on my own with it came to dealing with the pain.
He continued, stating that I should avoid painkillers unless I really needed them and if they were the only effective treatment available, and that I should only take a couple of pills after surgery, and that he hoped my surgeon wouldn't give me "thirty pills," because it was dangerous to have that many tablets of opioids loose in the house.
"Opiates make you feel good in the short term, but they're not good in the long term," the attending told me.
I've heard the lecture "opioids are bad" before, and often throughout my experience with painkillers. Many doctors expressed adamantly that I should not be on morphine considering my age, the lack of evidence of what was causing the pain, and the prior diagnosis of a mental illness (which raises the likelihood that I would become addicted because I would be "self-medicating").
I expressed to my case manager and to my mother that eventually I will have to have the pain talk with one of my doctors, and basically hit them up for opiates, although I would be comfortable with just receiving tramadol again, which is a relatively mild opioid. However, when asking for pain killers, doctors can have a variety of reactions, including sympathy, righteous anger or indignation, and apathy. You never know what you're going to get until you just ask, which is a humiliating experience. Doctors are afraid to take a patient at his/her word when it comes to physical suffering since often such suffering is not visible on the outside.
I am more liberal with the use of pain killers than the current attitude within the medical community and in the media dictates regarding these drugs--probably because I have never dealt with addiction myself. However, while I can see (and know because I've read up on it) that substance abuse is a grave matter, so is being in extreme pain. I think it's a pointless argument to decide which is worse. What we also know from research and data is that people who have noncancer, chronic pain are not the majority of those who become addicted to opioids. The vast population of abusers are those who received pills from friends or family, either given to them or sold to them. While pain patients do become addicted, they shouldn't be our target for the war on opioids--and by posing restrictions and barriers to pain relievers, we are unjustly increasing the toll that pain has on both the body and the mind for patients.
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