Sometimes when the pain is really intense, I take two Norco's, not together exactly but one and then another after an hour.
I almost went to the Emergency Room, but instead, I met my case manager at a local dog park, and watched Beck run around an open field, part of the property own by perhaps the wealthiest family in the area. I walked a little, and felt knives in my back every time my foot fell onto uneven ground.
Getting in and out of the car causes extreme pain, so I've talked myself out of grocery shopping on several occasions. I know what this feels like: like the year 2008, the first time I attempted suicide, promising myself that I wouldn't live in pain anymore. I drew a weak, faint line in the trail grounds. No more. But, of course, I survived, and miraculously I healed all on my own with no surgery. It was no less an act of mercy by God, who while He struck me with this agony, He also promised to cure me--as if this was all part of some rocky, burdensome trail I was led down, some glorious journey that would prove my worth as a human being.
I went to my GP, who ordered an MRI, and nothing else. He went into a long, labored lecture on how he felt uncomfortable prescribing me pain killers because they would interact with my psychiatric medications, and that it might cause kidney or liver damage. Reasonable concerns, but that wasn't the truth.
"You're not worried about the drugs interacting," I say to him. "You're worried about me getting addicted."
"Well, that too." He then tells a tale about a TV program that talked about how people get injured, start taking opiates, and then move on to "harder stuff."
That happens, surely, and there's an essential point of truth: most heroin addicts start out with prescription pills, about 75% of them. However, the vast majority of people who are addicted to opiates are not the pain patients--it's the people who have borrowed or paid for pills through friends and relatives. In a survey of patients with an opioid substance abuse disorder, only a little more than 14% got their pills from their doctor. A small percentage got their pills through a drug dealer.
The problem is, we really haven't come up with a better way to treat pain. I've read from different sources that morphine was developed sometime from 1803-1806. We have other pain killers, of course, but to my knowledge, all of them cause addiction and physical dependency. Which poses a public health concern. How do we effectively treat pain when we know that at least a small portion of our patients will develop addiction issues?
One major hurdle: you can't point out an addict before he/she actually becomes an addict. In other words, your GP can't sit down next to a patient in a fifteen minute window, and confidently say, "Oh, this person is an addict. No drugs for him/her." There are warning signs, of course, that you can look out for. My favorite, going back to my earlier point, is a person using drugs which were prescribed to someone else---big, red flag. So, my GP can't decide on his own if I'm going to develop addiction issues. He has no way of knowing. Most people recognize that if you don't need opioids to treat pain, well, then don't use them. They're no longer like candy that you can pick up at your local liquor store, at least not in the United States.
In other parts of the world, the situation is very different: people are crying out in pain that is not treated well or effectively. They need more morphine in hospitals and clinics because of immense suffering and lack of access to health care.
And, as some of us know, the price of heroin has been going down while the potency is going up. Our drug habits support all sorts of small communities and economies around the world.
A point I made on Facebook, which I will repeat here, is the fact that my mother's dog, Suki, injured her back, probably from jumping on and off furniture. She was in serious pain. If you touched her back, she would shriek. My parents debated taking her to the vet, but resolved those differences after I offered to pay for the visit. Initally, the vet was very concerned that her problem might develop into paralysis, but he was more concerned about her pain level. So, the vet suggested a morphine shot, an action of which I supported greatly. The dog received the shot. The next day when the dog came back to the vet for a quite follow up, he was still worried about her pain management and ordered a fentanyl patch for her leg, just to help her get over the "hump." After that, he suggested some steroidal anti-inflammatories in hopes that if the swelling went down, it would cease pressing on her nerves. Excellent strategy.
My GP performed a few, basic tests to see how I would react. My patellar reflex was almost completely gone. My foot didn't move at all. After that, he took off my boots, and pulled down my socks (after I explained to him how hard it is to dress myself), and touched my ankles briefly, asking me if I can feel anything. He ordered me to walk around, up and down the hall. So, I did.
He concluded that I would be fine in a few days, and that I should take Advil or Tylenol (by the way, even the over-the-counter dosages of Tylenol sends people to their deaths, hundreds every year).
Then the GP tells me to put my boots back on and meet him at the front desk. He leaves me alone in a grossly white examining room.
I have no recourse, I can't force him to treat me (in the medical sense) how I want to be treated if it's against his good judgment. He makes that decision for me. In a way, it makes sense, of course, because I've never gone to medical school, still haven't started my residency, and yet, he survived all of that and more--so he should be wiser than me. However, did he really have my best interests at heart or was he serving his as I struck fear into his small, metal, medical heart?
Why do we, as the medical community, naturally assume that an addict poses as a pain patient, in order to stroke sympathy and deceive with trickery the naive physicians who are only trying to help? Why? Because we can't see pain? We can't measure it from some crude picture? Lots of people have extreme back pain, and their lumbar MRI comes back perfectly normal. Are they liars or is it that we just don't have the ability to see into every nerve and muscle fiber? Why can't you admit that you are blind?
Here is a truism from the uneducated: treat pain.
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