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Question on Pain Management vs. Addiction

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Old 10-20-2008, 06:21 AM   #1
Join Date: Oct 2008
Location: Knoxville, TN, USA
Posts: 2
Gle HB User
Question on Pain Management vs. Addiction

Hello all,
I have some issues I need some help with concerning addiction and pain management.

I have Crohn's disease. Because of Crohn's, I have had to have some very extensive abdominal/pelvic surgeries. Due to these surgeries, I have a great deal of scar tissue, nerve damage, and a very large open wound that will never heal. These problems cause some serious chronic pain, as one would probably expect.

For many years, my general practitioner and a pain clinic managed my pain - however, I got to a point where I was using pain medication to self-medicate, not only pain but also depression and anxiety. This led down a dark road of addiction that many have also traveled.

My doctor and pain clinic cut me off - understandably so. I was exhibiting the usual symptoms: showing up with excuses for why I had to use more medication that usual, running out early, the typical stuff.

I am now going to a methadone clinic. As far as addiction goes, this is a WONDERFUL treatment for me. Cravings, withdrawal symptoms, those things are dealt with very well by the MMT (methadone maintenance therapy). As far as pain control, though, it leaves ALOT to be desired.

They dose you once per day with a high dosage - this is supposed to last until the following day, when you repeat the process.

Methadone can suppress withdrawal symptoms for 24 hours or so, but it can't treat pain for nearly as long. The medicine is effective at treating my pain for only about 8 hours or so, really. After that, I'm in a great deal of pain for the remainder of my day/night.

These clinics are NOT ALLOWED TO TREAT FOR PAIN, period. It is against the law, they cannot do it. So, the fact that I'm in tremendous pain is out of their realm of treatment.


I need help, folks. I just don't know where to turn. I lost my general practitioner, and no longer have a GP. I still have my gastric surgeon, and he is aware of my methadone treatment. I no longer have access to the pain clinic I was at, either.

I live in TN. Treatment here for addiction is VERY BIASED, and addicts are looked down upon like the SCUM OF THE EARTH. It's the middle of the bible belt, and problems like addiction aren't thought of as medically treatable. In fact, I have to drive over 100 miles one way just to get to a methadone clinic for treatment.

I am so frustrated. Split dosing with my clinic is not an option - even if it were, they just can't treat pain, as I mentioned. For a short term emergency kind of thing, my surgeon could help, possibly, but certainly not for the chronic pain issues.

My question(s) is/are this: What do people do in this situation? From what I've read and heard from others, the fact that I am a recovering addict doesn't mean that I should have to live in excruciating pain for the rest of my life. But, where do I go for treatment? Does anyone know of a pain management group/doctor in the East TN area that will help a patient on methadone?

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Old 10-20-2008, 11:52 AM   #2
Senior Veteran
Join Date: Feb 2005
Posts: 1,115
slipperyslope HB User
Re: Question on Pain Management vs. Addiction

I have an excellent Pain management Dr in Arden NC. His name is Briane Bothe it is near Hendersonville NC/ Asheville Area, I would give his office a call, he might be able to help you. I know its not TN but its not that far is it? I am sorry your in this situation. Perhaps a good PM can help you with some options to control your pain and addiction, my Dr is very caring and understanding.


Old 10-20-2008, 04:13 PM   #3
Join Date: Aug 2005
Location: USA
Posts: 462
conductor HB User
Re: Question on Pain Management vs. Addiction

Dear Gle,

I'm sorry you are in this very difficult situation. If you can find the right internal medicine doctor, he/she might be willing to help you. Be blatantly honest with the doctor and be prepared to sign your life away (practically) when it comes to their narcotics policy! Then, live up to your word of only using your medication for pain.

You do not--in any way--deserve to be in pain because you once abused opiates. With appropriate oversight, your pain issues should be addressed as any other health issue should be.

We wish you well, and I hope you will keep us posted. I have a feeling there are many silent watchers who are going through this experience, too!

Jon (Conductor)

Old 10-21-2008, 10:36 AM   #4
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Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: Question on Pain Management vs. Addiction

Hi Gle, The first thing you need to do is address the addiction problem. MMT isn't rehab, if there is no counseling involved, It simply prevents phsyical withdrawal. Untill you adress the issues in your life that lead to the abuse, I'm not sure it's realistic to let an addict decide when they feel comfortable going back to their drug of choice if nothing is in place to prevent the same thing from hapening again. In what way have you addressed the reasons you became addicted, are you presently involved in any type of PM educational program or one designed to address the issues that allowed the problem to get out of hand in the first place?

Do you have some type of support system to turn to should those same feelings pop back up. Have you learned anything about yourself, your addiction, coping skills or where to turn when taking meds as prescribed becomes an issue. Driving 100 miles one way sounds like a pain but MMT isn't recovery, it isnt treament for addiction or pain, It's simply buying you one day at a time. Have you seen an addiction counselor, become involved in a 12 step program or sought any help at all aside from replacing meds you have control of with a single dose you don't.

You decided you needed methadone and are willing to drive 100 miles to get it, but if you haven't decided to address the addiction problem with a profesional, why would any doc believe that anything would be different the next time around.

Forced compliance with MMT doesn't mean someone is all better and no longer at risk. Education, rehab, whatever it takes to look at the bigger picture beyond how you get through today is what it's going to take to find PM when you have a history of addiction.

Yes there are people with histories of abuse and addiction, but generally those problems have been well adressed before someone is willing to put their licence on the line for someone that has a history of abuse.

If you haven't completed a recovery program or educational program that has given you some type of coping skills and resources to use when the urge to take an extra pill hits again, why would a doc see MMT as anything other than replacing one drug for another. Can you go to a PM doc now and say you completed or are presently involved in a recovery program. Can you say your sobor, have the tools and a support system in place to prevent the same thing from happening again? If your sobor, in recovery and willing to particpate in any plan the doc decides is neccesarry to protect you and his licence then you may become a candidate for opiate use to treat your CP.

Have you looked for a local addictionologist or out patient rehab program, Some addictionologist do treat CP with meth or other meds that can be dosed more frequently. Seeing an addictionologist where you actually treat the root source of an addiction is certainly going to give most PM docs a sense that you have a support system in place and are not at the same risk you were when they cut you off last time. It really comes down to what's different now to prevent the same thing from happening again.

Good luck, Dave

Last edited by Shoreline; 10-21-2008 at 10:41 AM.

Old 10-21-2008, 11:11 AM   #5
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slipperyslope HB User
Re: Question on Pain Management vs. Addiction

I have to say that Shoreline brought up some good valid points, and I think it is important that you do seek some sort of treatment for your addiction before you show up at a PM Clinic. it will give you great credibility. I gave you the name of my PM Dr and you could start with him and ask him what his opinion is, and what he might suggest you do becasue he really isn't that far from you, about 1 hour each way I beleive. But he is strict and he does drug test at every apt he does a UA and uses a lab to send it off too so its accurate, he is easy to talk to and I am sure he has seen this situation come up before as he has been a PM Dr for a long time now. He does not except most insurances, he is a cash only Dr right now b/c his practice is new. He did have a huge practice last year but that practice was closed down and he has since opened his own practice and he is even more strict now than ever. But he is compassionate and very smart and empethetic to people in pain, I also like his office staff.

good luck please let us know what you decide to do and if your going to call the PM Dr I mentioned in my previous post. I think he might be able to help you with a plan for your pain and past addiction issues, but really it would be great if you checked into something beforehand, for credibilty and to get better again so it doesn't happen again to you.


Last edited by slipperyslope; 10-21-2008 at 11:12 AM.

Old 10-22-2008, 06:58 AM   #6
Join Date: Oct 2008
Location: Knoxville, TN, USA
Posts: 2
Gle HB User
Re: Question on Pain Management vs. Addiction

I understand why you feel the way you do



Let's make that clear.

Opiate addiction is NOT solely a mental problem - it is considered a disease, and is typified by repetitive behavior to satiate an internal deficiency of endorphins - this repetitive behavior leads to a dangerous and debilitating spiral until the obtaining and using of the drug is the sole focus.

MMT involves taking methadone to curb withdrawal symptoms and to RESTORE THE NATURAL BALANCE WITHIN THE BODY - the methadone replaces the damaged/destroyed endorphin system so that a person can maintain a normal life.

It does NOT simply "buy you one day at a time". I cannot stress that enough.

The idea that "confronting the reason for addiction" is somehow the way to BEAT drug addiction is a sad, sad farce.

Is it important to understand the "reason" one becomes addicted to opiates? Absolutely.

My reason was depression coupled with a NATURAL LACK OF ENDORPHIN PRODUCTION DUE TO SUPPRESSION BY YEARS OF LEGAL, PROPER NARCOTIC USAGE - I could no longer do many of the things I was used to doing, and I became depressed - the physical dependence on pain medication was depressing as well. I began to use the medication, not just for pain, but for the depression - which at first works well.

Once I realized that I was using the medication for more than just pain - I knew there was a SERIOUS problem here and that I needed help.

So, I did the thing that was decidedly "proper" by everyone's statements. I went to rehab, 12-step programs, counseling, etc.

What I found was this: No matter how much mental focus, debate, confrontation, etc that I did.... My body was still distraught and damaged. I did a proper "detox" with Suboxone. I, like most others, was convinced that once I was free of the withdrawal symptoms, I would be able to deal with the reasons I became addicted and could go on from there.

Here's what 99% of folks don't know about OPIATE addiction. Even after overcoming the withdrawal, after facing the mental aspects - and defeating them. After all of that...

You MAY still not be alright. My body DID NOT recover - and it WOULD NOT. I was very successful with my rehabilitation during those times with regard to mental and emotional issues. I dealt with those things, and then waited - and waited... And waited....

See, no matter how much I did for those mental issues, no matter how many 12-step mantras I repeated... My body DID NOT PRODUCE ENDORPHINS LIKE A NORMAL PERSON DOES. Months, even a year plus of waiting and being assured that I was fine - no response. Numerous anti-depressant/stabilizing medications that deal with SEROTONIN and DOPAMINE levels did not work.

There was no way to get my ENDORPHINS back ship-shape.

This is called PAWS, "Post-Acute Withdrawal Syndrome".

In a nutshell, it means that though you are through your body's immediate dependence on the opiate medication to stave off withdrawal symptoms, your body's natural chemistry is STILL out of whack.

The general rule was 3-6 months - if your levels aren't back to normal after that amount of time, they probably won't be... EVER.

So, there's the problem with OPIATE addiction. Your body's natural chemistry MIGHT be so damaged and depressed that it will NEVER return to normal.

As you know, without ENDORPHINS, you will experience anhedonia. Lack of pleasure experience.

So, the condition my body was in after rehab.... I had dealt with things, successfully. I knew how and why things happened as they did. But my body wasn't working right - without EXTERNAL ENDORPHINS, my body was unable to function normally.

This happens with other drugs, also - most notably, ANABOLIC STEROIDS can depress a person's testosterone levels temporarily. However, extensive use MAY (and this doesn't happen in ALL cases) lead to PERMANENT DAMAGE to the natural testosterone regulation mechanism.

This is what happens in many cases of opiate addiction - and NOT only addiction, but dependence also - addiction involves the mental aspect, but PAWS is independent of addiction.

YOU may find that if you stop your opiate usage - even if you have ZERO mental dependence - your body may not return to normal functioning after a while.

You, too, might be left with a life where you simply are not capable of being "well".

And THIS is why methadone maintenance is successful - and is ALSO the main reason that many folks on MMT are advised to remain on for life.

Personally, I still undergo counseling - I enjoy it - but addiction isn't the issue we discuss, it's a life in pain that gets discussed.

I know that the so many folks view MMT as a simple replacement protocol - you just replace the drug you're addicted to with another drug to which you'll become addicted.

It's NOT like that, though - instead, I've replaced a drug to which I became ADDICTED (meaning that I used the RUSH from my short-acting narcotics to deal with unhappy times, depression, issues that I simply had not the ability to face) with a drug to which I became DEPENDENT.



I am on methadone, and I will STAY ON METHADONE FOR LIFE. It is clear that my body does not properly produce endorphins at a level needed for normal function.

THAT is what the methadone is for. In MMT, the primary goal of the treatment is RESTORATION - the pain-killing property of opiates is actually considered a SIDE-EFFECT when viewed in this manner.

So, this is where I'm at. I will NOT stop methadone unless there is another way to restore my body's natural endorphin production. BUT, on top of that, I need a medication that can be used to reduce pain.

All this stuff I've written above is the big problem with MMT and pain management. The idea that an opiate may be used PRIMARILY for a function OTHER THAN ANALGESIA is a very foreign concept to pain management folks. They have an issue with this.

The misconception that methadone treatment is NOT treatment is just ridiculous. It is a REAL treatment. It restores natural function - with it, a person can focus on their LIFE and not on the endless CHASE to try and feel normal again.

Anyway, I've provided alot of info in here - I'll leave time to respond.

I sincerely hope that you all will REEVALUATE your position on MMT. It is NOT NOT NOT what most folks think it is - it is a much deeper and more important idea than just "holding off withdrawal one day at a time". That idea is simply wrong and misinformed.

If only people understood MMT better, it wouldn't have the stigma that is does - it is simply the best option out there for long-time opiate addicts, and it is ALSO a great treatment for long-time DEPENDENT people who no longer have pain issues and have stopped their pain medication - yet still experience PAWS. This happens quite a bit - and it just gets labeled as "addiction", of course - the person no longer has pain, but still has a need for the opiates... It's not abuse, not even really addiction, but it WILL manifest this way - the body will do what it feels necessary to restore endorphin levels.

And again for my personal case - I want to make sure you all understand that I am NOT planning on stopping the methadone, and that that is a MAIN POINT that will have to be clear with a pain management program.

The methadone is the closest thing to restoring natural endorphins as there is available. It ALSO prevents abuse of other narcotics (you'd have to look into this, I won't explain it here as I've already written a book).

So, the idea is for me to CONTINUE my methadone - but have something to deal with pain ALONGSIDE. This is valid, and important.

Last edited by Administrator; 10-22-2008 at 11:03 AM. Reason: It is fine to post opinion, but not OK to chastise those that take the time to reply.

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