6 years of hell and more

for the last 6 years they have had me taking everything from tramadol, xanax, morphine, diladud, oxycontin, oxcycodone, codeine, oxcycodone ir, vicodin, norco, soma, flexeril, meloxicam, mobic, on top of that I used to be an alcoholic, and use illegal drugs cocaine mostly weed, and whatever else to stop the pain from the total disc replacement surgery in my back.  Here is the ****** up part, I can't get off them even if I wanted to, I would be in chronic pain and I am only 37 years old.  This is ******!  the list of meds up there is not even close to what they have been pumping me full of over the last 6 years and I am just sick of it.  I can't try to work out to get the pain to stop because I am trying to get disability and if they see that I will get denied.  Does anyone know of anything that I can do to stop the pain?  I have permanent nerve damage, and it starts in my back goes down right leg into foot.  Now it is in my knee and this sux more than anything I could imagine.  I would like to stop taking all of this medicine but until I can be mostly pain free then I am stuck! HELP!

[J T Junig, MD PhD]

I realize that pain meds appear to be the only answer-- but they are only a seductive trap.  Tolerance develops to whatever you take, leaving you worse off than before you started them-- dealing with the same pain, but the added misery of withdrawal if you miss doses.

I strongly recommend doing whatever you can to improve function, and taking concerns about disability money out of the equation.  You would be much better off exercising your way to improved function, without disability benefits, than you will be WITH benefits, but deconditioned and more disabled.  

If you look for the information from PROP-- Physicians for Responsible Opioid Prescribing-- you will read about opioid-induced hyperalgesia, the phenomenon where use of opioids increases pain sensation during chronic pain.  I myself have seen a number of patients find that their pain was much lower OFF opioids than ON opioids-- including people who swore that they would never tolerate life without pain pills.  In their cases, they eventually lost their prescribers for one reason or another, and were forced through horrible detox, finding after the withdrawal ended that the pain was greatly lessened.  I realize it is hard to believe that from your position, but doctors who work with opioids will agree with me.

Even if you decide to stay on opioids, there is no need for multiple varieties of mu receptor drugs.  The best approach is to take a long-acting opioid to cover 80% of your opioid needs, and then use immediate release opioids for 'breakthrough' pain.  A typical combination would be oxycontin twice per day plus smaller doses of oxycodone as needed.  Then you could add a med for neuropathic pain for the nerve damage;  something like gabapentin or Lyrica.  Benzodiazepines like Xanax or Valium are not appropriate for your situation-- especially given your history of alcoholism.  They are CNS depressants, and will only make you tired and forgetful, and possible depressed.

Exercise, in a form that doesn't worsen your condition, will be the only thing that has a chance of truly improving your function and your chance for happiness-- so do what you can.  If you are at a healthy weight and you are aerobically conditioned, any pain condition will be much more tolerable.  I wish you the best.