After surgery, healing, pain meds

I started having pain in my left shoulder and side about three and half years ago. I finally had herniated disk surgery in September of last year. I am still in a lot of pain and the doc says I may need more surgery. In the mean time he says that I need to attempt getting off my pain medicines (hydro 10/500) for which i have been on 8 per day for over 3 years. I am not worried about withdrawals as I have gone through that before and it just has never been for me what others describe going through. However, I am in a lot of pain and he says that it could be the addiction itself, and that my body has stopped making it owns endorphines. He says this will change when I go off the medicines. He intends to walk me down slowly. How long after I completely stop taking anything will my body produce the endorphines on its own? I hurt so badly in my shoulder, in the same place I always did before the surgery and I have been on and off the pills, sometimes for weeks to no improvement. To me it seems that there is still an underlying medical problem to address. Being in pain is so tiring, and frustrating. I have to live my life and I can't do it in constant pain.

[J T Junig, MD PhD]

I see patients in your situation often, and to be frank, there are no easy answers.  Your docs endorphin theory sounds interesting, but is not really a fact-based comment;  it is best taken as a general comment that 'perhaps something in your body is changed from the meds, making you have more pain'.  In reality we know little about the role endorphins play in a situation like yours.  From a neurochem standpoint, the level of your endorphins should be fine--  chronic opiates cause changes in the receptors on the 'post-synaptic' neurons, and the endorphins come from the 'pre-synaptic' side.  Taking opiates changes the response of the receptors-- not the secretion of endorphins.  

But even if we knew exactly what your receptors were doing, we are not at a state of knowledge where that translates into an understanding or predicting of the person's pain level.  We do know that in some cases, patients who have pain will do better when taken off their pain meds.  This strange occurrence is not well understood, and we cannot predict who will benefit from stopping pain meds and who will not.  That you are being taken off pain meds is more because of the style of practice of your doc, than a universal understanding of how to treat chronic pain.  I agree with your doc to some extent;  because of tolerance, taking high doses of pain pills is usually a mistake, as you will only get tolerant to whatever level you are taking.  Better to be tolerant to a low dose and in pain, than tolerant to a high dose and in pain.

I am always uncomfortable with patients in your situation, so I imagine your doc is uncomfortable as well.  We want to help;  we are taking your money and you are expecting good things.  The discomfort can sometimes lead to problems in the doctor/patient relationship-- anger will flare up from either the patient or from the doctor.  Sometimes the doctor will distance him/herself, or avoid eye contact-- at a time when patients need to have someone at least listen to their story.  This is where a 'multi-dimensional' pain practice can sometimes be helpful, but having people who understand this dynamic.  While your main goal is pain relief, the frustration comes across in your message, and perhaps the right person could offer some support.

Finally, every now and then a patient is correct in feeling that something physical 'isn't right'-- if your surgery was not real straightforward, or your recovery abnormally slow or poor, you might consider getting a second opinion-- in such cases it is best to choose a person from a completely different group of doctors, so that you get a true 'fresh look' at the situation.

[GeorgiaBlue98]

A related discussion, Still having issues... not sure where to turn was started.