She has been in constant severe pain for over 15 years. The pain in her upper back defied explanation, identification or treatment. It continued its relentless course undeterred by needles, pills, scalpels and physical therapy. Family physicians, internists, orthopedic surgeons and pain specialists all failed in their attempts to provide relief or answers. The universal response was an increase in pain medications, with the end result being a daily dose of morphine 5 times the recommended limit yet no discernible change in her pain.
She came to me hoping against hope for an answer. At a previous visit I had promised to set aside time to review whatever records she could provide. She scheduled a lengthy visit and came with a CD of her medical records. I opened the electronic copy of her chart and reviewed with her the 240 pages of data it contained. It contained volumes of data but no answers. All of her tests, MRIs, blood tests and CT scans, were normal. Like so many chronic pain patients multiple explanations had been eliminated but no cause had been found.
The only treatment not yet tried was a frightening one. Research has shown that there are many patients whose pain is actually worsened by high doses of pain medication. “Opioid induced hyperalgesia” is the big-worded label for the condition, a fancy way of saying that not only has the patient become tolerant to pain medications, the pain medications have actually caused the pain to increase. The only treatment is to stop the medication, all of it. For the immediate term, pain is certain to increase. What isn’t certain is that the pain will be better in the long term. As bleak as this choice is it was her only hope.
My heart broke for her as I entered into the computer a referral to the addiction specialist who could guide her though her detoxification. Her tears and fears were overwhelming. The recommendation was so easy for me to make yet the road would be so difficult. I felt a sense of sadness and anger at the failure of the medical profession to help her and my inability to provide her with an answer. Her unhappiness and disappointment were palpable.
A few days later I received a sad and angry email message. In great detail she shared her feeling that I had failed her, that my name was being added to the list of doctors who had dismissed her concerns and failed to listen. She had hoped for more tests, more specialists, more… something. My inadequate reply was that I did not see any other options and my opinion was that stopping the pain medications was the best option.
I have thought about her ever since. I have reviewed her chart over and over again in my mind, wondering if there was any diagnosis that I might have missed. Sadly, the location and nature of her pain had been thoroughly and extensively investigated. There is nothing more that I can do. Her hope in me was misplaced.
My name has been added to her list of uncaring doctors. Her name has been added to my list of patients to pray for.
Thanks for reading and sharing, and for praying for this patient.