The Pain Relief Network

Professionally:
I’m a family doc who specialized in addiction medicine and later in opioid therapy for chronic pain. I quit practicing clinical medicine in 2001 – which is a long story I discuss elsewhere. (Like on youTube: http://www.youtube.com/doctordeluca)

Brief bio and CV here: http://www.doctordeluca.com/Library/Personal/DelucaBio-current.htm

War on Doctors/Pain Crisis blog here:
http://www.doctordeluca.com/wordpress/

As a Patient:
I’ve had acute episodes of lower back pain going back to medical residency in the 1980′s. It became majorly worse post-op major abdominal surgery in 1998, but never had anything beyond episodic treatment until 2005 when I had completed six months of interferon and ribavirin for Hep C.

The chemo cured me of hepatitis virus entirely, but in it’s wake the pain became chronic and severe, my lower back condition was diagnosed (bulging discs L4-L5-S1 with nerve impingement on the right), and I became very disabled. I was exhausted, lost 40 pounds, the back pain was constant and flared with intense radiation into right buttock and leg; miserable all the time and not able to walk enough to leave the house one week out of four.

Plus the interferon (I think) left me with a second pain syndrome – Fibromyalgia-like pain syndrome affecting my shoulders, arms and hands, mostly, and fatigue, stiffness, mental dullness. My symptoms seem pretty classic for “Fibro”, as is the physical exam. The worst of it feels like is napalm or lava on my shoulder blades – weird: hurts like hell, but I can move fully, could pick up a 56 pound kid if I had to without problem or additional pain even… just hurts like hell, comes out of nowhere, goes away abruptly too, and thankfully that acute pain is not constant.

I delayed demanding pain treatment because I had a history of alcohol and drug problems from my teens until age 33 – twenty years ago. I lived with chronic, moderate to severe and disabling pain for years, and it wasn’t until after the interferon chemo, well into 2005, that I finally brought my wife with me and had her tell my doc what my life was like. I was so confused with shame and pain that I couldn’t do that myself (even though I’m a doc myself).

Anyway, it was stupid to delay seeking real pain care, and I was lucky that when I finally asked, I did receive. I’ve been on buprenorphine (Subutex – initially above 12mg a day, now below 6-8mg a day) for about three years. I am MUCH better – the lower back pain almost entirely resolved with only occasional bad days and never anything like being unable to walk half a block I used to regularly endure. The opioid is much less effective against the ‘napalm shoulder’ symptom, but my sleep is much better, my general stiffness much better, and the Fibro symptoms I still have daily are not routinely disabling – I can pretty much plan activities and do what I set out to do, physically.

While the opioids are not as effective on the Fibro pain as on the lower back pain, they have (in combo with cannabinoids – dronabinol, and clonazepam at night for sleep and anxiety) improved my sleep and strength such that I can exercise progressively more, and that increased mobility and movement seems to causing a slow but steady decrease in pain and medication needs.

That is, I think I’m in a virtuous healing cycle thanks to adequate chronic opioid analgesia. The meds help me move, and the movement decreases my pain, and I need less meds over time. And I’ve gone SLOW – I stayed on high doses of bup for over a year, never considered lowering it till I was damn sure I was out of the woods.

It amazes me, but it’s true – over the past two years I’ve gently cut back the daily dose with my doc, and never cut back when I was in bad pain. GENTLY. And it’s working. I’m getting better, taking less medication and getting the same relief from it.

I am fortunate; crazy lucky. I got proper treatment for pain before it was too late, before the pain had damaged me beyond the sort of repair I am experiencing.

That’s my story, in a nutshell. Thanks for hearing me, for taking this testimony.