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Chronic pain for almost 2yrs and still struggling through life……

Well here is my personal story. Im 36 and a single mother. I was in a car accident back in august 2008. Ever since then it has been down hill. Well after the accident i seen my family doctor n she said i just had soft body tissue bruising or something like that. She prescribed me some vicodin.

Well that was the start to a VERY long and painful road. Well i then came accross some chiropractors at a clinic. They were very good doctors. Finally after a few months of things getting worse they decided to send me for some mris on my neck and back. First i went for the back. Nothing really major was found there except for some arthritis. Well four months later i found out through them on a visit that i have three buldging discs in my neck.

Now i hadnt had any of these problems before the car accident. Then the doctors there sent me to a pain doctor. He saw me then told me that i also have degenrative disc disease in my whole cervical spine along with the three buldging discs. He also prescribed me vicodin.

After a lil while he decided to try an eipideural injection. First one was a cortisone injection into my neck. well that one seemed to not do a lick of good for me. The pain only got worse from that night on. Well after that i had seventy of my vicodin stolen from my purse!

It was a family memeber who was on the same medicine as me n he is an addict n abuses his medication n sells it! I at the time didnt think he would of done that to me so i saw no harm in keeping my medicine in my purse.

Well i called my doctor n told him about it. He told me i would have to file a police report n bring him a copy of it n he would then give me some more medication. Well i then did that. Nothing ever came of it.

The doctor then did a 2nd injection after a lil while since i wasnt getitng any better. This time he did a nerve block in my neck. This also did not work. He then prescribed me percoset. He also tried a percoset neurotin combination to see if that helped. It did for a little while…..well when i called him n told him that this wasnt working he uped my dosage of the percoset. He told me to take two at a time.

Well i did that n it was working. Well when i called to get a refill because by him just verbally uping the dosage i ran out of my medication sooner he said he was gonna send me to a surgeon.

I asked him why he would do that just because i needed a refill? then he told me he misunderstood me n just told me to come in and get my script. Well when the pain worsened after a while and i called the doctor he wouldnt refill my script for my pain meds. I went a whole month trying to care for my animals, myself and my 1 1/2 yr old daughter while in severe pain w/out any pain medication. I tried to self medicate with alcohol but im NOT a drinker n it didnt help.

Finally i went to my apt with this pain doctor again n balled my eyes out n basically asked why is it ok that i should haver to suffer in pain because some man hit me n im having problems with my spine? finally he asked me what he should do for me and i told him to give me the percoset back so i wouldnt suffer as much as i was. So he did.

Anytime after that if i mentioned the medication he acted funny n ignored what i said or told me “well thats not gonna happen” so i gave up. Well i just continued to get my medication n suffer with what i had been given.

Well recently i read online about a spinal cord stimulator n wondered if that was the solution? i sent away for the information on it n recieved a package fed exed to me. In it was a dvd and a phamplet and a list of doctors who did the procedure n implant. Well it was the begining of december n i noticed that when i went to take a pain pill that my bottle looked a bit lower then it should.

Well come to find out right before xmas my family member had stolen some of my pain pills again! So then i got a safe n started locking them up. Well when i called my pain doctor about the spinal cord implant n medication to tell him that the pills werent lasting as long as they used to n to see if he does the spinal cord stimulator he decided to drop me as a patient!

Well now i am suffering n i am gonna be out of my medication this coming monday! i saw a new pain doc but he woudnt prescribe me anything n wants to do an injection into my neck again but into the side of it this time. He told me to have my family doc prescribe my meds til he gets my records in a few weeks.

Well my family doctor did it twice but wont fill them again because she said she wants me to get them from him instead!

Im sooooooooo friggin sick of takening pills for this that i cant see straight. Im trying to go through every other possiably instead of surgery.

My old pain doctor everytime i saw him said i have a surgical problem n there was nothing more he could do for me.

My family member who ABUSES his drugs n has stolen mine gets everything under the sun with supposed back problems.

I DONT understand how people who r clear junkies get everything under the sun but people like me who need some sort of relief n help it seems the doctors dont want to help them? is it maybe because i have lawyers involved???

if anyone has any idea on what i should do please do so either here or at my email… evilfairy33@gmail.com or if u know of any good doctors who specialize in neck pain or chronic pain please let me know if u live in michigan southeast michigan somewhere…

i have nobody who understands what im going through or to talk to about this…

tyvm for listening everyone n i wish u all at least one pain free day 🙂

23 years old and uncurable

hi i’ve been on this website for around 3 years and i have made some great friends who understand what i’m going throught. i have had LPHS for 6 years now and am still uncurable. if anyone wants to ask any questions feel free to email me. its totaly_tweety@hotmail.com. . i also want to tell people about a fanatastic doctor who is helping my surgeons even tho he lives in ohio and i’m in scotland. his name is dr herbert and he is at ohio uni in research. if your doctors are sturggling to help as there is very little info on LPHS he will send a wealth of info that has helped me i’m still in pain but At least it helps a bit much better than having opium based drugs which slowly kill you i’m still on them but at a lower dose with some new tablets and also a THC (the active ingredient in cannabis) nasalspray!

i just want to say i have made some fantastic friends here.
again feel free to contact me

Kirsteen

NY – Beth Israel Medical Center

Russell Portenoy, MD
Pain Medicine Specialist
Chairman, Department of Pain Medicine and Palliative Care, Beth Israel

Depression and Chronic Pain Is Extremely Common

In some patients, depression follows the pain, and if you can effectively treat the pain, the depression would get better. And in some patients the depression seems to drive the pain, says Dr. Portenoy. He explains that when these two conditions coexist, patients need carefully coordinated treatment.

Dr. Portenoy is among New York Magazine’s “Best Doctors” for 2008, as listed in the June 16, 2008 edition of the magazine. The New York Magazine list is excerpted from Castle Connolly’s annual guidebook, “Top Doctors: New York Metro Area.”

Address

First Avenue at 16th Street
New York NY 10003
Telephone:(212) 844-1505

Questions About Using Opioids for Chronic Pain

Q: Would you say that opioids are a last resort?

A: No. Opioids should be considered for every patient with chronic, moderate to severe pain, but in every case, you would only prescribe the opioid after carefully considering the responses to several questions.

Q: What are those questions?

A: First, what is typical treatment with respect to this pain? Second, is there some other therapy that has as good or better efficacy and safety? Third, is this person at relatively high risk of opioid side effects for whatever reason? And fourth, is this patient likely to be a responsible drug taker, or is there a history of substance use problems?

So in some cases, for example a patient with severe pain who has not done well with several steroid or other drug injections and physical therapy, and who presents to the doctor with back pain so severe that he can’t walk—that patient might be considered a candidate right then for a trial.

Q: What is an example of that review process with a typical patient who has arthritis of the knees and hips.

A: Everybody would agree that the first-line therapies typically would include acetaminophen, physical therapy, or a TENS unit, or maybe—if there’s a single joint that has some swelling—an injection.

The next-line therapy would be an NSAID. But if that person has a history of an ulcer or a history of bad heart disease, the NSAID risk gets to be relatively high. So that patient might be considered for a trial of an opioid at that point.

Q: If I’m that patient and I’m put on a trial, how will I use the drugs?

A: Almost everyone with chronic pain appears to benefit more from regular, fixed, scheduled use as opposed to PRN [when needed] use. There is a general perception, two decades old, that patients do better if they have pain medicine in their blood 24/7. It’s done in a sustained way, so that the blood levels don’t fluctuate much.

Q: In the whole range of treatments for chronic pain, where do opioids fit in?

A: The chronic use of opioid therapy to treat noncancer pain syndromes, such as headache and low-back pain, and arthritis, continues to be controversial. Most pain specialists nowadays would say that opioids might be considered in any patient who has chronic, moderate to severe pain, but generally should only be implemented if there are no other treatment options that have a favorable and safe effect. The shortest way of saying this is that most pain specialists would not consider opioids first-line treatment for chronic noncancer pain except in highly selected patients.

But we have accumulated clinical experience that suggests the following: There is a sub-population of patients with chronic pain, who can be given access to long-term opioid therapy, and they will experience sustained and meaningful control of pain in the absence of intolerable side effects and without the development of tolerance or the need for dose escalation. And they will not develop any aberrant drug-related behaviors consistent with abuse, diversion, or addiction.

Q: What about the use of opioids for breakthrough pain?

A: It looks like about 60% of patients with chronic pain have flairs that can be called breakthrough pain, and in the cancer population, the use of a short-acting opioid co-administered with a long-acting drug is the standard of care.

With noncancer pain, it’s a moving target. People are trying to figure out if it should be the standard of care or not. I think it should not. I think it should be a case-by-case decision.

Q: What are some of the risk factors when opioids are being considered? Do they all relate to addiction?

A: No. Suppose you have a patient with very bad lung disease who might be at risk for the respiratory effects. (Opioids can suppress breathing.) Or you have a patient who has severe gastrointestinal problems—where the constipation induced by the opioid might become very problematic. Or you have an elderly person with arthritis who has a mild dementia: In that case, the bias would be to try an NSAID because the opioid has a higher likelihood of causing cognitive impairment.

Q: Is the ultimate concern, though, addiction?

A: No, it’s broader than that. It’s responsible drug use, a term I use purposely because for clinicians, addiction is an uncommon problem—a very, very serious problem, but it’s an uncommon problem.

Q: So there are irresponsible uses that do not involve addiction?

A: What’s much more common for clinicians than addiction is what has been called aberrant drug-related behavior. Behaviors like doctor shopping or frequent visits to the ED [emergency department], or increasing the dose during pain flare-ups without permission. Or taking an opioid to help you get to sleep at night, or taking it when you’re feeling anxious. Or in some cases using an illicit drug, like smoking marijuana on the weekend, without telling you.

A clinician who is trying to prescribe these drugs safely ought to be monitoring all of those behaviors and trying to work with the patient so that the behavior regarding these drugs is responsible—meaning take the drugs as prescribed.

Q: It’s not as simple as saying that opioids deliver a “high,” is it? What “benefits” do abusers get from the drugs?

A: There are studies that have been done that show that in the usual person—with no history, and no family history of addiction—the typical mood response produced by opioids is dysphoria, not euphoria. But in some cases, they might be driven by co-morbid psychiatric disease—they may have anxiety disorder and realize that these drugs produce some reduction in anxiety. Or they have a depressive disorder—these drugs were used in the 1950s as antidepressants before we had any real antidepressants.

Or the patient may have a co-morbid psychiatric disorder associated with impulsive drug use—they would take any centrally-acting drug, any drug that alters their consciousness, impulsively.

There are also people who have an addiction biology, and it’s profound. I talked to a physician who became addicted to opioids, and he told me that the first time he took an opioid, it was like he had discovered something very magical about life. He said, “I knew this was my substance, this was something that I needed.” With a single dose.

Q: What is the risk of actual addiction?

A: Most scientists who work in this area think that about 10% of the population in developed countries have the biological predisposition, the genetic predisposition, to potentially become addicted. Truly addicted. Which is a huge number, 10%.

Q: If a chronic pain patient passes your various tests and is a good candidate for an opioid, what happens then?

A: At the present time the professional community is telling doctors that they have two obligations whenever they prescribe a controlled prescription drug.
Number 1: To know the pharmacology so that the patient’s outcomes—meaning the pain relief they get, and the side effects they experience—those outcomes are optimal.
Number 2: They need to do risk assessment and management to ensure that the patient takes the drugs in a responsible way, and there is minimal risk of abuse, diversion, and addiction.

Q: What does that mean for the patient’s experience?

A: Every patient should undergo a comprehensive assessment and risk stratification. The doctor takes a history and then makes a decision: Is this person at high risk or at low risk of developing problematic drug-related behaviors?

The most accepted factors that put a person into a high-risk category is a personal history of substance abuse now or in the past, a family history of substance abuse now or in the past, or a history of major psychiatric disorder. And there are many, many other factors: Current smoking, history of physical or sexual abuse.

Q: Give an example of a high-risk patient.

A: A young man who injures his back at work and has pain for six months, sees a doctor, and the history reveals that the patient binge drinks on the weekend, uses marijuana three nights a week, and has a brother who has been through detox. If an opioid is being considered for that patient, then the structure of the therapy should be very defined and very rigid, it might include any or all of the following.
An opioid agreement that is used to educate the patient about responsibilities and consequences of bad behavior
A small number of pills prescribed
The requirement that the patient returns with the pill bottle so that a pill count can be done
The requirement that the patient gets urine drug screens periodically
A requirement that the patient gets a consultation with an addiction-medicine specialist
The requirement that the patient uses only one pharmacy, so that you can track what has been dispensed

Q: What about a low-risk example?

A: A patient 70 years old develops bad knee and hip pain from arthritis, and the history reveals no personal history of substance abuse, including no use of alcohol, no family history, and no known psychiatric disease—that patient has very, very low risk of developing problematic behaviors. For that patient, a structure might be to come back in a month and provide a phone call in the middle.

Q: Sounds complicated. Should chronic pain patients seek out a specialist?

A: Only about 5% of people with chronic pain ever see a specialist. This is a type of therapy that, for 20 years, people like myself had been promoting as needing to be done by primary care doctors.

Q: What advice do you give patients who are looking for possible opioid treatment?

A: I would like patients to think, “Opioids may or may not be appropriate. But I need to see a physician who’s comfortable with prescribing opioids and also knows how to do it in a way that’s safe and effective for me. When I go into that physician, I know that I’m going to have to be honest and let that person do a good assessment. And I’m going to have to provide my records to that person. If that means that I have to have urine drug screens, so be it. If I have to sign an opioid agreement, if it’s reasonable and educational, I’ll sign it. If I have to go and get treated by a psychologist at the same time and I can afford it, I’ll do it.”

There has to be a recognition that this is a controversial therapy that takes a lot of effort on the part of the clinician, and the patient has to not only adhere to the therapy, but also has to communicate and be willing to be monitored.

Q: Given all that, do you believe that opioids are underused in the treatment of chronic pain?

A: Absolutely. I’ve seen this controversy in the U.S. going back and forth for about 25 years. This is a pendulum that swings back and forth depending on how frightened people are of addiction and abuse, and depending on how much the advocacy community gets the word out about undertreatment.

There’s a whole political and social context here that is not based on any known science. And in the 2000s we seem to have the pendulum shifting toward more denial that the therapy can be useful, more reluctance to prescribe, more concern about regulation.

Q: That’s an unfortunate swing for those people who would benefit from these drugs.

A: No question. But I want to acknowledge what my colleagues would say, many of them—that 25 years of research has yet to show the evidence that long-term opioid use is effective for chronic pain.

There have been a large number of good clinical trials, but they’ve all been either short-term or in very selected populations, or didn’t measure all the issues.

But the bottom line is that we have about 9,000 years of clinical experience showing that they can work. And you also have a consensus in the professional community of pain specialists—not just in the U.S., but also in Canada and England and other countries in Europe. You have a consensus that has evolved based on the data that do exist and the observations that exist.

The real issue is, let’s stop arguing about should patients ever get opioids and start arguing about who should get them and how you prescribe in a way to optimize the outcomes.

Q: Of course, even when drugs work, patients don’t always take them.

A: In the past 20 years, there’s been all of these new modified-release formulations, so now there are once-a-day drugs, twice-a-day drugs, patches that last three days, all for the treatment of chronic pain.

So you would think that compliance would be easier because it’s more convenient, and in some respects that’s true. But we just did a little study here, which we haven’t fully analyzed yet or published, and what we discovered in our group was this: In almost 100 patients, about 50% were non-adherent, and the vast majority of that group was undertreating.

It raises questions: Why are they undertreating? Are they afraid? Or do they have side effects? Is it money?

The bottom line is, most patients are not out there acting like [drug addicts], most patients are pushing you to give less, or not taking everything you prescribe. They’re not interested in abuse, they’re interested in getting off this stuff!

Development of new pain-killing drugs that are not addictive

US and Australian research team which has made a breakthrough in revealing how opioid drugs such as morphine both relieve pain and also cause addiction.

The scientists tested a new drug called AV411 that blocks morphine’s effects on glia cells but not on neurons, resulting in effective pain relief without the side effects of addiction.

Currently, AV411 is in clinical trials at the Royal Adelaide Hospital. And it is being developed by Avigen Inc., a Californian biopharmaceutical company.

University of Adelaide (2007, November 23). Strong Pain-killing Drugs Without The Addiction. ScienceDaily. Retrieved November 24, 2007, from http://www.sciencedaily.com/releases/2007/11/071123210617.htm

Loin Pain Hematuria Syndrome (LPHS)

Loin Pain Hematuria Syndrome (LPHS) is an extremely rare disease, where there is unexplained flank pain and Haematuria. Often misdiagnosed as a hypermobile kidney has the same symptoms. This is poorly understood condition for which specific diagnostic criteria are lacking.

Here are some facts about LPHS:

  • LPHS was first identified in England in 1967 among women who were taking birth control pills.
  • Approximately 90% of the reported cases of LPHS are female.
  • LPHS was first noted in men in the 1980’s.
  • LPHS was first noted in the USA in the 1980’s.
  • The first renal autotransplatation for LPHS was done in 1982.
  • Cases of LPHS have been reported from England, Canada, USA, India, Australia, Ireland, Scotland and Germany.
  • The age range for LPHS is from 6 to 50 years.
  • There are approximately 200 cases of LPHS in the world; no doubt, there are more undocumentated cases.
  • Pain attacks due to LPHS can occur several times per week, every few weeks, or every few months. These pain attacks can last from hours to weeks.

    Here are some guidelines to help you decide if you think you need to investigate this problem with your doctor.

  • The condition is mainly characterized by intractable pain involving the kidney and abdominal areas.
  • Microscopic blood or blatantly obvious amounts of it can be seen in the urine. Clot retention can also occur.
  • It is extremely important that physicians recognize the need for adequate pain medication for this disorder.
  • Forcing fluids by mouth or I.V. are very helpful in decreasing the hematuria and in reducing the risk of clot retention.
  • Be prepared to see several doctors and yield to psychiatric exams before you get a correct diagnosis. This is common with any disease that is not common, such as diabetes. LPHS has only been diagnosed in a few hundred people around the entire world, so this is one disease that is not likely to pop into a physician’s head.

    related articles

    Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. agrs@liver.rpa.cs.nsw.gov.au

    Some patients with the loin pain/hematuria syndrome suffer incapacitating flank pain. No effective therapy has been reported. Uncertainty persists concerning the authenticity of the pain and the role of surgery in treatment.

    Forty-six patients with loin pain/hematuria syndrome and intractable pain were evaluated following treatment either by renal autotransplantation (30 patients, 10 bilaterally) or by renal denervation (20 patients, four bilaterally) over a 13-year period.

    All patients had concomitant renal nerve excision and ligation and capsulotomy. There were 37 (80%) women and nine men aged 18 to 61 years (mean age, 33 years).

    Excretion urography and angiography were normal in all patients. Nineteen of 25 (76%) patients in whom renal autotransplantation was successfully accomplished and who completed a follow-up questionnaire were free of pain, including eight of 10 with bilateral procedures.

    The follow-up periods ranged from 1 to 13 years (mean, 8.4 years). Six patients have been free of pain for 10 to 13 years.

    Of 18 patients treated with renal neurectomy who were available for follow-up examination, 12 (67%) developed recurrent renal pain, including four who had pain relief on the other side following previous renal autotransplantation.

    The follow-up period for these patients ranged from 6 to 9.9 years (mean, 8.0 years). Three of four patients with recurrent renal pain following neurectomy were treated successfully by renal autotransplantation.

    The loin pain/hematuria syndrome is a rare cause of incapacitation, predominantly of relatively young females. The pain of the syndrome is organic.

    Renal autotransplantation achieves pain relief in three quarters of patients, but the procedure is often (30%) required bilaterally and has significant complications.

    Renal neurectomy is followed by an excessive incidence of recurrent renal pain.


    What is Loin Pain Hematuria Syndrome?

    by Marc F. Brazie, MD
    Division of Nephrology
    University of Maryland Medical Center, Baltimore, MD

    What is Loin Pain Hematuria Syndrome (LPHS)?

    LPHS is a rare kidney disorder causing attacks of severe flank pain and blood in the urine.

    Who gets LPHS?

    LPHS was first reported in three patients in 1967 who were found to have recurrent attacks of severe flank pain and blood in the urine (hematuria) in whom no other explanation could be found [2]. Since that time, it has been reported in several hundred people worldwide, although it is likely that there are many more unreported cases. It is more common in women (70% of all cases) [3-5], and has been seen mostly in the United States, Great Britain, Australia, and Canada, suggesting a white predominance. While it can start at almost any age, most patients will first develop symptoms in their 20’s [6].

    How do I know if I have LPHS?

    The predominant features of LPHS are recurrent flank pain and blood in the urine. The pain can occur on only one side or both, and may radiate to the abdomen, groin, or inner thigh. Pain episodes may be associated with low-grade fevers and a burning discomfort with urination. The blood in the urine may be overt (called “macroscopic hematuria”), or only detectible on a urine dipstick test or by examining the urine through a microscope (called “microscopic hematuria”). Up to 47% of patients with LPHS also have a history of kidney stones [7], but stones must be absent during pain episodes for LPHS to be diagnosed.

    What causes LPHS?

    As LPHS is a rare disorder, not much is known about the underlying causes. It is thought that there may be a problem with the glomerular basement membrane (GBM), which is the blood “filter” in the kidney, causing bleeding into the kidney tubules. These tubules can then become blocked by the blood cells, causing swelling and increased pressure in the kidney. This in turn leads to stretching of the outer layer of the kidney, called the “capsule,” and pain. Indeed, studies examining biopsies of patients thought to have LPHS have shown that in over 50% of patients, the GBM is abnormally thick or thin [7].

    What should I do if I think I might have LPHS?

    There are many disorders that can cause flank pain and blood in the urine, and as there is no specific test to confirm LPHS, it is considered a diagnosis of exclusion. It is very important to have a thorough evaluation by a kidney doctor (nephrologist) to be sure there is no other cause for the symptoms. This evaluation may involve laboratory tests, radiology studies, or even a kidney biopsy.

    What can be done for LPHS?

    Again, as LPHS is a rare disorder, it is not clear what the optimal treatment is. What is known is that patients with LPHS tend to have normal kidney function, which does not deteriorate over time. Thus, treatment is aimed at pain control and improvement in quality of life. Multiple therapies have been tried, all with mixed results. These include:
    • Medications such at angiotensin-converting enzyme inhibitors (a family of blood pressure medicines which reduce the pressure in the kidney and have been shown to be of benefit to some patients [8]), non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or ketorolac), and narcotic pain medications.
    • Nerve block procedures to decrease the pain signal from the effected kidney, and
    • Surgery to strip the nerves from the kidney, “autotransplant” the kidney (in which it is removed from its normal position and reinserted in the lower abdomen – this has been shown to relieve pain in up to 70% of patient in some reports [3,4]), or in extreme cases, remove the kidney altogether.

    It is best to discuss all the treatment options with your doctor, and ideally as part of a “multidisciplinary” approach involving primary care doctors, nephrologists, psychiatrists, and chronic pain specialists.


    References
    1. Dube GK, Hamilton SE, Ratner LE, Nasr SH, Radhakrishnan J. Loin pain hematuria syndrome. Kidney Int. 2006; 70: 2152-2155.
    2. Little PJ, Sloper JS, deWardener HE. A syndrome of loin pain and haematuria associated with disease of peripheral renal arteries. Q J Med. 1967; 36: 253-259.
    3. Sheil AG, Chui AK, Verran DJ et al. Evaluation of the loin pain/hematuria syndrome treated by renal autotransplantation or radical renal neurectomy. Am J Kidney Dis. 1998; 32: 215-220.
    4. Chin JL, Kloth D, Paulter SE, Mulligan M. Renal autotransplantation for the loin pain-hematuria syndrome: long-term followup of 26 cases. J Urol. 1998; 160: 1232-1235.
    5. Greenwell TJ, Peters JL, Neild GH, Shah PJ. The outcome of renal denervation for managing loin pain haematuria syndrome. BJU Int. 2004; 93: 818-821.
    6. Weisberg LS, Bloom PB, Simmons RL, Viner ED. Loin pain hematuria syndrome. Am J Nephrol. 1993; 13: 229-237.
    7. Spetie DN, Nadasdy T, Nadasdy G, et al. Proposed pathogenesis of idiopathic loin pain-hematuria syndrome. Am J Kidney Dis. 2006; 47: 419-427.
    8. Hebert LA, Betts JA, Sedmak DD, et al. Loin pain-hematuria syndrome associated with thin glomerular basement membrane disease and hemorrhage into renal tubules. Kidney Int. 1996; 49: 168-173.

  • No More secrets

    Banker hopes to help others get off drugs

    Kristi Metzger had it all: a job she loved as a bank vice president, loving family and friends, community activities, a house to shelter her at the end of a productive day.

    And a secret.

    Metzger was addicted to the prescription pain reliever Vicodin.

    After 10 surgeries in 15 years in a fruitless effort to relieve chronic pain caused by endometriosis, Metzger had almost quadrupled the maximum number of Vicodin she was allowed. And to keep her secret, she had turned into a liar.

    Now, after two stays in chemical dependency treatment centers, Metzger, 31, has decided to keep that secret no longer. She has begun talking to civic groups about her addiction to painkillers and the resources available.

    “My point is, addiction knows no boundaries,” Metzger said. “It doesn’t matter what you do or where you come from or how smart you are. It’s a very real problem, people are struggling with it, and I want to help.”

    An estimated 4.7 million Americans used prescription drugs nonmedically for the first time in 2002, according to the 2003 National Survey on Drug Use and Health. The number who used pain relievers was estimated at 2.5 million.

    Studies also suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and anti-anxiety drugs.

    “More women come to me for prescription drug use than men do, but I think the drug of choice has changed,” said Janell Christenson, a registered nurse and a certified chemical dependency counselor with Avera McKennan Hospital.

    “I can remember when it was Demerol that was most abused, then Percodan and Percocet. I don’t know the top one now, probably oxycodone or Vicodin.”

    First there’s pain

    Most addictions start out innocently, Christenson said. Generally people have an accident, injury, surgery or medical problem that causes pain and requires prescribed medication.

    Three things are required for someone to become an addict, said Dr. John Hansen, supervisor of Sioux Valley Hospital’s Pain Clinic. First is a psychological or biologic predisposition; second is a substance that can produce addiction or chemical dependency, such as the painkillers known as opiates, and third is an unrestricted access to the drug.

    That is why his clinic provides a highly structured environment in which the patient has no discretion in deciding to increase the dosage of their drug, Hansen said. In addition, the clinic offers a multidisciplinary approach providing physical therapy, psychology and associated physician services.

    Professionals can easily recognize the difference between a person with chronic pain who is properly using opiates and one who is abusing them, Hansen said.

    “People who have chronic pain who get opiates look better, their mood improves, they function more, and they look better when their pain is controlled. People who are chemically dependent, when they have unrestricted access to the meds they’re dependent on, they look worse, their behavior deteriorates, their mood can deteriorate.”

    That happened to Metzger, who cut herself off from family and friends as her dependency worsened.

    “My life was just constantly filled with, ‘When am I going to take my next pill?’ It got so incredibly bad (but) I thought I was hiding it well,” she said.

    At a high cost

    No local physician would have prescribed the number of pills she needed, but Metzger recalled something she had heard the first time she entered a substance-abuse center: Pills could be purchased online, after a quick chat with a physician.

    She was amazed at how easy it was to get her Vicodin that way.

    How costly was Metzger’s addiction? She has never totaled it up, but it easily cost her thousands of dollars to buy the pills online, she said.

    For example, the Web site my247md.com offers 120 tablets of Vicodin for $145. For Metzger, that was a four-day supply. That’s $1,015 for a four-week supply.

    When she was taking eight painkillers a day, she ended up at Keystone Treatment Center. On 30 pills a day, she frantically tried to hide her problem.

    But her family, particularly her uncle Ken Ness, president of the bank that employed her, knew something was wrong. He contacted Metzger’s parents and three brothers, and they staged an intervention after Thanksgiving 2005.

    “They had planned for me to go to Hazelden in Center City, Minn., and I just started crying as soon as I saw them all sitting at this table, and I knew that everybody knew and I had lied to them,” she said.

    After a sleepless night, Metzger’s parents drove their daughter to Hazelden.

    Metzger knew what was awaiting her, since she had been through withdrawal once before. This time, with her body’s greater reliance on drugs, it was much worse.

    “It was pure torture, the physical agony I went through,” Metzger said. “I was so sick, with flu-like symptoms. I was dry heaving; eventually I threw up the pills I’d taken that hadn’t gone into my system. The anxiety was worse than anything, and they couldn’t give anything until the pills were out of my system.”

    Metzger lay in a bed at the clinic, her body convulsed with tremors. Staff changed her sweat-soaked sheets several times. Doctors and nurses closely monitored her that first week.

    “I looked like ‘dead girl walking,’ ” Metzger says. “I was pasty white. I didn’t look like I was alive.”

    Slowly, helped by a drug that reduced withdrawal symptoms, Metzger began to feel better.

    Just before Christmas, she returned home. But the battle wasn’t over.

    All in the attitude

    Metzger’s pain had started years earlier. As a 15-year-old student at Hills-Beaver Creek High School, she was in a car accident. About the same time, she learned she had endometriosis, a painful condition in which the uterus’ lining invades the abdominal cavity.

    The condition worsened during college. Eventually, an ovary and part of her fallopian tubes were removed. As the pain persisted, and it became less likely Metzger would ever be able to become pregnant, depression surfaced.

    But she persisted in maintaining a positive front. She became a trust officer and vice president at First National Dakota Bank. She played piano, tennis and golf. She volunteered with Sioux Empire United Way, the Sioux Falls Community Foundation’s investment board and Kiwanis Club.

    And she kept swallowing painkillers.

    “I took these pills to get up, I took them during the day at work, and I took them to go to sleep, so now my life revolved around these drugs,” Metzger says.

    She realized she was addicted in July 2004, after undergoing surgery. She entered the chemical dependency program at Keystone Treatment Center in Canton in October 2004.

    But her attitude was wrong.

    “I went there very naïve, not knowing anything about addiction, thinking that this is really a fluke that happened to me, I’m not really the addict type, I shouldn’t be here, and when I was with other alcoholics and drug addicts, there was really arrogance on my part,” she said.

    That arrogance is gone. Metzger attends two Alcoholics Anonymous meetings a week, and she volunteers at a halfway house.

    Jane Pugh of Yankton serves as Metzger’s AA sponsor.

    “She has her ups and downs,” said Pugh, who agreed to let her name be used. “It’s a new lifestyle she’s learning. She’s also discovering who Kristi is.”

    To help in that discovery, Metzger has left the bank. She lives with her parents, who now reside in Brandon. She can return to a career when she knows she is healthy, Metzger says. It may be in law or chemical dependency counseling.

    Whatever it is, it won’t involve secrets.

    “I just don’t want people to worry and be scared that this could be the end for them,” Metzger said. “There are treatment centers, there’s doctors willing to help you, there’s pastors at your church. There’s resources.”

    BY JILL CALLISON
    PUBLISHED: October 6, 2006

    Accidental painkiller deaths rose 91 percent, between 1999 and 2002.

    A report, published in the online “Early View” edition of Pharmacoepidemiology and Drug Safety, listed 4,451 deaths for opioids without cocaine or heroin, while cocaine alone caused 2,569 or heroin alone 1,061 deaths.

    The deaths from opioid-based painkillers — including oxycondone, hydrocodone, fentanyl and methadone — have increased in recent years, as the drugs themselves have become more popular on the black market.

    Indeed, the profile of those who registered a significant number of accidental painkiller overdoses in the study — men in their 40sdoes not match “those of people who typically experience chronic pain, who are more likely to be female and older.”