Michael’s story shows how he had to withdraw from opiate narcotic medication as a necessary first step to managing his pain. His history illustrates the complications which may arise from chronic low back pain — particularly its potential to produce habituation to potent narcotic drugs.
Michael’s story also shows how someone’s conviction that there is a surgically correctable cause for their pain can lead to obstructions to becoming a well person again.
‘My head went through the window and my feet went under the dashboard. I was aware of pain in my right knee and found that the ignition key had driven through the cartilage of my knee, ‘ recounted Michael, 26, a doctor.
Michael had a legacy of chronic back pain from the accident which happened on his way to work in the early hours on a wet morning when driving conditions were treacherous and a taxi sped through a stop sign.
‘It all happened so quickly. It was just a blur and then my car was hit and went out of control into a power pole. I arrived in hospital by ambulance but was able to walk into casualty where I was supposed to work the next week.
‘Three days after the accident I noticed back pain. At first it was in the middle of my lower back radiating out to my right hip. I also had pain on the left side slightly higher up which radiated into my tail bone. But I was determined to get up and about.
‘Within a week I was on crutches and discharged. A week after getting back to work, my back was sore so I consulted the orthopaedic surgeon on duty. X-rays showed I had a mild crush fracture.’
Michael began to realise he had the beginnings of a long- term pain problem.
‘I had a week off lying flat on my back. It didn’t help. I had various treatments including TENS therapy, and then a full plaster jacket.
‘I kept on trying to work wearing a low-back brace. But my back was still bad. Then, in virtual desperation, I agreed to have a spinal fusion operation.
‘The convalescence meant being an in-patient for two weeks and then having to wear a brace. I still had persistent low-back pain. At times it was excruciating backache down the centre of the spine.
‘It hit like lightning . . . Because I continued to have problems, I was referred to other specialists who gave me powerful medications including Percodan, Fortral injections and Palfium (a highly addictive narcotic drug).’ While this would make him feel euphoric, the back pain continued to dog him. He was even given morphine and pethidine injections without benefit and with increasing tolerance to very large doses.
His pain was becoming more agonising and his left leg felt strange. He was next given Methadone. When that had little effect, Omnopon, another potent narcotic, was tried. In growing desperation he returned to the surgeon who had originally operated on him.
Infection of the operation site was excluded by a radioactive bone scan. But Michael was still in agony. He believed that one of the injections used to diagnose his pain (a myelogram) had caused him further problems by affecting nerves in his back.
Before coming to the pain clinic 18 months after the accident Michael had seen various other doctors. Nerve blocks were performed, without avail. His main concern was about taking Omnopon three times a day. He had been taking potentially addictive medications for a very long time to help him through each day, despite which he had worked as a hospital intern on and off.
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