for what? no pass from me.
this is a patient that has no discernible pathology, negative studies on imaging multiple times. has tried blocks. has tried RFA. no benefit to any (suggesting that cervical spondylosis is not present or treatable)
"working" as a self-employed contractor, who admits that his clients would not hire him if they knew he was on opioids. concerning...
clearly tolerant. clearly dependent. having withdrawal symptoms that occurs when he is 1/2 day short.
he makes comments about doctors messing up but alludes to the fact that he never does. blames them throughout the interview - never his fault. also, he outright admits that he lies to his doctors.
he is relying solely on opioids for "relief", has no concept that this relief that he might be getting is illusory and temporary. says he might be interested in CBT/psychology, but does not ever explore or talk about using this avenue (comments how he thinks it is interesting but it wont be able to cover his pain, doesnt ever say he has tried or is using it. also, being psychologically dependent on opioids means that he has never really utilized CBT)
he is getting max 2 hours per dose of opioids. on 110 MED (assuming he calculated it correctly - we dont know for sure). his lowest level of pain is a 6. last 2 hours are miserable between doses. feels this is not enough, and he needs more but he is worried his doctor will cut off his supply. he feels he is being noble by not taking extra - when this is a sign of tolerance and lack of benefit from said dose.
he and she do not feel that this is any way close to an adequate amount, and even if given whatever he needs, he doesnt feel he would ever get back into society.
she expresses some possibility for CBT, but clearly both of them do not believe that this should be the primary treatment, and relying on opioids is appropriate in their minds.
lots of denial.
- classic line = "other people are ruining it for the rest of us." denial in that addicts wouldnt jump through the hoops that they do to get opioids.
- denial that he can do things without the meds. yet he does know that he cannot do anything like watch a movie without his pills
- they are in denial in that she knows it is not hard to identify drug abuser from someone who is not.
- also denial - quoting that only 3% of chronic opioid users are addicts.
- defers on answering whether he knows that there are side effects from the medication.
he is an addict, regardless of her protestations.
this gentleman is managing his life and psychological issues through opioid medication.
finally, ironically, her biggest fear is that she will lose him to suicide when he wont be able to get his opioids. one can argue that she lost him a long time ago to the same dope.
fyi to those interested, i spent only an extra 2 minutes after listening to the segment typing this note....
