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then you realize that many patients self-medicate while taking opioids including methadone....
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the lack of alternatives is a common limitation, but falling back on opioids is not the correct answer. your answer seems to suggest that someone who has failed everything is automatically a candidate for a narcotic.
these make up the vast majority of my referrals.
what I tell them is that the treatment is worse than the disease, and while chronic pain could cause quality of life concerns and functional limitations, opioids will cause both, and will lead to multiple iatrogenic effects. it is not in their best interest to be put on narcotics for the rest of their lives.
i tell them people can have good quality of lives while having chronic pain. pain is a subjective experience. that's what we need to focus on, and work on.
some times the best thing to do is "nothing". at least nothing medical or interventional.
funny thing, and I know you are thinking about this - but the vast majority of people come back for follow ups.
except for the addicts.
Let me clarify, I have about 3 patients on methadone. Opioids are far from a panacea and are not indicated for everyone who has failed more conservative measures but there's a time and there's a place.
I honestly hope that if I or any member of my family is suffering from chronic pain the way some of my patients are, I can find someone with a similar mindset to the one that I have. I am sure and I hope you feel the same way about yourself. Either way, it'll probably get annoying and boring to go back and forth so let's agree to disagree. You are welcome to have the last word if you'd like.