I have a 36 y/o male with no known SA history and a 13 year h/o mid back and chest wall pain. He has MRI evidence, unchanged for several years showing a thoracic disc extrusion. His pcp recently decided to see if Percocet 5/325, qid would help him. He loves it. He has tried TESIs by another provider which did nothing to relieve his pain and says he will never try any additional injections. He has tried everything else conservative (everything-I could think of to ask) but never surgery, which he is willing to consider. He says the Percocet is the only thing that allows him to hold his daughter at night and to function. He is visibly excited that he finally found something that works for him. I discussed at length with him the risks of long term opiate use. He is un-swayed, saying, Something needs to be done. Other factors to consider: He has other pains, including neck, hip and knee pain and headaches. He is a well-built individual and mentioned that his pain is worse when he works out. I want to do what is best for him long term but also feel some obligation to accept his autonomy. He knows the risks, he knows the alternative treatment options How do you handle this situation?