Chronic pain is a complex issue

Dear Dr. Roach: My 63-year-old husband has been on painkillers since 1994, when he tore his ligaments around L-5/S-1. He had back surgeries in 2002 (fusion and hardware) and 2005 (remove bothersome hardware, and two weeks later, emergency debridement surgery for infection).

Over the years, he has taken every form of opiate out there, and when workers’ compensation decided to stop paying for his OxyCon-tin last year, his pain management specialist put him on buprenorphine 2 mg, twice a day. Nothing really helps. He also takes gabapentin for neuropathy.

His pain doctor has now retired, but the doctor’s associate keeps prescribing the tablets each month with no discussion of trying to wean him off. I’m not sure if these meds were intended to be for life. He has never abused the dosages, but he seems to think that if he were weaned off the medication that he would be in an unbearable amount of pain.

Otherwise, he is in excellent health. We eat well, do yoga and Pilates, and ride our mountain bikes several times per week. — R.A.

Management of chronic pain is a complex issue. One study found that chronic opiate use did not actually reduce the pain the person is in, at least by self-reported pain measurements. Over time, the body adjusts to the amount of pain medication. On the other hand, there are some people who have much better pain control on opiates, so an experienced pain management specialist must use his or her best judgment, and sometimes a trial of reducing dosage is appropriate. Gabapentin is a common treatment to reduce overall pain. However, it is important to recognize that complete cessation of pain is unrealistic, and keeping the pain manageable and keeping up activity are appropriate goals.