Opioid Addiction and Dependence, A True Story
The management team promised that the customer's new computer equipment would be up and running by Christmas. That gave the technicians only a few days to install racks of heavy servers wire it up before the holiday.
"What started out as an ordinary day at work turned into a day I would never forget," one of the techs explains. "Waiting in the frigid cold of the customer's computer room, I debated on what to do when my coworker failed to show up." The install was supposed to be a team job due to the awkward size and weight of the equipment. "It was the last day of the installation and the job had to get done by close of business."
"I had no choice but to tackle the two-man job of lifting the equipment by myself. This turned out to be a decision that affected my life from that day forward."
The worker hoped the pain was only temporary. He suffered through the holidays using over-the-counter medications like Tylenol and Advil. These proved to be ineffective against the increasing pain in his lower back. By New Year's, he was in excruciating pain. He scheduled an appointment with his doctor and was advised to open a worker's compensation injury claim.
Physical therapy was the first prescribed treatment. Somehow, they decided that exercise would help. This remedy caused more pain and didn't address the injury. For the Workers' Compensation process to continue, it was a required step.
The doctor recommended back surgery, however, a battery of less invasive procedures were required to be completed before Workers' Compensation would authorize the Endoscopic Lumbar Discectomy. After nearly a year, it was finally approved.
The worker says, "After the minimally invasive back surgery my pain was manageable only if I limited most activities like walking and didn't lift anything heavy. As time passed, the back pain increased with such magnitude I went back to the doctor. This time the medications failed to reduce the agony of three herniated disks."
The patient was diagnosed with failed back surgery. The cushioning effect of the discs no longer existed and as the bones began to wear against each another, the result was grinding and consistent pain. The only solution that would remedy the root cause of the pain was three level spinal fusion surgery.
But despite the evidence shown by the MRI and multiple X-rays, the insurance company refused to approve the recommended surgery on the L3, L4 and L5 vertebrae. Instead, he was referred to a Pain Management clinic that prescribed stronger pain killers and more physical therapy exercises that were too painful to perform.
"Discectomy is surgery to remove herniated disc material that is pressing on a nerve root or the spinal cord.— Web MD
Stronger Medication Added
After two long, painful years of appeals to the Texas Worker's Commission, wading his way through the required paperwork, the worker lost his case against the insurance company representing Worker's Compensation. They refused to approve the surgical procedure prescribed by an orthopedic surgeon.
During those two years of waiting, the patient developed an increasing tolerance to the effectiveness of the medication he took daily. With no other medical solution, the Pain Management Specialist steadily increased the doses and types of pain killers prescribed to keep the patient mobile and able to hold down a full-time job.
As the pain relieving effects wore off each drug, the doctor added more pain medication. Eventually, the patient was taking a daily combination of Hydrocodone, Valium, Robaxin, Oxycodone (Percocet) along with Fentanyl Transdermal patches that began with 25 milligrams of strength and increased to 75 mg. over time. Soon, they added Hydromorphone, a powerful drug used to anesthetize patients during surgery also known as an opioid pain medication also considered a narcotic.
The Effects of Medication
Before surgery was finally authorized, the injured worker's legs, ankles and feet swelled to double their normal size during which he continued to work a full time schedule. He considered himself lucky that his job could be done mostly telecommuting. At this point, wearing regular shoes was impossible due to swelling.
Soon, he became less mobile and experienced shooting pains down his legs, even when lying down. This prevented him from sleeping in a regular bed. He avoided the shooting pain by sleeping in a chair sitting upright.
Medication was prescribed to address the shooting pains in his legs and the swelling which was diagnosed as lymphodema due to minimal circulation from remaining upright twenty-fours a day. Soon more medications were added to the mix: pills to reduce swelling, to increase circulation, to relieve anxiety, to address the ongoing pain.
X-ray Post Surgery
Finally, the day of surgery for spinal fusion arrived, thirteen years after the original injury. Three-level spinal fusion surgery was prescribed to relieve the nerve pain and to stop vertebrae from grinding against one another. A framework of Titanium rods, pedicles and screws were surgically implanted into the actual bones through a fourteen inch incision in the patient's lower spine, .
In the Intensive Care Unit
The Neurosurgeon confided that the Anesthesiologist was seriously concerned when the patient required four times the normal amount of anesthesia before surgery could begin. This was a result of resistance to the medications that had been taken for so long.
The rehabilitation process after surgery included a short term stay at a rehabilitation hospital. Every movement became an exercise in endurance and stamina. Under the strict supervision of nurses who rationed the drugs during rehab, it became painfully clear that the patient was hooked on painkillers.
The results of these medications included memory erosion, foggy thinking, shortened attention span and a volatile state of emotions whenever the next pill would come due. At that moment, a new journey began trying to break free from this dangerous and addictive medicine.
The Patient's Struggle to Get Off the Meds
"This has been the most difficult struggle I've ever faced including the pain of the fourteen inch incision in my back held together with staples, performing the physical therapy to stand and walk again, and even worse, aspirating the wound to reduce the post-surgical swelling. But none of this was as difficult as the physical and psychological pain of withdrawal from narcotics.
"Reducing the doses and getting rid of the Fentanyl patches turned out to be incredibly hard as going without them resulted in episodes of anxiety, distress and sleeplessness. Over the past year and a half, with perseverance and a lot of self restraint, I stretched out the frequency and doses of medicine a little at a time and finally stopped taking the strongest medications altogether."
"For the first time in over two years, I've been without a patch for nearly two weeks. The episodes of anxiety attacks where I feel like crawling out of my skin have not stopped completely, but they are becoming less severe with each return incidence. I'm sleeping through most of the night and have returned to work, finally able to clearly concentrate on my technologically challenging job in the computer industry.
I look forward to the day when I'm completely free of these seriously addictive prescription drugs."
Lumbar Spine Surgical Procedure
Opioid dependency and addiction is a serious issue that has become the topic of much discussion. Legislation and more regulations have been aimed at the soft targets, doctors, who are accused of creating this epidemic. But it's not entirely their fault.
In reality, it's a result of the insurance companies trying to save money by denying claims and making their clients wait for much needed surgery, as it was in this case. When people become addicted to pain medications they will turn to any source to relieve their withdrawal symptoms, including street drugs.
© 2013 Peg Cole