Pain and Suicide: The Other Side of the Opioid Story

A former patient whom I'll call Jack came to me for help after three back operations. He was on disability because of his pain. I treated him for about four years, struggling all the while to get his insurance to cover his therapies. I tried to get him to see a psychologist, but his insurance would not pay for the service. He was on what most physicians today would term a high dose of opioids and other medications. I wasn't convinced that the higher dose was any more effective than a lower dose. He was mostly inactive and reported little improvement in pain or function while on his medication.A device was implanted in his abdomen to deliver medication directly to his spinal canal where it could be more effective, allowing me to reduce or eliminate his oral dose of opioids. I began to reduce his opioids per our agreed plan, but as we began the taper he claimed his pain was too severe. He simply could not tolerate the pain. I insisted that we had to reduce his medication, that the medication being delivered to his spine should allow us to provide pain control equal to or better in effectiveness than the oral medications. He had never over used his medications. He had never showed any signs of drug abuse or …