I started Frank's case in early May of 2013. Frank was a 43 year old out of work carpenter. He had injured his lower back after falling about 12 feet off some construction staging (scaffolding). Frank's DOI was in 2005 and by the time I had received his case it had already settled. Prior to his case settling Frank had been through the normal treatment pathways which included activity modification, oral medications including opiates, physical therapy, and interventional pain management (injections).
None of these treatment modalities were terribly effective in resolving his pain. Ultimately he was connected with a pain care center in Massachusetts for chronic pain management. He was given narcotics every month without any other treatments. When I met Frank he was taking 120 mg of OxyContin per day which is 180 mg morphine equivalents. The cost per month was about $800 for just the opiates. He had been on these meds for three years. The insurance carrier would have paid close to $28,800.00 over the three years he was taking OxyContin. Monthly urine toxicology screens are about another $900.00 per month.
His physical exam showed a significant reduction in lumbar motion with diffuse back pain, an abnormal gait pattern, and guarding. Physically he was very deconditioned from lack of activity due to pain. His doctor opined that Frank might have an element of opiate induced hyperalgesia (OIH) and recommended tapering off his meds and getting into detox. Frank was set up to get into detox but decided not to, and stopped his meds on his own.
Frank went through opiate withdrawal on his own at home. He and I were in contact every day for about two weeks while he came off his meds. Sometimes we were in touch several times a day. By late May, Frank was off his opiates. His pain had initially increased slightly and then started to decrease slowly.
As the next several weeks went by Frank’s pain became less and less. In mid-June Frank called me one day and said he had actually slept through the night for the first time in 8 years! Normally pain would awaken him at night. With his pain reducing, his doctor and I had Frank start aquatic physical therapy which progressed to land therapy. Frank’s pain continued to decrease during the late June and July (2013) time frame.
By the end of July Frank had transitioned to a home exercise program and was doing very well. In late August Frank and I went back to his doctor for one last follow-up. He was completely pain free. His lumbar range of motion was normal. His exam was unremarkable. He was given a full duty work release on 8/26/13, and was able to return to work shortly thereafter.
As you can imagine Frank was to say the least very happy. All of his pain was gone. All he had to do was stop taking his opiates which were keeping him in a pharmacological prison of sorts.
Frank likely had OIH. Following this recovery Frank resumed what most of us take for granted. He started dating, found a girlfriend, became socially active, and rejoined the work force as a productive member of society. It’s a shame that his pain management providers at the pain care center just outside of Boston didn’t realize what was going on. This makes me wonder if the pain management provider was missing things or was this a way of keeping someone on meds for a revenue stream into the medical practice.
Frank’s story is not representative of what everyone on chronic opiates will experience but his story does demonstrate what is possible for some people. Every so often I check in with Frank and he is doing just fine.