Her doctor might be able to refer her to a pain clinic. When I had sciatica a few years ago and nothing seemed to help, I went to pain clinic. It was staffed by a couple of anesthesiologists. They injected a long lasting medication and the patients came back every few weeks for more injected medication.

joann- You have a hard problem to deal with...
I do feel for your sister- she probably does have real pain sometimes, but if she can't use Rx meds responibly, she could be in real danger.
A riend just had a friend of hers die a few weeks ago because of overdosing on pain meds. She too, was using the pain meds inconsistantly.
I would suggest that you get her into a long term rehab program before she kills herself when binging.
Call the hospitals near you to see if they have programs for the pain/drug addiction. You tried talking to her, but because she is addicted, she does not want to 'hear it'. You may need to become pushy- for her own good. Your own good too- it is emotionally draining on you to have to be thinking about this all the time.
It won't be an easy road, but needs to be done.

I too, need to use strong pain meds- but I have always been stingy using my meds. I have had to use them for 10 years now. This spring, when I had pneumonia, I had to be on high doses of steroids. My pain was so diminished because the steroids decreased the inflammation in my back, that I rarely had to use pain meds or a few weeks.
It proved to me that I wasn't addicted, which made me happy. Yes, you are right, about 3% get addicted- but somebody has to be that 3%, making it hard on the patient and family.
Be strong and try to get her into a longterm program.
Good luck- I will be thinking about you both.

Real pain Stinks. You maybe dealing with two issues here. Alcohol abuse or addiction and pain medication addiction. Plus the fact that she is in REAL pain and needs the pain medication. She needs some intervention where she can get off the alcohol and pain meds that Aren't doing her any good and then getting her on some that will do her some good. Her family and friends may have to step in and get her into a program away from home in a facility that can help her. It will not be over nite. When one is in physical pain it is sooooo easy to grab anything to eliviate the pain and before you know it you are addicted, then you have two problems. No one understands unless they have been there.
Think intervention and drug and alcohol program away from home...the only way I think.

I feel for her and you and the whole family. It is not an easy road.

Darleen

Just my theory but I think people with mental health problems perceive pain differently than those who don't have mental illness to deal with.

For example there has been some writing done on how many people who suffer from fibromyalgia are often also bipolar.

DH is bipolar and seems to have a much lower tolerance for pain than most when he's down. When manic they feel less pain and end up injuring themselves more frequently and the cycle continues. Fortunately he takes his meds and usually trusts me to tell him when I think he needs to adjust his dosage or the time he takes them.

So if she is not taking whatever meds she needs (or they need to be adjusted) she is not only treating her perception of how bad the pain is but also self-medicating her head with the narcotic pain relievers.

The real solution is get her mental health issues addressed. If her brain chemistry is out of whack so will her ability to deal with pain both real,perceived and a combination of the two.

The pain is real. A pain clinic may be able to help also but they need to be aware of her history of over-medicating so perhaps they can find a method of pain management that has no "street value".

Wildchild is on to something. Drew Pinsky says that addicts perceive pain as a response to a positive experience to previous drug usage. In other words, for both biological, and psychological reasons, these vulnerable people perceive the existence of, and the severity of pain differently than most of the population does. I see this all the time at work, some of the people who have become addicted to pain meds have relatively minor physical problems according to their medical reports (which makes me wonder why the doctors prescribe such strong medication), and then I see people with fairly severe problems who have a resistance to taking meds. The issue gets more cloudy as the medical condition gets more severe. I've seen many clients, and other people O/D on prescribe medication, and it's scary. I hope your sister accepts help.

What is the cause of her pain?

The problem is, she's in real pain. She had a long list of verifiable physical problems, any of which could be enough to warrant narcotic pain meds.

snip

(She's tried all sorts of alternative treatments (acupuncture, massage, acupressure, chiropractic, etc.), without success.)

Has she ever really tried to get to the root cause of the pain? It would be my 'guess' that a good surgeon could help her. You don't mention her ever having physical therapy. Is there some reason why she has not had that?

More details please.

Sue

Wildchild, I think you're exactly right. (And that's brave of you to say, too.) My sister is bipolar, too. She is pretty good about taking her meds and staying in treatment, but the doctors have always had a hard time treating her. She is depressed most of the time, with periods of mania. She's tried virtually every drug they use to treat bipolar, plus several rounds of electroconvulsive therapy.

Susan_on, that quote from Drew Pinsky was a lightning bolt for me. That's *exactly* what I think about her. She doesn't bring the problems on herself (kidney stones, car accident where the other driver was cited, etc.), but she is pleased when something happens, because it gets her attention and narcotic drugs.

It's hard to judge someone else's level of pain, but I always wonder. For example, right now, there's something wrong with her hip. The doctors thought it might have been fractured, but it wasn't, and they are thinking it's just a pulled muscle. I watch her - it's painful for her to walk, and she has to adjust herself to sit comfortably, but she'll watch television for hours without pain. It doesn't seem any worse to me than when my hip bursitis flares up - quite painful, but certainly bearable. It would never occur to me to use narcotics for my bursitis, but she immediately reaches for them.

Sue, yes, she's tried to get to the root of the pain. It isn't any one thing. At one point it was her shoulder. She had surgery, it got better ... and then there were kidney stones. They passed, she got better ... and then something happened to her hip. She goes to the doctor, does physical therapy, tries alternative therapies, but something else always goes wrong. And she always asks for something for the pain. I'm not at all convinced that getting rid of the pain would take care of the problem. In fact, I'm pretty much convinced otherwise.

I don't know that she's physically addicted, simply because she doesn't get enough of the medication. She certainly has a tolerance to narcotic pain meds, but so does anyone who takes them long-term, addicted or not. She misses the drugs when they're gone, but never has any sort of detoxing symptoms. (I'm intimately familiar with those, from watching my addicted clients when they get locked up without their drugs.)

She won't agree to hospitalization or treatment of any kind, and she's not at a point where she could be forced. She goes to work every day, her daughter is well cared-for (by me, when she's on a drug binge), she keeps her doctor appointments. No court would find that she was a danger to herself, and I don't really want to do that, anyway. I've spent a lot of years trying to save her from herself, and finally got it through my head that it's not helpful.

Linda_in_Iowa, I spoke to my doctor yesterday, and she recommended the same thing as you did. I've got the name of a pain clinic, and I suggested that she go. We'll see.

All I can say is, you and your sister and her main doctor must sit down together and really discuss this. Surely there must be something she can take that is effective yet non-addicting.

Oh, we've discussed this! My sister claims that NSAID and muscle relaxers do nothing for her, and that the only thing that works are narcotics.

My sister claims that NSAID and muscle relaxers do nothing for her, and that the only thing that works are narcotics.

Where is her pain now? What is causing it? Is it just one doctor that has prescribed the narcotics over a long term? Is it same same doctor that prescribes them with each new thing (pain) that she gets?

The pain this time is in her hip. No, it's not just one doctor. Our regular doctor refers her to specialists, who then prescribe the medications. The specialists are relatively free with the medication, and I think legitimately so. They're dealing with people in serious pain, and statistically, the risk of under-medicating people with legitimate need for pain meds is *way* higher than the risk of over-medicating someone who's prone to overuse or addiction.

The doctors keep tabs on the medications. They won't give her a refill until the correct time is up, and she never calls to say she's "lost" her prescription. What happens is that she uses them correctly ... until she doesn't. Then she doesn't use them at all, until the next injury.

The doctors keep tabs on the medications.

But, does each Dr know what the others are prescribing?
Do they notify her regular doctor with each new prescription...and does he know that she is getting narcotics from several sources?

Addicts will use the medical system by having several doctors prescribe, instead of trying to get all their drugs from a single source who might cut them off.

I used to go to a pain management program designed to teach me to deal with pain without meds, after I was in a serious MVA. This was at my request because I HATE pills. There are many, many techniques, and not all of them worked for me, but I found things that do work. It takes commitment and drive to do it, and it's not for everyone, but it sure was worth it for me.

I really don't think anyone is giving her too many pills, or that she's getting them from more than one source. She goes to one doctor at a time, as the incidents occur. I don't think she's addicted, either. It's misuse, rather than addiction. In a certain sense, addiction would be easier, as it's more straightforward.

As of today, both our regular doctor and her therapist have recommended a pain clinic in our city. I think she is going to go. I'm pleased that she actually mentioned this to her therapist. (She says they talked about it for her entire appointment.) She's never really accepted that there was a problem before.

I think what got to her this time was that yesterday, she was talking about a conversation she'd had with a neighbor, wondering whether she'd sounded dopey, and Chloe started imitating how she'd sounded - slurring her words, hard to understand. She could dismiss it when it came from me, but took notice when it came from Chloe.