Dependence Does NOT Equal “Addiction”


One thing to know is this …Physical dependence and tolerance are “NORMAL” physiological consequences of extended opioid therapy for pain and should NOT be considered “addiction”….(*FROM “Michigan.gov)determination-quotes-2b65cd82f385b22d6dd21fd2f9ce5bf9f

Hello Luvs,

Today I have so much on my mind and I have a lot of information to share with you. Most of the information that I have is from my own support group, my own experiences and Internet sources (which I will list).  I was in a Motor vehicle accident in 2002. I have been through so many medical issues due to that accident. I have suffered through 8 years of PT/OT, 3 years of MTBI rehabilitation, approximately 10 surgeries, worsening Dysautonomia/POTS/NCS, a CVA (stroke), Mild Heart Attack and just too much to list here today without boring you to tears.  I have chronic pain and along with that, my body ended up with a Neuro-autoimmune disease called “Complex Regional Pain Syndrome Type II”. It’s also known as “Reflex Sympathetic Dystrophy type II”. Some people will call it “RSDII or CRPSII”; as there are two types of this disease: type I is from an Unknown etiology and type II, the one I suffer with, is a result of a Foot surgery in 2007, 5 years following the car accident. My type is also called “Systemic”, which means it is in my body pretty much everywhere now. That happened by accident through years of it’s continue spread.  Then following my 2nd pacemaker surgery in 2013, the absolutely wonderful Neuro-Cardiologist, who did the surgery researched the disease and found that sometimes a surgeon can help prevent the disease from spreading or going systemic, by doing an internal surgical wash of “Bipvucaine”. I was hopeful and happy. I just knew it would work. The fact that he cared enough about me to even try that, made me just feel so happy and cared about. But unfortunately, it did spread and mine is now systemic.

At first I was tested, re-tested, Neuro-Psych tested, Psych tested, Pain clinic tested and given just any and every kind of test available. I had several specialists including:  a Physical Medicine and Rehabilitation physician, G.P, Neurologist, Cardio-Neurologist, Cardiologist, Psychologist, Neuro-Psychologist, Orthopedic specialists of different types and more! I ended up being hospitalized for “Pain control” by the  G.P.that I had been seeing since 1986! When a newer physician in his office came to see me and he was quiet and kind and really seemed to “listen” well etc. I asked if I could “switch” over to him, as it was the same office. It was all good and I had been referred to a pain specialist, Dr. D. Dobritt in Michigan. He helped me for 3 years and I did everything asked of me. I even got a medical record letter from the Pain Pycshologist and Psychiatrist Dr’s that he uses, stating that I do not have an “addictive personality”. I never smoked, drank or did any recreational drugs. I barely ever took an Aspirin if I had a headache prior to that car accident!

I stopped going to the pain Dr. because he told me that he wanted me to have an “Intrathecal pain pump” surgically placed into my spine, which would drip 1/300th of the amount of oral medication I would need. But I had been in an auto accident and I was tired of “fighting” for everything I needed with them. I did win a lawsuit and I was put into “Catastrophic claims”; but still could not get them to pay for the pump. I surely didn’t have the money and my regular insurance would not pay since it was not their place to pay for auto claims. I was going to try the pump trial at least, just to see what comfort it might give me. The auto insurance said “NO” and I’d about had enough of IME Dr’s and fighting for what I needed. I gave up and quit everything finally after 8 years of PT/OT and 3 yrs of TBI rehab and about 10 or more surgeries. I think I told you already that I’d been tested by the Psych Dr’s at the pain clinic and they gave me a medical record letter stating that “I do not have an addictive personality”.  It’s true and even when the Dr’s gave me Vicodin and other meds to try and help my pain, I suffered through the pain and always took less than what I was prescribed. The Psych Dr. even wrote in my letter that “Suzanne does not want to take the medicine for pain as it is prescribed, but instead tries to get by with less”. He continued by writing that He told me to take the allowed or prescribed amount and “not to worry” about it because the Dr. has prescribed it for me.  Well, if you know me at all, I’m a person who does not like being “controlled”. I did not ever want to be feeling “controlled” by some medicine or feel “married” to my pain Dr. !!  As time went on though, I didn’t just suffer from the events of the car accident. I acquired a very painful or the “MOST” painful of all chronic pain diseases, called “RSD- Reflex  Sympathetic Dystrophy” . I was first diagnosed with CRPSII by the surgeon who performed the foot surgery. I got a second opinion only because I’d never heard of that disease before and I just wanted to be certain. I got a 2nd opinion from a well known staff Physician who specializes in Orthopedics of the foot/ankle. Then I got a 3rd opinion and 4th opinion. My pain got worse and I was forced to take the medicine prescribed for me.

When I chose to not get the pain pump, that pain Dr. told me pretty much to “get lost”. No, he did not use those words, but that is how it felt to me. I always was a good patient and did all that I was asked to do and tried to do it even taking less meds than I was allowed to take. He would not even talk to me again or let me set up an appointment, but instead, he had his physician’s assistant, Jim G., give me the news.  He called and told me to “just go ahead and have my General Practitioner, Dr. Pete Bullach Jr, take over prescribing the pain meds because he, as a pain Dr., is “under a microscope” and prefers that the pain meds are not provided via his office. He said that “Dr. could consult with him any time needed”. He told me not to make another appointment because “there was nothing left he could do for me and my pain”. I was devastated because I felt that we had a good working Dr/patient relationship. I felt believed and I believed in him. But as usual, I just did what I was told to do and kept seeing my GP and he did the prescribing.  Unfortunately as my pain got worse due to more surgeries and the spreading of the RSD/CRPSII, and the new diagnosis’ of R.A., Chiari I malformation, Degenerative Disc disease and now Hypermobility syndrome III and more, the doseage was just increasing.  Dr. Bullach just increased my pain meds and offered me no other future or help for the future.

The past 3 years, I was asking him to take me off or down from the pain medications. I was afraid that I was taking too much even though it was helping. He told me time and time again that I should “just let him worry about it”. He also told me that the medications “got me out of the hospital bed that was in my living room” and I “don’t want to go back to that”! He told me to “let him worry about the pain meds and just continue to do what he said”. Every time I would bring up trying to go down in doseage, he would tell me to “just let him worry about it”! He even told me that he had a plan worked out that when he felt ready for me to go down on my pain meds, that he would just put me into the ICU at the main hospital. He would “knock me out” for a few days and they’d watch me carefully because of a previous CVA and heart attack in ’05 and ’06. When I awoke, I would be “off of the medication” and not have to go through any withdrawls, or at least not remember or feel it at all. I would be safe and watched in the ICU. In no way did I feel like I was an “addict” or a “bad person” at that time. I felt that I was doing everything I was told to do by a Dr. that I trusted with my LIFE and my husband’s LIFE!

Well, from my couple of previous posts about this subject, you can understand how totally betrayed and flabbergasted I was in December 2014, when with only 2 days notice, I was told that Dr. Bullach “was leaving and going to work at an Urgent Care an hour away in Jackson, MI”. Later I’d find out that he’d known about his new position since October 2014, but failed to share that information with me and many other of his patients.  In October I had even brought him a letter from my medical insurance company, stating that they would not pay for my pain meds any longer in the doseage that he was prescribing, after March 11, 2015; unless a certified pain Dr.agreed with his treatment plan. I brought and showed him that letter in October and he told me “not to worry at all”.  He said that he “would personally speak to my old pain Dr., D. Dobritt, and he would send a letter explaining everything to him and some of my records that he would need.”  He told me that I had nothing to worry about, that he would “take care of me and of everything”.  When I walked into his office that December day, in 2014, you can imagine how blindsided I felt.  Then later to find out that he was investigated by Federal marshals or agents (I found this out from a legitimate source or several actually)for over medicating many of his patients and he was actually “fleeing” to get out of trouble before trouble came to him first!!  He fled to an Urgent care facility where he’d be incapable of writing such prescriptions again. He lied straight to my face telling me how he was “working too much and he missed his sons and he was going to work someplace else to be able to free up time and be with his wife and kids more often”. It was a bold face lie, he betrayed me and it feels really awful.

I went to the pain Dr. appointment on Jan 2, 2015 and in my previous posts, I think I already explained what happened. I told him that I did not want to and would not go to a “Detox” clinic. That was not what I deserved after being told even by him several years ago to “trust him” and “take the meds prescribed” and that “it was OK and it was safe”. I am a strong and motivated person. I’ve been through alot of terror and frightful experiences, including painful ones. I can do this and I will do this. My husband called and made a second appointment for Dr. D. Dobritt, the pain specialist. He told the secretary that I’d been going down on my own, with the pain meds and that I’d gotten down at that point, at least by 75% of what I’d been taking at the time of my visit one month prior!  I went to my scheduled appointment that was at 8:00 am on Feb. 16th, 2015. If you know anything about pain, you know that is very very early for someone who has a hard time just putting their feet on the floor in the mornings, due to extreme pain. Add into the equation 75% less pain medication and you have a woman in some real pain, but a determined woman who was doing everything on her own with the love and support of her husband. When I arrived at the pain Dr. appointment, they let me sit in the waiting room for about 1/2 hour, only to find out that “the Dr. will not see me”!  What??? Why?? Why would they let me make the appointment? I smelled something rotten going on there and it was an awful feeling.  I had some young office girl tell me that the Dr. refused to see me “unless he had a letter signed from the DETOX Dr. (*Dr. H. Malinoff) that he had recommended that I see at my last visit”.  I told the girl that I’d already gone down on my own 75% or more! I told her that I didn’t need anyone else’s help. I was not an “addict”, I would Never take Methadone or Suboxone and after researching that Dr. who Dr.Dobritt wanted me to see, I realized that he was not for me! A person who is on SSDI for PTSD and who’s suffered at the hands of numerous “bullies”, just did not need another “bully” (Dr.) in her life! I read 16 reviews of this physician. ALL 16 were really bad reviews! People said he was “Dr Jekyll and Mr Hyde” and that he “put them into tears by calling them names”. I don’t go by reviews usually. I know that disgruntled people or patients will write bad things when they don’t get what they want sometimes or when they are angry! I don’t put alot of heart into what I see usually when others write bad things like that about Dr’s or places even. I know that there are disgruntled pain patients out there who want more meds and when they don’t get them, they go to the computer and write nasty things about the person who didn’t get them what they wanted. I know this is true of SOME, but not of ALL!  I know this because I am one of the valid/honest writers & readers not asking for anything except the truth and peace.  I’m not being vindictive in any way.  This is just a venue to allow my readers and other pain patients hopefully, who are like me, to know the truth of what has happened to me and what can happen even to honest and good people.

This “detox” Dr., as I read more about him on his own website; told of a story how he broke his foot and “walked on it for 3 months.” His wife finally forced him to go to Orthopedics and he had a surgery. He tells of how he “went through all of this without taking any pills for pain”.  He also stated how if someone wakes up in the morning, puts their feet on the floor and they have “no pain”…then they should “look in the Obituaries, because they should be dead if they have no pain whatsoever”!  I could not believe this was a Dr. who was revered by this other pain Dr. and the physician in the GP’s office who took over a few of Dr. Bullach’s patients!  This guy who takes people off of pain medications from the moment they walk into his office, and puts them on a program of Methadone or Suboxone or worse; and then forces them to go to 12-step programs can NOT understand what living day in and day out, 365/52/7/24 in chronic intractable pain is like?  Having a broken foot for 3 months and it “hurting when the weather changes” is still not the same as having: systemic CRPS II, RA, OA, Chiari I, Long thoracic nerve pain, bilateral patella femoral pain, Lumbar and Cervical Radiculopathy, Polyneuropathies, and Degenerative Disc Disease all at the same time!! He does not know what PAIN truly is.

A true pain patient like myself tries hard to hide it. This is sometimes mistaken as “not really feeling that badly”. We try hard to hide our daily struggles with pain because of this exact situation. We try to hide it because nobody really understands. Try to think of a time when you were in really bad pain, then multiply the intensity by 10 times or more! Then imagine having that intensity of pain day in and day out like I mentioned above for 365 days per year, 52 weeks per year, 7 days per week and 24 hours every day without relief or without very much relief! Try next to imagine this pain is never going to go away! It’s going to be there for the rest of your life. That kind of pain is hard for anyone to imagine, but it’s nothing like a broken foot for a few months! Also, taking medication that several Dr’s all knew you were on for 12 years or more and doing exactly what you are told by your physician, your GP, does not make an “addict”.  Just because I put on make up and try my best to look as good as I am able, does not mean that I feel wonderful at all!

I feel as though I am “stuck” in a body of which I have no control. I have to go each and every day with nobody truly understanding what I go through. If I talk about it too much, then nobody wants to be around me. If I don’t talk about it, then they think it’s not there. It’s a no win situation even when I visit the Dr’s office. They want you to give them a Number of how you feel, on a scale from 1-10, with 10 being the worst pain you have ever felt.  First of all, that would be different for everyone because maybe the worst pain you’ve ever felt was an ingrown toenail (and those do hurt, by the way!)?? What if the worst pain you have ever felt was childbirth? At least you get a “prize” at the end of it and there IS and END to it! So you see that cannot work for everyone. Just like my pain is in various places throughout my body. My shoulder may be a 3 today but my lower back may be an 8! But they only want “ONE” number to describe your pain that day!!! Geesh!

I’m luckily getting some guidance from a GP that I’ve known since 1986. But he really doesn’t want me for a patient. He feels “stuck” with me because my GP left in a Hurry and I had no place to go!   I refused to go to a pain /detox Dr. who wins prizes for writing these “great articles” about how he “helps” people with pain get off of their medications. This detox Dr. gets articles in “Detroit Hourly” magazine for his “greatness”.  Well, talk to the patients because anyone can be “book smart” and write an article with precision and big words. But not every Dr. can have empathy and accept a challenge with dignity and kindness. That is what I want, a physician who will treat me with the respect that I deserve. One who will look at me and not my husband, when I bring him into my appointments with me. Lastly, I want a Physician who will listen to me and believe in me as much as I believe in myself.  It’s taken many years for me to believe in myself. But I know that even though this is awful, painful and very difficult; I can do it!  But then what next? I will always need something for pain! What do I do as I decrease my pain medicine dosage even more? The pain is increasing and my mobility is decreasing. I can now do something for an hour before I need to stop and go home to rest. Prior to this time, I could at least go out for a few hours before having to go home and rest.

Lastly, just because a pain patient can do something one day, such as go shopping for 2 hours, doesn’t mean that the next day or next week they’ll be able to repeat that. Chronic pain is such that it is just as confusing to the patient/sufferer as it is to their friends, family and physicians. It is like “hot and cold”…..one day we can do something and the next day we may not be able to do it. I may wake up tomorrow and not be able to “go out to lunch” as I had planned. Friends and even family get upset when we cancel plans. Each day is different and we never know how we will feel. I try very hard to be “normal” and chronic pain is hard to understand if you do not suffer with it. The Dr’s who are “pain” Dr’s have not suffered from it, for the most part. They don’t know what it feels like, they only know what they learned from a book and from their patients. If they are a good pain Dr., they will learn from their patients.  Remember, nobody WANTS to feel this way. Shame on the Dr. who sent me away because I wouldn’t go to the “detox” Dr. whom he wanted me to see! Shame on him for not helping someone who he’d already known, trusted and believed at one time and for 3 years! He wiped his hands of me and didn’t want to be involved with helping someone else’s “mistake”.  Just shame on him! The worst thing that you can say to a chronic pain patient  when they are taking pain meds, is to say that they have a “drug addiction”. People who do not have a history of addiction or problems with drugs, and who are living with chronic pain, like myself, do NOT WANT to take these medications or narcotics!! WE/they need them to function and get through the daily activities of living. Our Body is physiologically dependent on them and we are tolerant of them.  But a definition of “addict” is not equal to “someone in horrible chronic pain with a legitimate chronic pain disease who has been prescribed Narcotics / Opioids to help ease their pain for years and then suddenly someone decides it’s time to take them away and send them to Detox!

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