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Addiction and Substance Abuse

Treatment for post-thalamic stroke pain

06/05/2006

Question:

i suffer from pain due to a left thalamic stroke. i also have had problems with abusing the opiates prescribed for me. what other options do I have? i live in Boca Raton, Florida and i`m not sure where to go for help. no one seems to have any answer.

Answer:

It is a very difficult situation when faced with the "dual diagnosis" of a chronic pain syndrome (your post-stroke pain) and an addiction problem (your problems with prescribed opioids in the past).  Typical approaches to either diagnosis while ignoring the other one commonly fail!  The optimal solution to your situation depends on many factors that are particular to your history, so I will try to give some general guidance:

1) If a person has a chronic pain syndrome and a history of substance abuse issues, they really must embrace a full addiction recovery program.  The disease of addiction has been described by many as a "hole in the soul that hurts".  If this "chronic pain of addiction" is not treated with a comprehensive addiction recovery program, it will continue to intensify the pain of ANY other chronic pain syndrome that you have ... making it pretty un-responsive to intervention.  I do know many patients who have found that once the addictive disorder is addressed, the residual chronic pain syndrome is mild enough that they can manage it without opioids (though they would never have expected this to be the case).  I also know patients who have still required strong analgesic iintervention even after they were "working a good sobriety program".

2) If a person needs daily maintenance opioids to treat a chronic pain syndrome ... but they continue to abuse and lose control over prescribed opioids as an outpatient (making it unsafe to continue to prescribe), then one safe (though inconvenient) option is to have the patient enroll in a Federally Licensed Methadone Maintenance Program or Suboxone Maintenance Program.  Again, I have seen many cases where this is the only safe way to provide daily mantenance opiods to some patients with legitimate chronic pain problems and active addictive disease. 

I hope these general principles help you begin to form some plans.

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Response by:

Ted   Parran, MD Ted Parran, MD
Associate Professor of General Medical Sciences
School of Medicine
Case Western Reserve University