DEAR DR. ROACH: I have gone to the veterans hospital for my medical needs for the past 25 years. I have had four major back operations and a total knee replacement; I also have peripheral neuropathy. They put me on hydrocodone/acetaminophen and gabapentin for the pain and neuropathy. These two combined have helped me tremendously for the pain that I have had constantly for the past 20 years. Now they are going to take away the pain medication because they say they will prescribe it only to people who have chronic pain from cancer. They are going to give me something called Baclofen, a muscle relaxer. Is it a narcotic?
If that doesn’t work, they will give me something else. I told them I do not want to be a guinea pig. Why change something that has worked for my pain for many years. They tell me that pain meds do not cure pain, so how do people with constant pain survive without some type of pain medicine? — L.P.
ANSWER: I have written before about the concerns of using narcotics (opiates is a better word for medications related to opium — such as morphine, oxycodone or hydrocodone) for chronic noncancer pain. However, your situation explains clearly how inflexible rules don’t make sense. Some people with chronic pain from arthritis, spine problems or other causes do not do well on opiates. Their pain isn’t well-treated, and they require higher and higher doses, with side effects ranging from constipation to confusion. It’s because of this that many guidelines now recommend against treating noncancer pain with opiates. However, guidelines are to help show what is good for most people. They aren’t meant to force your doctor into a certain course of action.
In your case, it sounds like the opiates have been working well. Changing to Baclofen, a powerful muscle relaxant and not an opiate, may not control the pain and may cause excess sedation. There are many times when it’s appropriate to make a change for someone using chronic opiates, but this isn’t one of them.