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were changed to non-opiate medications and custom formulated topical creams concurrently to manage their chronic pain. Further decisions also involved treating newly diagnosed OUD patients with medications like Suboxone and Vivitrol. The underlying diagnosis of chronic
pain was always revisited appropriately and addressed with comprehensive pain management treatment options that included, but were not limited to, physical therapy, chiropractic therapy, massage therapy, acupuncture, spinal injections,
and spinal cord stimulation. Patients also had access to onsite transcranial magnetic stimulation (TMS) if concurrent depression was present. These treatment decisions were supported by onsite drug screening and dispensary.
The ultimate treatment goal was to actively identify, positively intervene, and adequately treat patients suffering from OUD/SUD while the underlying diagnosis of chronic pain was effectively treated with all available traditional and nontraditional treatment modalities. In this kind of comprehensive practice where real-time decisions can be made with real-time discussion between pain management patients received the best care possible and had the greatest chance of abstinence and possible recovery from their OUD. The following two cases illustrate the critical interplay between behavioral health, pain management, and comprehensive therapies in providing patients an opportunity to recover from their addictive behavior and live a productive life.
CASE REPORT 1
This patient is a 57-year-old white male
back pain secondary to idiopathic severe thoracolumbar scoliosis, post laminectomy syndrome with three level lumbar fusion,
and bipolar disorder and a history of chronic heroin abuse for more than four decades without any continuous period of sobriety.
His typical pattern of use consisted of using nine bags of heroin daily, and included multiple hospitalizations for overdoses.
He was also abusing prescription opiate pain medications from his previous pain management providers. He had failed
to achieve abstinence despite numerous
drug treatment attempts over the last
12 years in Florida, prior to relocating to Delaware. His dependence on heroin can his habit. He was noted to have a supportive mother providing family support, but no other sober support network and a lack
of coping skills, further complicating his ability to achieve and maintain abstinence. However, the patient expressed a genuine desire to quit using illicit drugs in addition to prescription opiates.
He was treated by our Medication Assisted Treatment program with Suboxone and supported by the onsite counselor working with the pain management physician to make clinical decisions. The patient’s compliance was assessed on a weekly screening test that could detect heroin metabolites to monitor his compliance.
He was also treated with a comprehensive therapy program, non-narcotic pain medications, and spinal injections to control his chronic low back pain.
Because of collaboration of treatment plan between all the providers under one roof, the patient managed to successfully abstain from heroin. He could avoid losing his home and has stayed clean through the program for more than three months. Notably, this
is the longest period he has stopped using heroin in his life.
CASE REPORT 2
A 28-year-old female with a past medical history of endometriosis, coupled with years and chronic knee pain presented with OUD. She had been prescribed Oxycontin to help manage her pain associated with endometriosis, which evolved into to opiate heroin, approximately four bundles a day. She had voluntarily started Suboxone therapy in Indiana but was not able to stay clean due to her lack of a support system
or access to a substance abuse counselor. She was not able to hold a job for more than two weeks at a time in Indiana due
to her drug use. She moved to Delaware recently and was genuinely seeking help to overcome her OUD.
After patient evaluations by the substance abuse counselor and pain physician, she
was started on Suboxone and weekly substance abuse counseling. She attended
an onsite therapy program with emphasis
on stretching and strengthening exercises and laser therapy to help with knee pain secondary to a small meniscal tear. Since
the start of treatment four months ago, she cut the Suboxone dose by 50 percent and by her weekly urine drug screens. This is something she was not able to do on her
own for the past four years. Recently she acquired a full-time job.
DISCUSSION
According to the 2013 Global Burden of Disease Study, death from opioid use disorder has more than doubled since 1990. As many as 4.8 million people are estimated to have used heroin at one point in their lives.3 In recent years, OUD has been well established as a form of chronic brain disorder that has
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Del Med J | May 2017 | Vol. 89 | No. 5
