A reporter recently asked me about what harm I may have caused as a pain management physician who prescribes opioids. As I reflected on my last 10 years in this field, my response was that the harms I may have caused were because I underprescribed these drugs, not overprescribed them.
I thought of a 25-year-old patient, I’ll call him John, whose sciatic nerve was crushed in a motor vehicle accident, causing excruciating pain in his leg. We knew this would be a life-long injury, and that he would likely have to live with chronic pain. We tried everything I could think of — nerve medications, mindfulness techniques, desensitization, rehabilitation techniques, cognitive therapy, nerve blocks, and spinal cord stimulation — except opioids. John continued to suffer immensely from the debilitating pain, and eventually died by suicide.
Did he die because I undertreated his pain due to my own fear of prescribing chronic, potentially high-dose opioids in a young patient? I cannot know, but I worry and fear that this may be true.