Pain Management Case Study

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Luckily for Andrew, Becker runs the Opioid Reassessment Clinic, which is pioneering strategies to taper patients with chronic pain from high-dose opioid use to Suboxone, a clever sublingual tablet that combines buprenorphine and naloxone. When taken under the tongue, it provides pain relief and prevents withdrawal.

Naloxone is added as a safeguard to keep abusers from injecting the drug. When injected, it blocks the mu receptor and causes acute withdrawal, a physiological inducement to use Suboxone in the prescribed manner. In combination with intensive psychosocial therapy, it is a safe and highly efficacious treatment for opioid use disorders.

The brain has an elaborate network of receptors, neurons and centers dedicated to pain.

Opioids exert their effects by binding to mu-opioid receptors, which are densely concentrated in brain regions that regulate pain perception and reward.

He snorted it in one pass and shuffled back to his armchair.

It was bitter, but snorting heroin was safer than injecting, and he was desperate: his prescription pain medication was gone. A frayed, tangled mop of grizzled hair fell to his shoulders.We're finding that it's older and older patients, who start on the path to chronic pain, then on to opioids, then on to heroin.” Andrew's case is a “classic example,” he said. Murthy about the “urgent health crisis” caused by our lax approach to opioids now come to mind every time I consider writing a prescription for one of these painkillers.“The numbers are controversial, but as tens of millions of people taking opioids for pain age, we think 10 percent and maybe more will develop at least a mild opioid use disorder. We have to become more fluent in managing the co-occurrence of chronic pain and addiction.” His words and recent warnings from U. I also think of Andrew standing at his kitchen counter, hands trembling as he forms a line of heroin.’s free newsletters."data-newsletterpromo-image="https://static.scientificamerican.com/sciam/cache/file/458BF87F-514B-44EE-B87F5D531772CF83_source.png"data-newsletterpromo-button-text="Sign Up"data-newsletterpromo-button-link="https:// origincode=2018_sciam_Article Promo_Newsletter Sign Up"name="article Body" itemprop="article Body" had just bought 10 bags of heroin.In his kitchen, he tugged one credit-card-sized bag from the rubber-banded bundle and laid it on the counter with sacramental reverence.It had spread throughout his body and required more pills to tame.Andrew had transitioned from what is called acute pain (pain from his surgical wounds) to chronic pain (pain in the absence of an obvious cause). On a cellular level, this means that his neurons expressed fewer mu receptors, so he needed to flood his system with higher doses to get the same effect as before.I met Andrew the next day in the emergency room, where he told me about the previous day's act of desperation. Andrew had been a satellite network engineer, first for the military, more recently for a major telecommunications company.I admitted him to control his swelling legs and joint pain. An articulate, soft-spoken fellow, he summed up his (rather impressive) career modestly: “Well, I'd just find where a problem was and then find a way to fix it.” Yet there was one problem he couldn't fix.With nowhere to turn, Andrew mentioned his situation to his neighbor, who sold him diverted opioids—prescription medications hawked on the street. Andrew's dependence on heroin terrified him, and at 0 a day, it threatened to bankrupt him as well.This trajectory is by no means unusual, according to Andrew's lead doctor, William Becker, an addiction medicine specialist and assistant professor at the Yale School of Medicine: “Chronic pain is the new initiation to heroin.

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