Eight years ago, I had major foot surgery. I started jogging when I was in my 20’s and in my late 50’s I developed a relatively rare condition, Posterior Tibialis Tendon Dysfunction. I tried all of the conservative measures, but I was unable to walk more than 50 feet without considerable pain. Fortunately for me, there is a sophisticated, but major surgical intervention that can correct this condition.
The surgery was three hours long, involved a bone graft from my hip, several 4-inch screws, repositioning bones, removing the destroyed tendon, using another one of my tendons as a spare part, and cutting muscles in my lower leg to enable the surgeon to construct my new foot! Before the surgery, I was given a picture of the year-long recovery—10 weeks of 100 percent non-weight bearing, considerable pain post-surgery, months of physical therapy, and slow progress before I could walk comfortably.
I was in the hospital for three days, first on a pain pump, where I could give myself pain medication when I needed it, and then I was given a potent oral pain killer. My surgeon discharged me with 70 2mg Dilaudid pills, a strong narcotic medication. In those days, physicians wanted to aggressively treat pain.
After a week, I decided to stop taking the pain pills. I was still in pain, but I didn’t like how the medication made me feel. As I cut down on the dose, I experienced withdrawal symptoms, because I had already become addicted after days of continual use. I felt irritable, tense, and achy. When the medication started to wear off, I felt very anxious about having pain.
No one had talked to me about what I might experience when I cut back on the pills, how to manage pain without taking them, whether I had any personal or family history of chemical dependency or how I was going to manage sleep with a 5 lb. fiberglass cast stretching from my toes to my knee! In retrospect, when I think about my experience, I can see how an adult, vulnerable to drug addiction, might have gone down a very different and disastrous path. Just pick up any newspaper today and there’s an article about how narcotic addiction is resulting in the tragic loss of life in young and middle-aged adults. It is no longer just an inner-city phenomenon—it’s cast its shadow over suburban and middle-class life.
Today’s narcotic addiction crisis has many facets. The cheap availability of heroin from Mexico, the over-prescription of long-acting narcotic painkillers, complex social and economic distress, the cultural expectation that modern medicine should make us pain-free, lack of knowledge about how to manage and cope with chronic pain, and lack of understanding and resources for chemical dependency. If you are interested in learning more about the history of this crisis, read “Dreamland” by Sam Quinones. It’s shocking expose of how this catastrophe developed.
With changes in Washington State law, meant to protect patients from the over-prescription of narcotic medications, “Pain clinics” have popped up all the state. I have heard from many individuals that these clinics have not always helped them reduce their dependence on narcotics.
The treatment of pain, both acute and chronic, is complex. Chronic pain can be disabling. Many adults in pain don’t understand why their healthcare providers are so concerned about their use of medications that they feel help them function. They don’t understand why they are so dangerous. More education is needed. Tools for coping need to be more widely available.
My surgery was very successful. Today, I can walk 4-6 miles! I can’t jog anymore, which I miss, and I do have some chronic pain. But I have learned how to cope with it.
If you are struggling with pain, talk to your healthcare provider about resources for pain management.