Kathleen experienced a work related injury in which a box fell on her neck while she was standing on a ladder to retrieve something else from a high shelf. She suffered a C4 injury (the fourth cervical vertebra) which resulted in limited control of her shoulders and biceps. It was accompanied by a stinging sensation that she came to discover was related to damage to nerve fibers. She also noticed tingling and numbness in her fingers. It was diagnosed as neuropathic pain. Her doctor explained that the communication between her spine and brain was being mis-translated and that the signals were coming from locations below where feelings were interrupted. She was cautioned that this problem could be chronic.
Prior to the accident, Kathleen had been vibrant and active. An athlete, she had ridden her bicycle a few times a week, swam, worked out at the gym and played on a mixed gender soccer team. She had no prior history of addiction herself or in her family.
As a result of the injury, she needed to curtail her normal routine as she took time to recuperate at home while receiving treatment. It contributed to a sense of restlessness physically and a growing feeling of despair. Initially she was prescribed Motrin which is considered a non-steroidal anti-inflammatory drug (also known as NSAIDs). When the pain didn’t respond to it, she asked her physician for something stronger.
She was offered Oxycodone but was warned that it could become habit forming. At that point, what Kathleen was more concerned about was relief from what had become chronic pain. She developed insomnia and her depression increased. She made yet another call to her treating physician, who prescribed Nortriptyline (Pamelor), which also had applications for pain relief. It offered a slight measure of relief, but there came a time when her doctor became concerned about her ongoing requests, thinking that she should begin to wean down her Oxycodone dosage.
At that point, Kathleen began to experience symptoms of anxiety with transient and unexpected thoughts of ending her life, although she had no plan or intent. She told the physician, “If this is how it is going to be, I don’t know how to live this way.” After a few months of being away from her work environment and fitness activities, she began to feel isolated. Although her friends had visited initially, their contact dwindled. She hesitated to reach out to them, not wanting to feel like a burden since she justified that they were all living normal lives and she felt like an invalid.
The question that remained was whether this was a case of addiction or dependence. Kathleen was clear that her body had acclimated to the prescribed dose and was calling for more to meet the need for relief. Her doctor dismissed the initial inclination to think of her as med-seeking. He offered a referral to a pain medicine specialist. She followed up on his recommendation and the next week, she was sitting in an office with her new specialist who compassionately offered alternatives to what she had been doing to manage what seemed like intractable pain. These included:
- Restorative yoga
- Consulting with a dietician to consider an anti-inflammatory diet
- Cognitive Behavioral Therapy (CBT) to assist in exploring the psycho-social component she faced
Kathleen was willing to engage in all of these practices and in a few months, found herself returning to an adapted sense of a normal routine. She rated her pain most days as a 2 or 3 on a 1-10 scale which was manageable, when at the onset, she would have thought of it as a 10.