A Teaching Case

Dear Dr. Hochman:

I read your article in the March 2009 issue of Practical Pain management. I learned a new word.
Iatrogenic.... nice.

I used to be a chronic pain patient this is my story:
1. 1996 Hodgkins IIIB. 16 chemos in 12 weeks, 4 weeks of radiation.
2. Severe neuropathy ensued.
3. Oncologist throws me under a bus labelling me "drug-seeking". All I wanted was
relief. His words: "there is no pathological basis for me to treat your pain".
4. Stanford pain clinic took me in as a legitimate patient - all they needed was a look at my
medical records. I was in - in two days!
5. They titrate me up to 100mcg/hr duragesic q48h. Fantastic pain relief with no issues for 4 years.
6. I wanted to see if my nerves had recovered. Not after 4 years.....
7. They did recover after 6 years. Took six months to titrate down from Duragesic +
occassional Actiq for BT pain.
8. Was almost pain-free when I got off opioids - that was in 2002. Took six months to titrate down.
9 Oncologist retires in 2004. Calls me personally, and tells me [with tears] that he broke his hippocratic oath many times - with me being the most egregious.
10. I forgave him on the spot. Life goes on.

I am highly educated - Masters out of UCLA can design chips [integrated circuits]. I sought medicine [took more than prescribed, but told my doctor why, and sought another prescriber, though I knew it was illegal] - when my pain was not treated by my oncologist. Simple.

I rarely share this story with anyone. You seemed the most appropriate.

Sincrely,
B M
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Your case is an excellent teaching case. What stands out as unusual, however, is your recovery from the neuropathic pain. That is very unusual, in my experience. With your permission I would like to cite your case, without identifying you personally. OK?
Dr. Hochman