I do believe that you are in pain; I can see it in your eyes, your furrowed brow. I can see it in your hesitant gait, the cautious way you get up and down from my exam table.
But this is the first time I’ve met you. I don’t have your medical records. I don’t know anything about your kidney or liver function, whether or not you have heart disease or diabetes. You don’t know either, which is not unusual. Many people come to me for the first time without a list of medical conditions or current medications. We can work it out.
You can expect me to take a thorough history, do a complete physical exam, and request your old records. But I am not going to give you a prescription for narcotics today.
It’s not that I don’t believe what you’re telling me: I believe you when you tell me that ibuprofen doesn’t work or that you are allergic to it. I believe you when you tell me that all your other doctors have given you narcotic prescriptions. But I don’t know you yet, don’t know your whole medical picture. Narcotics are potentially beneficial and potentially risky. Dependence is a disease that is very common, and very difficult to treat. You should not expect me to take such a risk with your health at this point.
It is possible that your disease, be it chronic pain or opiate dependence or both, does not let you understand that. You may feel angry, depressed. You may lose your temper, behave inappropriately. If I suspect a narcotic use disorder I may offer you a referral to a local expert.
You may not like this, and I may be totally off base, but I have to give the best advice I have, whether you like it or not. I hope that you will be able to see this as an act of kindness rather than another obstacle in your efforts to get what you think you need.
I will continue to try to help you treat your pain, but I will choose medications for your pain and your other conditions based on what is likely to give the most benefit for the least risk. Sometimes this treatment may include narcotics, sometimes it will not. All I can do is advise and hope that my advice is good, and that you will follow it to the best of your abilities.
To you health,