QUESTION:
Dear Dr. Heller,
I am currently seeing a pain doctor for severe cervical disease and am taking 8-10 Norco a day and 4-6 methadone pills a day. I am now and for the last 10 years been in therapy with a wonderful Ph.D. Psychologist. I am a recovering alcoholic (10 years) and also suffer from post traumatic disorder (incest during a large part of my childhood). I am 47 years old and worried that it might be too late for me. I'm wondering how much more I can take. Am I to worry about the use of these narcotics when I know the pain is unbearable without them? There's so much to think about that sometimes it's overwhelming. If I decide to stop the narcotics, how hard will it be on me physically as well as emotionally? I know it will be hard to answer these questions when you don't even know me, but I would appreciate any wisdom you might be able to convey.
Thank you.
ANSWER:
The concepts of pain management have changed, and physicians are freer to treat
patients with chronic pain. If you need the pain medication, it is far better to take the
medication than to suffer. Pain will worsen your PTSD. This should be discussed with your
physicians.
PTSD can respond to SSRI medications, although usually these are people who also have the
BPD. Remeron is a spectacular medication for PTSD, and has been particularly helpful for
DID patients (f.k.a. multiple personality disorder). If the BPD is present I strongly
recommend Prozac and Tegretol for my BPD patients who are in chronic pain. I will often
add Remeron to these patients as well.
