Jennifer Adams, MD
Note: Patient name and some details of the case have been changed to protect confidentiality.
Acknowledgment: The author thanks Ingrid Binswanger, MD, MPH, and John Steiner, MD, for their help with preparation of the manuscript.
Requests for Single Reprints: Jennifer Adams, MD, Denver Health and Hospital Authority, 1100 Federal Boulevard, MC 3000, Denver, CO 80204; e-mail, firstname.lastname@example.org.
Adams J. A Balancing Act. Ann Intern Med. 2012;157:215-216. doi: 10.7326/0003-4819-157-3-201208070-00015
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Published: Ann Intern Med. 2012;157(3):215-216.
Nicole appeared on my primary care schedule the first week of every month. She was 29 years old when she began seeing me for management of migraine headaches, uncontrolled type 1 diabetes, chronic renal insufficiency, and major depression. She was unemployed, was without stable housing, and was a single mother of 3 children. She had been prescribed low-dose oxycodone 6 years prior to use only for severe refractory headaches. Over the years, we slowly increased her daily dose as she reported uncontrolled migraine pain. I told her numerous times that I thought opioids were inappropriate treatment for migraines, but alternative approaches to pain management were ineffective. At nearly every visit, she requested an increase in the number of pain pills she was prescribed and believed that I was not listening and did not care about her when I was reluctant to increase her dose. I was frustrated by my inability to effectively treat her headaches and believed that our time together would be better spent addressing her other medical issues. Although I wanted to treat her pain, I was worried that I was complicit in the development of an opioid addiction. This was not the kind of medicine I wanted to practice.
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