Observations Letter from New England

Treating Stella: the story comes first

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5281 (Published 24 September 2014) Cite this as: BMJ 2014;349:g5281
  1. David Loxterkamp, Seaport Community Health Center, Belfast, Maine 04915, USA
  1. david.loxterkamp{at}gmail.com

Patients who take narcotics for chronic pain are treated as pariahs

She is a wisp of a woman who steps cat-like into my examination room and anchors herself to the legs of the chair. She follows my gaze with a cool air of curiosity and suspicion. A tight smile belies the pain that nests in her eyebrows and forehead.

She is new to the practice, and before I can ask why she is here I remember the phone call on a busy Monday just a fortnight ago. A colleague asked whether I would see her on referral; only after my provisional yes did he tell me why. He had heard that I taper patients off narcotics; would I do that for Stella? Of course, I sighed. She needs as much help as any other.

“Your doctor indicates that he would like for you to be off pain meds,” I state as a matter of fact. “What do you think?”

“I think I’d like to be free of pain,” Stella replies. “My medicine is about to run out, and you are my only hope of getting a refill before withdrawal sets in. …

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