Pain Management Case Study

“You start out with a bottle of 30 pills, then there's only 20, then only 10.It's scary when you run out.” Months after his surgeries, after his scars were healed, he still struggled with deep, biting pain.

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Andrew had transitioned from what is called acute pain (pain from his surgical wounds) to chronic pain (pain in the absence of an obvious cause). On a cellular level, this means that his neurons expressed fewer mu receptors, so he needed to flood his system with higher doses to get the same effect as before.

’s free newsletters."data-newsletterpromo-image="https://static.scientificamerican.com/sciam/cache/file/458BF87F-514B-44EE-B87F5D531772CF83_source.png"data-newsletterpromo-button-text="Sign Up"data-newsletterpromo-button-link="https:// origincode=2018_sciam_Article Promo_Newsletter Sign Up"name="article Body" itemprop="article Body" had just bought 10 bags of heroin.

In his kitchen, he tugged one credit-card-sized bag from the rubber-banded bundle and laid it on the counter with sacramental reverence.

Surgery after surgery, opioids became Andrew's vitamins, as vital to his pain control as blood pressure drugs are for hypertension.

Yet in 2005 Andrew noticed he was feeling anxious about his pill supply.

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