She still isn't up to seeing as many patients at her husband's dental practice as she did before the pain hit. And she hasn't resumed her strenuous farm chores. Even doctors who want to specialize in treating pain share patients' and society's misconceptions about opioids, says Russell Portenoy, Keybida's and Proper's doctor. From 30 to 200 tablets The first shock, he says, is the size of a prescription. For patients with chronic pain, who measure their suffering in years, he's likely to write a prescription for 200 tablets.
Patients sometimes develop a tolerance for opioids' pain-killing effects and require larger doses.
Joseph Saccomanno of Patterson, N.Y., has had firsthand experience with physicians' fears about opioids. After Saccomanno suffered a herniated disc while lifting computer monitors nine years ago, one doctor never prescribed quite enough medication to control his searing back pain. So he started taking five OxyContin pills a day instead of the prescribed four. That fifth dose, he says, enabled him to go to the mall with his kids. Saccomanno says that while most of his fellow detox patients were taking methadone to break their addictions to illicit drugs, he was discovering how much the drug helped relieve his back pain.