With the pills, he could live his life. With the pills, he was free…Or so he told himself.

A fictional story by LVRC Clinical Associate Blake Bunker.   Michael grimaced as he hobbled to the meeting. His lower back throbbed with every step, as it had every hour of every day since the accident. It was a dull, constricting pressure that swelled up his spine and then down his hips. And then the fire came. Michael clenched his teeth, stopping to lean against a nearby wall. He could feel a tickling bead of sweat on his brow. Michael could handle the throbbing, the pressure in his back and hips. It drove him mad, but he had learned to live with it. The fire, however, was unbearable, and it came and went unpredictably. It felt as if a thousand molten needles had suddenly pierced his spine, and there they lodged, burning, burning, burning, until they stole away his breath, his sight, and his mind. When the fire came, it was all Michael knew. He tried to breath through it, as someone had once taught him, but nothing could resist the fire. It ruled him for those few seconds; a conflagration not just in his body, but his soul. “Hey…you alright, Mike?” Michael let out a breath as he turned to the voice. Jim, his boss, stood a few feet away, briefcase in hand. He was frowning, like an impatient father. Michael bit down on the inside of his lip and mustered a response. “I’m fine. Sorry. Give me a second. I’ll see you in the meeting.” Jim shifted his weight, unconvinced. “You don’t look fine. We need you in there, a hundred percent. The firm needs this deal. I can count on you, right? This isn’t gonna be another TPX, is it?” Michael grimaced again, this time out of embarrassment. The TPX deal had been his responsibility some time ago, one that would have made the firm a lot of money. But the fire had come that day, preventing him from proposing the deal in person, and things had fallen apart. Jim hadn’t let him forget that. “It’s just my back, you know,” Michael said. “Flares up sometimes.” “Been five years since the accident, right, Mike? We need you back, bud.” Michael scowled. Jim had done a lot for him: a year paid leave after the accident, and plenty of second chances since. But Jim didn’t understand the fire. “I’m fine,” Michael repeated, this time a bit angrily. “I’ll be in your meeting.” “Our meeting, Mike,” Jim said with a sigh. “See you there.” “Just lemme use the restroom real quick.” Jim nodded hesitantly. “Ten minutes.” Michael grunted his agreement, then made his through the maze of office cubicles to the nearest private bathroom. Once there, he locked the door behind him, rummaging about his suit coat pocket. The pill bottle, as worn and scratched as it was now, may as well have shone with golden, alleviating light. Michael dumped three pills into his hand, popped them into his mouth, and chewed. They tasted bitter and chalky, but Michael had grown to enjoy that taste; love it, even. He washed down the last chunks with a mouthful of water from the sink and waited.

How could his wife have ever claimed that the pills were the problem? The pills were the only thing in the world that could combat the fire; the only thing that could control it.

Everything went still for a several moments, still enough for Michael to hear only the ticking of his wristwatch. His back throbbed, of course, the fire smoldering, waiting to explode again. Just the thought of it brought Michael back to five years ago, to his seemingly innocent drive to work, to that moment the drunk driver T-boned his car in the intersection. Michael would never forget waking up in the hospital and feeling the blazing inferno in his back. It felt like he had been severed in two, which had almost happened apparently. The doctors said he had been lucky. “Lucky,” Michael said aloud to himself. The word tasted bitter on his lips, far more bitter than a mountain of chewed pills. Michael wasn’t lucky. He was cursed. Three years after the accident, his wife had left him. She had claimed Michael was a different person than the one she had married; a sad person, a resentful person. She had cried when she gave him the separation papers, and Michael had scowled at her like he had scowled at Jim. She didn’t understand the fire. No one did. No one. Michael checked his watch. Five minutes had passed, and his back still throbbed; the fire burning too hot, too close to the surface. Without thinking, Michael popped another three pills into his mouth, chomping down on them. He had taken his usual five in the morning, and five more at lunch. Another five wouldn’t hurt. He waited another few minutes and then a moment’s relief came. It swept down his spine like a snow drift, locking the fire in place. Michael felt a slight wobble in his knees, followed by a fleeting moment of genuine physical peace. He exhaled slowly through his nose, closing his eyes to the world. How could his wife have ever claimed that the pills were the problem? The pills were the only thing in the world that could combat the fire; the only thing that could control it. Michael needed the pills as much as he needed food and air now. He couldn’t imagine how terrible the fire must feel without them, even if they only gave him a second or so of this peace.

She didn’t understand the fire. No one did. No one.

Michael felt alive again; like a man again, not some pathetic, unemployable, unlovable cripple. With the pills, he could live his life. With the pills, he was free. Or so he told himself. He clutched at the thought. He opened his eyes, nothing how the alleviating cold of the pills had become a blizzard, freezing him in place. He suddenly felt nauseous. The wobble in his knees became a violent shake, and he lost his grip on the bathroom sink. He knew he was falling then. No! he tried to scream, but blackness overtook him and no words came. When Michael awoke, he was no longer in the office bathroom. He was no longer in the office at all, or even downtown. He was in a hospital bed, a steady beeping next to him. He blinked blearily, and noticed a sullen figure at his side. Jim. “Mike…” he said. Michael tried to sit up, but was whipped back by the fire in his back. It hurt worse than usual. He must have fallen hard. How many pills had he taken today? Too many, a distant part of him thought. This wasn’t the first time the pills, and the fire, had made him black out. “They told me you’re okay for now,” Jim said cautiously. “Gave us all a scare back at the office. What happened, Mike?” “My pills,” Michael mumbled. “I need…my pills. My back…” Jim frowned. “That’s not up to me. Listen, Mike…” There came a pause, Jim searching for the right words, or perhaps the least hurtful words. “Mike, this won’t happen again. I can’t watch you do this to yourself anymore.” “It’s just my back. It flares up. If I have my pills, I’ll be alright.” Jim sighed. “That’s the problem, though. They don’t make things alright. It’s just too much, Mike. Rest up, stay here for however long you have to. I’m not gonna’ let you go without insurance while you’re stuck in the hospital. But after that…” Michael fought down a dry gulp. “What?” “We’re gonna have to let you go, Mike. You need help. I’m sorry.” Jim stood to leave, a grim, regretful furrow to his brow, but not before handing Michael a business card. “Give this place a call. They can help you. I have to go.” “Wait,” Michael said. “Wait! It’s just my back. You don’t get it, dammit! No one does. I just need my pills, and I can work. Please…don’t do this.” “I’m sorry,” Jim repeated, and he left. Michael lay alone there with nothing but the beeping for company. He was furious at first. Furious at Jim, furious at the fire, furious at the accident that had kindled it, furious at his ex-wife and the world and everything else. But then that fury faded, and underneath swirled only despair—black and fathomless. Jim had been a friend once. Jim had cared about him, stuck his neck out for him. Michael’s ex-wife had done the same, and for years. Michael had been surrounded by people trying to protect him, and slowly, in a long, mournful procession, they had left him. Michael wanted to blame them all, even now as he lay alone. But he couldn’t. He couldn’t even blame the fire. He realized how much more it burned now than in the beginning. The pills weren’t helping anymore, he knew. They were making things worse. When the nurse arrived at Michael’s room, she offered him pills much like his own. But she didn’t understand the fire. And for the first time, Michael realized that he hadn’t understood the fire either. It had enslaved him, and he was weary of its shackles. “No,” Michael said, looking at the card Jim had given him. “I need a phone.”

For those suffering  from chronic pain, just waking up in the morning can become an exhausting and daunting task. Unfortunately, chronic pain is often treated with one opioid painkiller after the next. While opioid painkillers can be an important short-term tool to aid in healing, they are a poor long-term solution, and can easily, and insidiously, spiral into dependence. Opioid-induced hyperalgesia is a condition in which long term opioid use results in increased sensitivity to pain. This means that not only do opioid painkillers cease working in the treatment of chronic pain, but they make it much worse. And the spiral continues. Long term chronic pain can indeed be treated without the use of opiates. If you or anyone you know is suffering from both chronic pain and an accompanying dependence, help does exist. Throw off the shackles of your fire, wherever it may burn, and seek a better way of life. Sometimes, it is merely a phone call away.