Irony

short: fentanyl or orthopedic devices as analgesic; discuss.

My surgeon told me today he wants me off of the fentanyl and that I need to wean off the back brace. Okay, I guess. When I think about it, though, I'm kind of startled that, given the choice — between fentanyl and the back brace — I'll pick the brace every single time. I suppose I was expecting that I'd want to make sure my supply of fentanyl was uninterrupted, since I use it to stop pain. But, that's also what I use the back brace for.

The difference between the two is important. The brace, while it doesn't give me any euphoria (it's hardly true that the fentanyl gives me any euphoria anymore, either), I am 100% sure it will work, every time I use it. There's no tolerance, no fussing with the pharmacist or scheduling a visit to the doctor's office. It prevents me from reinjuring myself, and it helps me walk around, drive, even sit in a chair, as though I had not sustained any injury. Granted, I think that's what the fentanyl is supposed to be doing, nominally, too, but I guess I've read enough about opiates or drugs in general that I expected that on some level, my body would demand the drugs more than relief from pain.

It's both pleasing and a little unnerving. Pleasing because that tells me I'm not kidding myself about why I'm using the drugs; I have felt, every time I've been given a strong narcotic for pain, that it was expressly for pain, and not to feed some addiction. The fact that I get injured a lot gives me just enough self-doubt to think, am I really that prone to injury? Is it possible that I am getting this injured, this often, on purpose, to sustain a drug habit?

Normally, I would have scoffed and said there was no chance, and even acted offended at the suggestion. But, when one looks at the track record, it would be easy to make a case for it. And so, the nagging bit of doubt. I hadn't considered the brace's place in this equation. The problem with the brace is not addiction or withdrawal, or cost or licensing or anything as sordid as any of that. The problem is that, while keeping my body fairly safe by supporting my spine, it provides support that I'd normally be providing with the muscles in my back and on my sides (the obliques). By using the brace all the time, I ensure that those muscles will atrophy as they're not needed, and any time I am not using the brace, I'll be in pain because those muscles aren't up to the task.

And now the unnerving: the brace is so effective at preventing pain and injury, it makes me actually stop and think, can I just wear the brace forever? I mean, I have kept all the other orthopedic devices from previous injuries and accidents: knee and wrist braces, et cetera. But, isn't that what I had expected to feel for the fentanyl? That since it is so effective at blocking pain, that I'd actually consider using it in perpetuity?

Well, actually, no, I would not consider using fentanyl in perpetuity. Because, frankly, it's shitty as a pain reliever compared to the brace. It has additional side effects like fucking with my sleep schedule and the suspicious look from pharmacist and nurse alike (clearly, this guy has been using the patch too long, we have to get him off of it); features I really don't like. The brace, by contrast does not. I have also developed tolerance to the fentanyl so that, not only am I still taking the drug, I am taking the drug and pain is breaking through it ("breakthrough pain"), making me want more of the drug, and that makes me uncomfortable. There's a checks-and-balances thing going on whereby I am thinking to myself, I don't like that feeling, and I recognize it as dependence. I guess.

So, between the two, I'd prefer to use the brace, to not be given fentanyl again, and to have the sure-shot prevention of pain and injury that is the brace. But, I can't have that either, and the only way I'm going to get from here to some pain-and-injury-free future is hard work at physical therapy, and not allowing accidents like that (or at least, doing my best not to cause them) to happen again in the future. But, for the meantime, I'm cutting back on the fentanyl, back from a hundred mikes down to seventy-five, and I have to cut back on my use of the brace, too. I wish I had known the brace would be this much of a problem down the road; I'd have stopped using it earlier. Having the brace to sustain me while I tapered off fentanyl, or the fentanyl while I tapered off the brace would have made my life a lot easier. Now, I have to taper off both, and that more or less guarantees I will be spending some of the next month in (perhaps substantial) pain.

Drat.