MANY DESPERATE PATIENTS TURN TO POWERFUL PAINKILLERS FOR RELIEF

Failed back surgery syndrome is the term medical science has coined for
people who develop even worse pain after an operation to relieve back pain.
Equally common is the companion problem of addiction to narcotic painkillers
patients take to relieve the pain.

The latest to acknowledge the problem is conservative radio commentator Rush
Limbaugh. On Friday, he told listeners during his radio program that he is
addicted to painkillers and is checking into a rehabilitation center. One of
the drugs he reportedly used is OxyContin, a highly abused prescription drug
with euphoric effects similar to heroin.

Limbaugh started taking narcotic painkillers "some years ago" when a doctor
prescribed them after spinal surgery. The pain worsened, and he started
taking more pills.

"Rush Limbaugh is one of hundreds of thousands of Americans who are addicted
to pain medication," said Joseph Califano Jr., chairman and president of the
National Center on Addiction and Substance Abuse at Columbia University.

The problem of drug dependence on painkillers after back surgery is not new.
U.S. Supreme Court Chief Justice William Rehnquist, who has a long history
of back pain, developed a dependence on a prescription sedative and was in a
detoxification program directed by a neurosurgeon at George Washington
University Hospital in the 1980s.

"Many patients with back surgery have persistent pain and are at risk of
addiction," said Dr. Dennis Dobritt, president of Tri-County Pain
Consultants, a Farmington Hills facility associated with Providence
Hospital.

Each year, as many as 150,000 Americans undergo spine fusion procedures to
shore up portions of the back that have degenerated because of overuse, age
or injury.

Surgery may not work. Three or 4 of every 10 people who undergo traditional
back operations develop scarring that can contribute to more back and leg
pain, experts say.

To control escalating pain, people often turn to higher amounts of
painkillers.

Dr. Michael Boyle, medical director of the Maplegrove Treatment Center, a
West Bloomfield program affiliated with the Henry Ford Health System, said
painkiller addiction is hard to treat.

First, the person must be taken off or weaned from the painkillers. Then, an
alternative to narcotics to control the pain should be found, he said.

"To get the person off the pain medication is not a major problem," Boyle
said. "Keeping them off is the hard part."

Dr. Samir Fuleihan, chief of the anesthesiology department at Wayne State
University and Harper University Hospital, Detroit, said his clinic requires
patients to sign contracts agreeing to random urine and blood tests for
narcotics to ensure patients don't get drugs from other sources. Then they
try a variety of approaches first to try to reduce pain.

A new drug, buprenorphine, promoted as a treatment for heroin addiction,
helps when other approaches to prescription painkiller addiction fail, said
Dr. Maher Karam-Hage, medical director of the Chelsea Arbor Addiction
Treatment Center.

Still, rehabilitation typically takes six to eight weeks in the hospital and
as long as six months of recovery and weekly doctor visits, he said.

Dobritt said several new procedures are helping people with unrelieved back
pain. Another new technique, discography, helps determine which patients
with pain might benefit from surgery or some other procedure. But despite
the advances, many are forced to live with pain.

"The problem is we don't have the best treatment for a lot of these spinal
conditions," Dobritt said.