interesting, and yes I can see how you feel that you're in a predicament. Honestly, the situation that you're in depends on a few things- what KIND of thoracic outlet do you have? How many times have you seen your surgeon/his office/staff ect already in preparing for your eventual surgery. Would you say you have a pretty good relationship with them? Are you in outpatient rehab/therapy/AA now? Do you take methadone at the moment, or anything similar? You said that you've been mostly clean for 6 months- does that mean that you haven't taken ANY prescription medication OR other drugs? If so, your tolerance would have lessened, which is good news for your upcoming surgery.

After you've answered the above questions, I think we can help guide you a bit more. I have had the rib resection and scalenectomy bilaterally and I also didn't suffer severe/extreme pain. But I didn't have nerve involvement, and it is my understanding that patients with dominant arterial or venous TOS really have an "easy time" if you will, in the recovery/healing process. I have A/V TOS.

Good luck to you! My brother in law is a recovering heroine addict, its a tough and often misunderstood road. We're here to help, no judgement. We want you to get the surgery when you need it, and get the appropriate care. We certainly don't want to have you feel like you're going to be pushed into a corner and forced to give up your sobriety in an effort to relieve your post op pain. Cheers!