I would rather NOT be on opiates, I have no good option. Opiates do not fully erradicate pain for me, however, I have more issues than strictly small fiber neuropathy. Opiates DO let me live a more active life, which will in the long run prevent many of the problems associated with sedentary living.

If you are not up and moving, you get osteoporosis, you don't eat well due to pain, your GI system plugs up, and you lose muscle mass, you socially disengage, get depressed and anxious....among other things. Not treating chronic pain causes more problems than treating it. Chronic pain patients seldom abuse medications. I agree with the article.

Taking an opiate is less damaging to me, than not moving due to pain. I will live a better life on opiates than off, and I will cost the 'system' less money in the long run, as I am less likely to develop problems due to sedentary living, and the other numerous problems that chronic pain patients develop.

There is a bias to prescribing opiates to younger people. Young people with chronic pain do not get adequate treatment. I lived 20 years with moderate pain from injuries from a severe car accident, and likely disease intermixed...with no pain management....I got by, but life should have been easier, and I did suffer from the lack of pain management for all those years. Now, being older, perhaps there is less bias, and also, my disease pathology is undeniable, and probably my shelf life is shorter...making me a more acceptable 'risk' for opiates.

The longer you have a relationship with a doctor, the more likely they are to know you, to know your medical problem, and the more likely they will be, if they ever were inclined to, prescribe an opiate for you.

That said, some one may at some time question your doc, and get their defenses up. It takes a lot of courage for docs to treat chronic pain patients with opiates....many take flack for it.

In my experience, "pain clinics" are less likely to prescribe opiates.

After a full evaluation by a specialist, the more likely your internal medicine or primary physician will be to prescribe. They are the ones who end up caring for you long term, and should be the ones who with your neuro or specialist, coordinate your care.

There is a phenomenon of specialists not wanting a long term relationship with patients, especially at some larger research facilities, and you get that 'dumped' feeling.....they refuse to prescribe opiates as that locks them into seeing you long term, and if you are a boring case, they want to invest energy elsewhere....you get discharged to your primary's care anyway. Many will tell you right up front that they do not do pain management.

Many research facilities, see you once or twice and come to some conclusion that is either a diagnosis or sydnrome....and send you to a 'lower tier' for care. I have been fortunate to have been followed for 4 years, but I get less now than I did when I was a brand new interesting case. Unless I manifest new pathology, they have no more to offer me and if I am lucky, they will see me for follow up.

My primary feels confident enough to prescribe opiates for me, based on my medical history, and from what she knows of me, and also her own personal philosophy. As much as I do not like the idea, I don't have a option that works, other than opiates.

Some diseases take a long time to fully manifest, and it is not rare to see many people take 10 years before they get correct diagnosis. That is a long time to suffer and wait, but, you see it happen fairly often.