[HouseMDFilter] What *are* the options for treating addiction in patients with severe chronic pain? (Spoilers for the January 9th episode and
In the TV show, one of the major subplots is House's addiction to Vicodin. This is explained as having begun 5+ years ago when he experienced muscle death in his leg, which resulted in high levels of pain at the time and (I believe) continuing to the present.
In calling him an addict, is the implication that his pain is no longer real, but is now a physical dependency on the drugs? Or is his pain still as real as ever, but his physical dependency is 'too strong'? Or perhaps he has two issues going on - pain, treated by Vicodin, and an addiction fed by an overavailability of Vicodin, and his behavior and personality are seen as symptoms of the latter. Or his Vicodin-seeking behavior - hoarding the drug, stealing it, etc. (Too many 'or's. I'll stop now.)
Then assuming he is addicted, what would his options for pain management be? In a Season 1 episode, Cuddy tells him that there are other ways of managing pain, but it's not clear what these are - presumably if there was a nonaddictive method of treating pain, that would have been the original treatment. I can't imagine that anything less effective than the narcotics House is on would be acceptable to a patient with that kind of pain. Are there alternatives that are considered more acceptable because there is less of a risk of psychological dependence, at the cost of a greater physical dependence (in contrast to Vicodin, which is the other way around), or a difference in the euphoric effects?
Note: I'm aware that there are a broad range of opinions on pain management, ranging from the relatively prohibition-ish attitude of the DEA
to the more permissive attitudes of some pain management doctors, including some who have been accused of acting as 'prescription mills'. But I suspect there's more to this than that.
(One last thing, as long as I'm here - Wikipedia says that buprenorphine is not administered orally. Wouldn't someone
have noticed that the pills were Vicodin, or something other than buprenorphine?)