I recently had an encounter with a "chronic painer" who just completed treatment and post treatment described his addiction as a beast that needed to be fed at all costs, lying to not only his physician, wife, family, but himself. This gives one great pause about how any one can treat such a patient.
When the patient doctor relationship is inherently based on trust and the beast within cannot play by those rules, how can we treat such a patient?
I do my best, follow the guidelines, and do not have much advice and this component of medicine is the least gratifying for me personally.
