About Us

Over the past several years, Doctor Gordon has become interested in the problem of diagnosing and treating addictions in chronic pain patients. Chronic pain is becoming recognized as a medical disorder, and a new medical specialty has developed to meet the need of these patients, who number in the millions. The prescribing of opioid medications is often an aspect of pain treatment, and between 10 and 30 per cent of such patients become addicted. Thus, chemical dependency in chronic pain patients has become epidemic in our society. Whether they have obtained their medication from a pain clinic, a primary care or other physician, or illegally, the end result is a desperate situation in which the patient not only still has chronic pain, but now also is addicted to pain medicine. Signs of such addiction include, but are not limited to, taking more medication than prescribed, calling for early refills, lying about "lost", "stolen", or otherwise mysteriously missing pills, obtaining medication from multiple doctors or sources, faking or exaggerating pain in order to obtain medication, development of tolerance for high doses of medications, and becoming irritable and exhibiting characteristic signs of opiate withdrawal when medication runs short. Such patients are on the horns of a dilemma. On the one hand, they have severe pain, and on the other, they are unable to control their use of medication prescribed to provide pain relief. Worse, if they seek drug dependency treatment, they are typically presented with another dilemma. Traditional treatment philosophy is geared towards total abstinence. While this is hard enough for the usual case of drug addiction, it is nearly impossible for the patient with severe chronic pain. If patients are discharged from their doctor's care because of medication abuse, and if they can't be treated for their drug dependency at drug rehabilitation centers (their chronic pain is usually too severe to be tolerated without opioid medications), then the only options remaining have been to enroll in a methadone program, or to obtain drugs illegally. The methadone programs, while an option for some, leave much to be desired for many patients, not the least of which is that they are not designed to meet the needs of pain patients.

Fortunately for many of these patients, another option now exists. In 2003 the Food and Drug Administration licensed the drugs Suboxone and Subutex for the treatment of opioid addiction. Similar in some respects to methadone, the active ingredient, buprenorphine, is long-acting, can be administered once daily, and relieves the craving of the addict for opioid drugs. Unlike methadone, however, these medications can be prescribed for the treatment of addiction by any qualified physician out of his or her own office, rather than at a methadone clinic. Furthermore, buprenorphine, although it is an opioid drug itself, has a much lower abuse potential than methadone, and is much safer to administer. Please see the article, "Medication-Assisted Therapy".

Buprenorphine has also been extremely useful in the treatment of chronic pain. This makes it an ideal drug to be used in chronic pain patients who have lost control of their opioid use. Because of its much lower abuse potential, patients achieve good pain relief while seldom escalating the dose of their medication. While it does not meet the needs of all patients, we believe that well over half of such patients can achieve successful pain control using buprenorphine. Buprenorphine is also now available as Butrans, a transdermal patch licensed by the FDA for the treatment of chronic pain. Belbuca, a film designed to be attached to the lining of the mouth, contains buprenorphine, and is also licensed for treatment of chronic pain.

Michael C. Gordon MD, LLC, is now able to offer specialized addiction medicine treatment services to patients who have developed both chronic pain and addiction. We provide evaluation services to self-referred patients to help them decide if indeed they have become addicted to their medication. We also accepts referrals from other physicians who, in the course of their management of a patient, may become concerned about the possibility that an addiction has developed.

All patients will have a comprehensive evaluation at intake. This evaluation will include an interview with Doctor Gordon, a drug screen, and review of medical records documenting prior pain treatment, medical and surgical history, and if applicable, prior psychological and psychiatric evaluations or addiction treatment. Patients are asked to fill out paperwork and bring the completed forms to their intake appointment. All forms can be downloaded from this website. Completion of the forms prior to arriving at the office saves everyone valuable time.

Treatment is designed to help patients recover from the dual disorders of chronic pain and drug dependency. Since both of these disorders are chronic, the goal of treatment is dramatically improved quality of life, as opposed to absolute cure. Some will achieve more pain relief than others, but in every case we hope for a substantially diminished domination of the patient's life by pain. While we will deal with pain issues in treatment, we are not a pain treatment clinic per se. Patients will need a multidisciplinary approach to chronic pain treatment in order to achieve the best possible results. We will communicate with and cooperate with all the providers of care involved in the management of each patient's case.