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A patient with previous opiate abuse is reluctant to try therapies, writes Dr Honor Merriman.
Charlie is 42 years old. When he was 34, he was involved in a major road traffic accident and suffered spinal fractures. He was ill for some time and, since he had abused opiates in the past, these were only used in the acute phase of his recovery and he was quickly weaned onto anti-inflammatory medication.
He made a slow adjustment to life after his accident and never returned to work. He was offered physiotherapy on several occasions but never attended any appointments.
Charlie has now developed knee pain, which is proving difficult to treat; clinically, he has osteoarthritis. As a result of short-term excessive alcohol intake, he suffered …