JoAnne Aldredge couldn't deal with the pain.
Her fibromyalgia was so bad the 45-year-old Scott Air Force Base resident would cry if she had to shake hands. Her oxycodone pain medications weren't working to curb the chronic, body-wide pain and tenderness so she was tempted to go to the emergency room to get more. Instead, on July 27, she went to her family clinic in Belleville.
The ball was now in Chris Herndon's court. Herndon, a doctor of pharmacy and an assistant professor at Southern Illinois University Edwardsville, heads a team that manages the clinic's opioid patients. They are referred by the clinic's doctors who are either worried their patients will abuse the drugs or aren't comfortable prescribing more opioids.
Despite Aldredge being described as a model patient, the team monitors her prescription intake because of her complicated medical history and because the drugs are potentially dangerous.
This clinic's team approach is rare locally and nationally, Herndon said.
In many cases there is "no evaluation of who we should be giving these pain medications to," he said.
Herndon's patients are forced to undergo drug tests and must always bring in their pill bottles. The team also checks Illinois' pill monitoring database to see the patient's prescription history.
"If you are going to get pills from us, you pretty much have to sign your privacy rights away," Herndon said.
Identifying the source of chronic pain can be difficult, and the patient may have an untreated psychological issue that manifests itself in physical pain.
"You don't really want to chase pain. You want to prevent it," Herndon said.
Herndon's team -- which on that day consisted of a medical resident, a pharmacy student and the clinic's director in behavioral medicine -- weighs several factors when deciding what and how much to prescribe a patient.
One patient that day, a man in his 20s who had post-traumatic stress disorder, wanted more Percocet. His request was denied, in part, because an outside doctor was prescribing Xanax to treat the disorder. Combining those two drugs can be deadly.
"He's begging not to wake up," Herndon said.
Aldredge had been trying to address her extreme pain since April 2010. Opioids are only part of her entire pain management plan: Aldredge does acupuncture and had been doing aquatic physical therapy.
But without opioids, she can't even cook.
"My husband was basically doing everything," she said.
Aldredge's illnesses -- she also has circulatory sleep apnea, gastroesophageal reflux disease, depression and hypothyroidism -- have taken a toll on her marriage. She wonders where she would be without a supportive husband and access to quality medical care.
As for fibromyalgia and the pain: "It will never go away."
Aldredge's pain medication was increased that day. Though Aldredge errs on the side of caution when taking her medications, she admitted there is always the temptation to take more painkillers than prescribed.
"Becoming an addict is a great concern for me," she said.
Herndon estimated a quarter of his approximately 50 patients are drug seekers. His final patient that morning fit that description.
Herndon said the woman knew how to play the system. She came in late and figured, rightly in many cases, that the doctor would be running late and would just give her what she wanted.
But Herndon told the woman he could not prescribe the painkillers she wanted because they would complicate other medical issues she was dealing with. She didn't care; she just needed more Vicodin.
Herndon, obviously frustrated, speculated she would probably try to buy drugs on the street if she couldn't get them legitimately.
"That lady will wind up dead -- guaranteed."