Before Steve Pulliam needed any chemotherapy or radiation, before the symptoms associated with pancreatic cancer became so painfully apparent, before doctors determined that the tumors tangled throughout his abdomen were inoperable, his body just ached.
That's what a decade of active duty in the Navy did to his joints.
His doctor at the Ralph H. Johnson VA Medical Center in Charleston prescribed a high dose of ibuprofen and a few other "minor grade" medications, but the chronic pain in his knee and right foot largely persisted.
So the 51-year-old James Island resident decided to sign up for the VA's pain management clinic early last year, "not really knowing what it was," he said, to see how it might help.
The pain clinic, launched at the VA in 2009, includes a team of health professionals whose goal it is to reduce the number of opioids prescribed to patients at the hospital, primarily because there's little evidence to support that the long-term use of painkillers does much to actually eliminate pain and because opioids are really addictive.
Opioid addiction isn't a unique problem among veterans, although a group of South Carolina congressmen recently sounded an alarm that they believe VA hospitals in Charleston, Columbia and Augusta have become some of the largest "pill mills" in the country.
In fact, the Centers for Disease Control and Prevention reported earlier this year that patients in South Carolina carry more painkiller prescriptions per person than residents in most other states.
State leaders have recognized the problem and are trying to address the issue within the larger medical community.
Gov. Nikki Haley recently convened a new Drug Abuse Prevention Council, which is expected to publish a plan of action later this year.
Meanwhile, the pain clinic at the VA Medical Center in Charleston believes it has developed a model that works. As doctors, pharmacists, psychologists and nurses work together to ween their patients off a dependence on pain pills, they offer alternate therapies instead: fish oil, acupuncture, aromatherapy and meditation, to name a few.
An estimated 1,200 patients at the Charleston VA are currently prescribed an opioid, not including cancer patients. Dr. Robert Friedman, the pain clinic's director, said the clinic has helped 400 veterans step off the drugs in five years.
"The people who buy into it are 150 percent behind it," Friedman said. "Every single one of those patients, their pain scores have gotten better."
The first time Friedman tapped four acupuncture needles into Pulliam's head, the patient couldn't believe the results.
"From the waist down, no pain orthopedically. It was like 'Whoa. This is amazing,' " Pulliam said. "A lot of people think acupuncture is quackery. . No. If you haven't tried it, try it because you will not believe what it can do. Total elimination of pain."
This was great news, until Pulliam's health turned south. On Aug. 25, 2013, he was diagnosed with pancreatic cancer. During a meeting this June, a team of doctors from the Medical University of South Carolina and the VA Medical Center told him that they could not operate. The cancer had grown tentacles that made it virtually impossible to remove the tumor.
"I noticed one of the female doctors was crying. This isn't going to go the way we planned," Pulliam remembered from the team meeting. "If you're not able to get every last drop, if you have to leave some of it, it's going to come back with a vengeance."
His life expectancy is unknown - perhaps six to 18 months. In August, his medical team was still trying to determine the best course of chemotherapy. Past rounds of different drugs were so painful - "imagine hell," Pulliam said - that he's unwilling to sacrifice his quality of life for small gains in longevity. "If it's only going to give me two months, it's not worth it."
Pain pills are an essential part of his treatment now, but alternate therapies he learned about through the pain clinic offset the amount of opioids that he needs to take.
He still regularly sees Friedman for acupuncture, has learned to use lavender and rosemary oil on his stomach for their medicinal benefits and drinks an Egyptian licorice mint tea to sooth his digestive system, a brand that his physician recommended.
"Some people just don't understand pain. Unfortunately, I'm one of those people who do," he said. "There's a lot to be learned from Eastern medicine. ... A little bit of information is an extremely positive thing."
Reach Lauren Sausser at 937-5598.