@ruudolpho I am so HAPPY you brought up the question about pain medication, this is a topic that weighs heavily on my mind as I too use pain medication to maintain a quality of life that is enjoyable. So, in my experience I have found pain medication has helped in several ways. I use Tramadol, the side effect of possible constipation helps control the horrific diarrhea that some of us MALS patients experience on daily basis. I believe both pain and malabsorption of food leads to our significant weight loss, so pain medication slows down the gut helping alleviate this problem. Also, I have found if I take my meds prior to eating the pain is substantially less and I am able to eat nutrient dense foods compared to eating a diet mainly of carbs. If I use it as pain rescue after I have eaten is does not work as well. I know each of us are different and metabolize medication differently, so my experience may not be the same as yours, however with the chronic MALS patient's I have spoke with we all have had success with pain meds. Here is the problem, with today's political climate on the perceived opioid crisis patients have to deal with shame, being stigmatized and made to feel like less of a human because of our pain. You obviously cannot afford to loose more weight, and I am happy to hear you have a reasonable physician that is addressing your pain. In my personal humble opinion, for you, like me, we are chronic MALS patients, I think it is reasonable and therapeutic to try pain medication and see if it works for you. For me, I have also lost a significant amount of weight, have become malnourished and have had exhaustion despite 2 successful surgeries (I say successful because the pain went away for 3 years, however like you the symptoms returned) During the the successful years my weight maintained at 155-160 I am 5'7 - I preferred the heavier weight as I had more energy and could eat normal meals (Still had bowel issues). My lowest weight was about a month ago at 116. I am currently struggling to maintain 120. For me my physicians have changed my medication from preventive to rescue on active ... so we will see how that works. There are few things you need to be aware of in chronic use of pain meds, there is a difference between addiction and tolerance. With long term use your body gets use to the dosage and people find they have to increase there dose for the medication to be effective, this is called tolerance and it is NOT addiction. There are things you can do to help with this if you work with your doctor closely. If you are fearful of addiction let your doctor know. I have been on meds for decades and have not had to increase my dosage, I have been fortunate, each person is different. I just want to say, I believe in some patients pain medication can significantly improve their quality of life, and I do believe it has many benefits for patients such as ourselves. There is a risk for addiction, but that is a risk for many medications, not just pain medication. May I ask, why you are uncomfortable taking pain medications? (I know this is a personal question, so do not feel obligated to respond). I have spoke with so many patients that this is a huge step, and when they find they are useful and improve their quality of life they become ashamed as if they were not strong enough to handle to daily pain that is dished out to them. As a nurse and as a patient I believe our medical community has done a disservice to many chronic pain patients.