ARLINGTON, Tex. – Pain management is dicey for a recovering substance-abuse addict. Drugs, by definition, ought to be avoided, even when they would be the first option for treating an excruciating injury.
Slugger Josh Hamilton(notes) of the Texas Rangers is a recovering drug and alcohol addict. He's also suffering from a painful groin injury. And he's trying to perform at the highest possible level on the game's biggest stage – the World Series.
It's an unworkable combination. Something has to give. Treating the injury with painkilling drugs might enable Hamilton to swing the bat more freely and run without constant discomfort. But most painkilling drugs are addictive. In addition to dulling an ache, they produce euphoria. The user craves more.
For the sake of Hamilton's ongoing substance-abuse recovery, he shouldn't use painkillers, two doctors said.
For the sake of the Rangers' quest to win their first World Series, maybe he should, any number of Texas fans might say.
Hamilton dodged the question of whether he took a painkilling injection, saying: "I plead the fifth," a response that sounds more like a confirmation than a denial.
The injury to his left groin occurred several weeks ago. He's aggravated it by playing, and he acknowledged that he'd be on the disabled list if this were the regular season. Rangers general manager Jon Daniels said the center fielder hasn't had an MRI because he's playing through the end of the World Series no matter what.
It's not even clear that the injury is just a groin strain. In 2009, Hamilton was initially diagnosed with the same injury, but it was later found to be a sports hernia. He had surgery and was on the disabled list for a month.
[Photo gallery: Cardinals-Rangers Game 3 preview]
This time, the injury inhibits Hamilton's ability to integrate his legs into his swing and generate maximum power. He's hitless in seven at-bats in two Series games and hasn't hit a homer in the postseason. He did, however, drive in the tying run in the ninth inning of Game 2 with a sacrifice fly, momentarily quieting critics who questioned whether manager Ron Washington should continue to bat him third in the order.
The more pertinent question inside the Rangers' clubhouse is how to appropriately treat the injury, given Hamilton's history of drug and alcohol addiction.
A physician who asked not to be identified because he works for an MLB team other than the Rangers said a cortisone injection wouldn't include addictive painkillers and likely wouldn't put Hamilton at risk of falling off the wagon. Cortisone is a steroid that reduces inflammation; it is not a painkiller. It also isn't normally used to treat a groin pull. But calming the inflammation with an injection could decrease the pain for a short period of time.
More important, another doctor said, is that Hamilton avoid potentially addictive pain medication.
"Anyone with a history of addictive behavior should avoid opiate-based pain medication," he said. "A lot of athletes have had problems kicking painkillers."
Hamilton is one of the most gifted players baseball has ever seen. The Tampa Bay Rays gave him $3.96 million after making him the first pick in the 1999 MLB draft, but less than two years later he injured his back in an auto accident.
During his injury rehab, he began drinking and using cocaine – first snorting it in powder form, then smoking crack. He was out of baseball by spring training in 2003 and didn't return until July 2006 because addiction took over his life.
He kicked drugs and alcohol, however, and within a year became an everyday player with the Cincinnati Reds in 2007 at age 26. The Reds traded him to the Rangers, and in his first season with them he led the American League in runs batted in with 130. Hamilton had made it back from the abyss to the MLB All-Star game.
But after three years of sobriety, he had a relapse in January 2009 while in Arizona for offseason workouts. He went alone to a pizza restaurant that had a bar, and one vodka and cranberry juice led to another. A visit to another bar followed, and soon anyone with an Internet connection could see what had transpired: Hamilton lewdly partied with three young women.
The relapse prompted him to redouble his adherence to a rigid program designed to eliminate situations which trigger cravings for drugs and alcohol. He has a large support group that includes his wife, father-in-law, clergy and coaches.
The system seems effective. Hamilton was the American League MVP in 2010, batting a team-record .359 with 32 home runs and 100 RBIs. He's been a mainstay in the Rangers' lineup, despite missing stretches with injuries ranging from broken ribs to knee tendinitis to lower back pain. He's even gotten through the horror of a man falling to his death from the outfield stands in Rangers Ballpark while trying to catch a ball tossed to him by Hamilton during the second inning of a game in July.
The biggest knock on Hamilton is that he faltered in last year's World Series, managing only two hits in 20 at-bats as the Rangers lost to the San Francisco Giants. Now he's 2-for-27 in World Series play and yearning to deliver. The injury isn't letting him, and he's frustrated.
Hamilton ran out of patience when he was repeatedly peppered with questions about his health after Game 2.
"Healthwise, it is what it is," he said. "I'm tired of talking about it. It's going to hurt until the season is over, so it's a non-issue as far as talking about it. So stop asking me, please."
Washington would appreciate the same courtesy when making out his lineup. He stuck with the left-handed Hamilton in the third spot even though the Cardinals had lefty Jaime Garcia(notes) on the mound – and even though Rangers right-handed batters Adrian Beltre(notes) and Nelson Cruz(notes) had been hot of late.
"Things are going around that Hamilton is dealing with some problems – and he is – but the nine guys I'm putting on the field are the nine guys who got me here," Washington said. "We're going to deal with them through good times and bad.
"If he tells me he can play, I'm putting him on the field."
So, what does cure a groin strain?
"Rest," a team doctor said. "That's it: rest. Don't aggravate the injury. Given time, it will heal."
Washington heeded that advice Friday, telling Hamilton to stay home rather than attend the Rangers' off-day workout. But it won't be enough. Hamilton sustained the injury six weeks ago. Then he tweaked it again running the bases against the Detroit Tigers last week in the AL Championship Series.
Now the stakes are higher. The Rangers can only hope the injury doesn't get worse and that Hamilton is able to contribute. And if he is taking medication to ease the pain, losing a baseball game might not be the worst that could happen.
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