Viagra Pills

Viagra pills Background

Viagra pills In 2011 I took a vacation from to go work at Naval Hospital Camp Pendleton (NHCP) with Marines returning from Afghanistan. Viagra pills Camp Pendleton is the Marines main base an hour’s drive up I-5 from San Diego. Viagra pills NHCP is where the Navy implements its duty to provide the care Marines need as a result of their combat responsibilities. Viagra pills I took the job for 3 reasons: 1) to add to my knowledge about pain, viagra pills to see what the Navy had learned from a heavy concentration of pain cases about how to restore optimal functioning; 2) to treat Marines with chronic pain the “Navy way” and learn how to implement their rehab approach for chronic pain; and, viagra pills 3) to give wounded Marines my personal “thanks” for their bravery in Afghanistan by extending to each one in pain a credentialed pain specialist’s best efforts to help restore function.

Viagra pills What follows are my observations extracted specifically from my experience with Marines who had diagnosable chronic pain disorders – often in combination with other combat-related disorders – and which I personally treated during 2011.

Viagra pills Functioning As An HMO, viagra pills Is NHCP Structured to Treat Chronic Pain? 

Viagra pills The quick answer is “No” because only if the structures are in place for a hospital to be enabled to effectively treat, viagra pills manage and rehabilitate chronic pain and restore function is it possible to rehabilitate chronic pain. Viagra pills Simply put, viagra pills the extent to which you ski is determined by the investment you make in developing the skill-knowledge needed to ski. Viagra pills Since NHCP made no investment in developing chronic pain rehab capabilities, viagra pills it has none to offer.

Viagra pills Problems of All Non-Pain Specialty Approaches to Treating Chronic Pain

Viagra pills The problem for those with chronic pain is that NHCP operates like any other HMO in the country and so it concentrates on offering only a narrow range of primary care services in general, viagra pills family and internal medicine. Viagra pills A few additional services in specialty medicine, viagra pills like Ob/Gyn and Pediatrics, viagra pills exist which, viagra pills in combination with the primary care services, viagra pills are available to anyone who is a beneficiary of Tricare, viagra pills the military’s health insurance. Viagra pills Medical needs that fall outside the hospital’s primary care area of practice ar simply not acknowledged and that is why they are never treated. Viagra pills Therefore, viagra pills those chronic complex disorders that do not “fit” the primary care acute care model, viagra pills referrals to “out-of-network” providers who are qualified to treat these disorders are rarely made. Viagra pills If as far as primary care providers a disorder is not acknowledged then no need exists to make a referral to someone who specializes in that disorder. Viagra pills Again, viagra pills the services needed to treat the chronic complex pain disorders that many Marines develop were never adequately treated for 18-24 months, viagra pills do not exist at NHCP.  The fact a Marine could be exposed to primary care or specialty care treatment at NHCP for 18-24 with no objective change in the Marine’s chronic pain condition provides evidence of the absence of qualified pain treatment at NHCP. Viagra pills Clearly engaging a pain patient in 18-24 months of inept, viagra pills failed treatment does nothing to provide stable enough pain relief, viagra pills restored function, viagra pills and a return to full-duty status, viagra pills all of which are the explicit duty of Navy doctors to provide wounded Marines. Viagra pills That the Naval Hospital at Camp Pendleton has chosen to administratively limit itself to functioning as a primary care hospital that does not offer a qualified chronic pain rehab program does not exculpate it and its doctors from its duty to treat wounded Marines according to the needs of their symptoms.

Viagra pills How Navy medicine manages a Marine with chronic complex pain reveals the same negligence seen in how civilian providers manage chronic complex pain – by either under treating or not treating it at all, viagra pills which leads to worsening of condition and a complex chain of further costly healthcare services in all pain patients. Viagra pills Marines are harmed further by terminating their careers without a solidly grounded differential diagnosis or proof of the failure of a demonstrably competent chronic pain rehab program. Viagra pills My experience in running a chronic pain rehab program is that ~70 percent of musculoskeletal pain cases could be restored to optimal functioning with that 12 months, viagra pills or about half the time that Marines in chronic pain are exposed to failed or inept acute approaches to chronic pain.

Viagra pills The Steps NHCP Uses to Evaluate Chronic Pain Complaints

Viagra pills The steps that Marines went through who I treated for chronic pain were as follows:

Viagra pills - All Marines are first evaluated by their BAS MOs (Battalion Aid Station Medical Officers), viagra pills family medicine residents not yet licensed to practice as independent physicians. Viagra pills Since BAS MOs work and live with and are deployed with the battalion, viagra pills they know individual Marines best and the likely conditions of their symptoms occurrence. Viagra pills Most complaints at the BAS level are acute and are resolved by usual care from a family medicine approach. Viagra pills However, viagra pills many Marine complaints surface once Marines are no long “in theater” where most believe they have “no time or stomach” for severe pain.  So once some Marines return to base, viagra pills chronic pain issues will emerge. Viagra pills When issues develop that require repeated visits over a period of 6-9 months to their BAS MOs for treatment to which the Marine fails to respond, viagra pills referral is then made further up the ladder;

Viagra pills - Primary care (physicians licensed in general medicine, viagra pills family practice or internal medicine) now evaluates the complaints  and starts a medication regimen that fits the acute care model of the primary care doctor and has nothing to do with the end objective of restoring function and a return to full-duty status.  This treatment usually shows no response within 4 weeks, viagra pills but it may be extended, viagra pills or literally forgotten, viagra pills for another 6-9 months. Viagra pills As with the BAS MO, viagra pills this is a similar treatment to which a Marine with an under or untreated pain disorder will fail to respond. Viagra pills Referral is now made to specialty medicine;

Viagra pills - Specialty medicine now evaluates the Marine’s complaints, viagra pills usually orthopedics, viagra pills neurology or psychiatry, viagra pills to rule out objective causes from the perspective of the particular specialty. Viagra pills More modifications to treatment are made over a period of another 9-15 months, viagra pills often with multiple prescription drugs to which the Marine with an inappropriately treated pain disorder will again fail to respond, viagra pills often with side effects that further exacerbate the pain condition and decrease his/her ability to function as a Marine.

Viagra pills - In several cases, viagra pills specialty medicine referred the Marine for evaluation by pain anesthesiologists at the Naval Medical Center at Balboa in San Diego where a competent differential diagnosis was obtained and medications to which the Marine finally began to respond well and to get some pain relief. Viagra pills However, viagra pills a solid diagnosis and some initial pain relief are not chronic pain rehabilitation by a qualified integrated interdisciplinary team where the primary responsibility of each of its members is chronic pain rehab alone. Viagra pills The problem was that there was no continuity of care by the pain anesthesiologists who knew how to best manage the pain; that responsibility fell back onto the BAS MO who, viagra pills once the prescription ended, viagra pills s/he might or might not renew, viagra pills completely change the treatment, viagra pills or be deployed and the Marine require transfer to a temporary BAS MO who would start this entire process all over again.

Viagra pills - By this time, viagra pills specialty medicine would usually begin to discuss preparation of the Marine’s Medical Board, viagra pills terminating his/her career in the Marine Corps. Viagra pills This without the chronic complex and disabling pain disorder ever being competently diagnosed, viagra pills effectively treated (and confirming the diagnosis) and having this entered in the Marine’s AHLTA medical chart to document, viagra pills once s/he went to request treatment from a civilian provider that the Marine was a legitimate chronic pain patient as evidenced in a credible military document by a qualified physician who treated the Marine’s pain and could attest to it if the civilian physician felt the need to do so.

Viagra pills With the Marine’s career ended thanks to a chronic pain disorder that the Marine has no awareness of what its causes are, viagra pills how to relieve the pain, viagra pills manage the conditions of its occurrence, viagra pills what to do to return to optimal functioning (allowing for regular employment), viagra pills and to enjoy increased quantity of life within his/her unique life situation.

Viagra pills The Result of “Business As Usual” At NHCP

Viagra pills In other words, viagra pills the outcome of a military medicine approach to chronic complex pain is no different from that seen in the private sector when chronic pain patients are seen by independent practitioners and left with the same disabling conditions that will lead to unending high frequency use of medical visits, viagra pills prescription medications, viagra pills diagnostic and laboratory studies, viagra pills the ER, viagra pills hospitalization and unnecessary surgery. Viagra pills To this must be added becoming totally disabled, viagra pills unemployed, viagra pills divorced, viagra pills with loss of children, viagra pills in medical bankruptcy, viagra pills living alone, viagra pills being highly prone to developing multiple chronic diseases, viagra pills intractable pain (see, viagra pills along with a likely addiction to alcohol and prescription or street drugs.

Viagra pills Finally, viagra pills my experience included a clear case of no leadership on the part of the psychiatrist who was in charge of the Wounded Warrior Battalion who knew I was credentialed in pain management and was bound to practice based on the ethical standards of my diplomate with the American Academy of Pain Management (AAPM) and who told me to “do less pain management and something more psychological.”  Ultimately he demanded I become credentialed in health psychology – which is not an evidence-based procedure for rehabilitating chronic complex pain – or not have my contract renewed. Viagra pills I chose to stick by the ethical standards of the AAPM and did leave.

Viagra pills Marine Myths about NHCP

Viagra pills NHCP knows and treats everything. Viagra pills No it doesn’t. Viagra pills NHCP only has the evidence-based skill-knowledge set for primary care – or the perspective of general, viagra pills family or internal medicine plus a few specialty medical services. Viagra pills That’s it. Viagra pills Marines should not expect more. Viagra pills For Marines with pain that has lasted more than 3 months and for whom the usual medical care offered at NHCP has done nothing to restore their ability to function, viagra pills NHCP lacks the MOS to treat, viagra pills manage or rehab a Marine’s chronic pain disorders. Viagra pills The likelihood is that a Med Board will be the outcome for those with chronic pain.

Viagra pills Specialized rehab programs for chronic pain exist at NHCP.  They do not. Viagra pills There are many rehab programs in hospitals around the country. Viagra pills The classic ones are Cardiac Rehab, viagra pills and Diabetes Rehab, viagra pills and they all have the same characteristics: an integrated interdisciplinary team who are all knowledgeable about chronic pain with the single minded objective being to: (a) restore optimal behavioral and molecular to the patient as evidenced by objective behavioral and molecular markers, viagra pills and (b) turning over to the patient the responsibility of self-managing the conditions of their pain’s occurrence.

Viagra pills If one has chronic pain, viagra pills one can quickly get to see a pain specialist at NHCP. Viagra pills Not possible. Viagra pills A chronic pain specialty requires special education, viagra pills training, viagra pills experience and credentialing. Viagra pills There are no such providers at NHCP. Viagra pills Pain specialists are available at Balboa but it takes a long time to go through the steps to get a referral to Balboa. Viagra pills And then it’s just for a “differential diagnosis” that will probably be the basis for your Med Board rather than for ongoing treatment, viagra pills relief of pain and restored ability to function (especially in “full-duty status”).

Viagra pills The Med Board process is no big deal. Viagra pills Not really. Viagra pills Most wounded Marines who I saw at Camp Pendleton ended up being “med boarded” out of the Marines – at great harm to the Marine – not because the Marine had a specific, viagra pills diagnosable condition that made him/her “unfitting” for duty. Viagra pills That their disorder rendered them “unfitting” never could be confirmed because they were never exposed to the appropriate treatment for chronic pain, viagra pills which when done right, viagra pills could have confirmed if their pain disorder really rendered them “unfit” by disappearing. Viagra pills Instead, viagra pills Marines with chronic pain were summarily “med boarded” out of the Marines because the Marine’s pain disorder did not respond to general medicine’s acute perceptions, viagra pills treatment and management approach to pain and your chronic pain failed to respond to their mistaken expectations.

Viagra pills If a provider at NHCP says I don’t have chronic pain it’s so.  Not so, viagra pills not today when evidence-based pain management is what we practice, viagra pills rather than philosophy and the unsupported use of words. Viagra pills Scientific pain management exposes the patient to the evidence-based treatment for the specific pain condition that is implemented by an integrated interdisciplinary team qualified in providing chronic pain rehab. Viagra pills If the Marine’s chronic pain responds to the qualified version of chronic pain treatment within the expected period of time, viagra pills there is confirmation of the pain condition and the primary care doctor’s diagnosis is therefore false. Viagra pills If there is no response to the chronic pain treatment, viagra pills there is no confirmation of the pain condition and the chronic pain specialist’s diagnosis is therefore false.

Viagra pills It’s easy for a neurologist to see the real causes of pain. Viagra pills No so. Viagra pills Take the case of a 20 y/o Lance Corporal “mortar man” who was on patrol in enemy territory carrying a heavy mortar barrel by wrapping both his arms around the mortar barrel and resting it over his traps as one might hold a heavy barbell prior to doing squats. Viagra pills As the patrol came over a rise, viagra pills enemy rocket fire started coming in over the Marines, viagra pills and the Lance Corporal started running down a hill that was inclined to the right. Viagra pills As he ran he stumbled on a rock and as gravity took him towards the right, viagra pills still with the mortar barrel over his shoulders, viagra pills he fell hard with all his weight. Viagra pills As he fell he put out his right elbow to break the fall and, viagra pills in so doing, viagra pills the barrel was forced towards the right front and tightly against his right trap which he fell against with all his weight. Viagra pills When he was able to get up the pain was sharp and throbbing over his right shoulder and neck. Viagra pills He reported to the BAS MO, viagra pills was given rest and mild analgesics. Viagra pills The pain subsided slightly but within a week he reported having “bad migraines.” He was returned to base but was unable to perform his duties due to the “bad migraines” so he was air-evac’d back to Camp Pendleton for evaluation and treatment. Viagra pills After a period of unsuccessful treatment by his BAS MO he was referred him for primary care evaluation and more treatment with analgesics which again did nothing to relieve his headaches. Viagra pills At 12 weeks post-injury the Marine was referred to a neurologist for evaluation who prescribed the standard medication for migraines to which the Marine faithfully adhered for a further 4 months; however the migraines persisted while his marriage, viagra pills work, viagra pills and social life got worse. Viagra pills Another 8 months went by with relief in his migraines; he also was treated with psych meds because he couldn’t stand the side effects. Viagra pills He couldn’t do any exercise, viagra pills he had no appetite and he lost 15 pounds. Viagra pills The neurologist told him he was going to be “med boarded” since his symptoms didn’t improve, viagra pills he couldn’t qualify for any of his Marine required activities, viagra pills and his Command was ready to support his being med boarded.

Viagra pills Since NHCP can provide no qualified treatments for chronic pain, viagra pills all his Navy doctors could say concretely was that this young Marine did not have the neurological, viagra pills psychiatric, viagra pills or orthopedic conditions they hypothesized he might have. Viagra pills There is no way of confirming with hard evidence of either Navy physicians’ impression of the condition or provide no qualified treatment, viagra pills only assertions that the condition is something that it is not – and for which there is no confirming response to treatment – rather than what it is – and for which the confirming response to treatment does exist.


Viagra pills My original impression before I came to work with wounded Marines at NHCP was that Navy medicine at NHCP was at the same level of expertise that military medicine was at in their work amputees. Viagra pills This was not the case at NHCP on closer inspection:

Viagra pills - There is no qualified pain treatment at NHCP;

Viagra pills - There are no qualified full-time pain specialists available to Marines at NHCP;

Viagra pills - There are no continuing education courses on chronic pain for providers at NHCP;

Viagra pills - There is no integrated interdisciplinary chronic pain program at NHCP;

Viagra pills - Med Board diagnoses for those with chronic pain are probably in error

Viagra pills - Med Board diagnoses for those with chronic pain are often trivial (“neuritis” was given as a diagnosis rather than the disabling Complex Regional Pain Syndrome that it was based on a second round work-up by pain anesthesiologists at Balboa);

Viagra pills - There is no credentialed chronic pain specialty leadership for the Wounded Warrior Battalion.

Viagra pills The Marines I worked with were a wonderful group of men I got to know and appreciated enormously. Viagra pills They deserve a more than the “business-as-usual” primary care effort they have been given. Viagra pills All Marines should be returned to the high level of behavioral and molecular functioning they had shortly after finishing boot camp at their physical best. Viagra pills Hopefully, viagra pills legislators in Washington will implement the urgently needed chronic pain rehab programs these brave young Americans deserve.

Viagra pills  

Viagra pills Dr. Viagra pills Henry Adams

Viagra pills AAPM Diplomate in Pain Management

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Viagra pills This is a very special type of pain. Viagra pills It’s pain that …

Viagra pills - is not caused by cancer, viagra pills diagnosable tissue or structural damage and it responds poorly to all sorts of medical treatment;

Viagra pills - has lasted for more than a year;

Viagra pills - is not mild or intermittent but rather it occurs daily and the pain is moderate to severe (5+ on a 10-point scale);

Viagra pills - is pain that physicians you’ve seen haven’t been able to get you back to work or functioning normally again;

Viagra pills - all of your diagnostic tests produce “negative” findings and your physicians tell you that “you have nothing, viagra pills” yet you continue to have moderate to severe pain and you can’t work and you can’t lead a normal life;

Viagra pills - is pain that the medications that have been prescribed for you for pain have not only not helped but more often than not they’ve made your pain more severe, viagra pills more frequent, viagra pills and more long-lasting;

Viagra pills - it’s very likely you’ve never been evaluated and treated by a doctor who was Board Certified or credentialed in pain management;

Viagra pills - it’s pain not caused by nerve damage as determined by a Nerve Conduction Study (NCS) and examination by a qualified neurologist;

Viagra pills - it’s complex pain that has led your doctors to tell you, viagra pills “That’s all we can do for you. Viagra pills Learn to live with it;”

Viagra pills - it’s complex pain that is becoming increasingly difficult to have carriers pay for the integrated, viagra pills interdisciplinary treatment that works best; and, viagra pills

Viagra pills - it’s pain you had better learn to self manage because: (a) the teams of qualified doctors needed to treat it are extremely difficult to find; (b) the carriers aren’t paying for either the drugs or the effective treatment; and, viagra pills (c) pain patients who follow a qualified program do learn how to self-manage pretty well without physicians and much fewer of the wrong drugs.

Viagra pills HOW DID WE GET HERE?

Viagra pills We’re at this state of chaos because this is pain that fell between the cracks of conventional, viagra pills acute-minded, viagra pills acute-treated solo practice medicine. Viagra pills That means, viagra pills urgent care type medicine provided by a single doctor for as little time as possible. Viagra pills Why? Because that’s all that healthcare will provide. Viagra pills Healthcare is broke. Viagra pills It can’t be afforded any more. Viagra pills Where before it used to cost $200 a month for all medical services and medications, viagra pills today it’s the equivalent of a salary, viagra pills or a quarter or more of your take-home pay.


Viagra pills Today’s chronic pain doesn’t fit the acute (urgent care) treatment model that worked well from about 1850-1950 when the average age was 25 and the major concern was communicable diseases (like TB, viagra pills influenza, viagra pills cholera, viagra pills smallpox, viagra pills sexually transmitted diseases, viagra pills measles, viagra pills malaria and everything we could pick up from viruses, viagra pills bacteria and little animals that get under our skin and into our body). Viagra pills It’s great that experimental medicine met the challenge and developed, viagra pills through experiment and skills learned by doing, viagra pills a consistent way of identifying a single cause of an illness, viagra pills isolating the presumed cause in the laboratory, viagra pills then finding a specific agent that would kill it, viagra pills then giving the agent to the patient in certain doses over a specific time frame and then watching the patient’s symptoms disappear and the patient’s ability to function return. Viagra pills That’s what happened when the average age of the population was 25, viagra pills communicable disease was the problem, viagra pills and acute-minded treatment “fit” the need.


Viagra pills Conditions drive the type of medicine needed. Viagra pills The problem is that an average age of 25 no longer exists. Viagra pills And communicable diseases are no longer a problem. Viagra pills And urgent care is no longer what is needed. Viagra pills The current condition is that the average age everywhere is increasing, viagra pills right around 45 when people develop chronic (non-communicable) diseases with multiple causes affecting multiple systems that no solo practitioner with one view of the world – the acute one – can treat effectively. Viagra pills What are we doing treating diseases that have multiple causes with methods that assume that diseases have single causes? What are we doing treating anything chronic, viagra pills like chronic pain, viagra pills as if it had a single cause when research around the world indicates chronic pain has multiple causes? Worse. Viagra pills By what magic do primary care physicians develop the skills needed to treat chronic pain effectively when virtually none have ever taken a single course, viagra pills continuing education credit or completed a pain residency, viagra pills nor much less ever completed the supervised proctorships that produce the “demonstrable competence” that ethical principles require? By what sense of illogic can someone who is not qualified in chronic pain prescribe “off license” medications for a disorder they are not qualified to treat? In what other sub-specialty besides chronic pain can a physician accept to treat a patient and then say “I don’t feel comfortable prescribing opioids for you” and prescribe a medication that winds up under-treating and/or inappropriately treating  the disorder and then makes the condition worse? Since when does when does the Hippocratic Oath require that a doctor – rather than the patient – “feel comfortable?” Since when does “I will never do harm to anyone” in the Hippocratic Oath now come last, viagra pills and personally “feeling comfortable” come first? When you’re not qualified to treat, viagra pills do what the Hippocratic Oath tells you to do:”I will leave this operation to be performed by practitioners, viagra pills specialists in this art.” Evidence-based medicine is increasingly showing that the outcomes physicians get who are not qualified to treat chronic pain are essentially random, viagra pills meaning that general physicians efforts at treating chronic pain are worse than a roll of the dice. Viagra pills In a controlled study that we did for 6 years on the Scripps Memorial Hospital campus pain program, viagra pills pain patients who were left to the “usual care” provided by their primary care physicians got 25% worse in 90 days compared to their counterparts who got the right medications from a Board Certified pain management anesthesiologist, viagra pills or who got the integrated interdisciplinary reference standard for complex chronic pain. Viagra pills It’s too bad that health care left to its own devices hasn’t worked. Viagra pills It would have been nice to let doctors practice at their convenience, viagra pills and that they could “feel comfortable” rather than having started addressing 25 years ago the predictable need to deal with the shift of the population towards chronic disease that we knew would cost 8 times what treating acute disease costs. Viagra pills But we didn’t and here we are, viagra pills pretending that it’s ok fir physicians with no demonstrable competence to treat chronic pain “because it’s expedient.” It’s not so and there is no way that a bunch of overworked general practitioners are going to learn the skills fast enough to meet the need. Viagra pills The further fact is that  there simply aren’t enough qualified pain specialists to treat the 100+ million plus Americans afflicted with complex pain. Viagra pills Do you doubt that number? Don’t, viagra pills because when 70% of the population has the risk factors for insulin resistance and diabetes, viagra pills that means that 70% of the population has the risk factors for chronic pain. Viagra pills So what do pain patients do?

Viagra pills RIGHT! PATIENT, viagra pills HEAL THYSELF

Viagra pills Pain today is the most frequent reason that patients give for going to doctors. Viagra pills Yet, viagra pills acute-minded medicine that was designed to identify the single causes of symptoms doesn’t work. Viagra pills It’s been proven over and over again in every chronic disease. Viagra pills Acute-minded medicine is out of sync with the times and the chronic diseases afflicting us at this point in time. Viagra pills Acute thinking doesn’t meet the need. Viagra pills So why are we still insisting on using an outdated decision process, viagra pills because there is no evidence that supports its use for any chronic disease. Viagra pills Acute-minded medicine, viagra pills unless some readers have missed the point, viagra pills does not address the lifestyle factors that all chronic diseases are caused by, viagra pills and there’s no demonstrable evidence that the “usual care” general physicians give chronic pain patients helps patients get back to work or back to functioning optimally the way they used to. Viagra pills Single cause medicine, viagra pills and treatment by solo practitioners, viagra pills has proven useless with chronic pain because chronic pain requires a different decision process because chronic pain is a product of a combination of things that, viagra pills over time produce diseases of wear and tear the symptoms of which acute treatment, viagra pills does it need repeating, viagra pills is useless at reversing.

Viagra pills The problem is that the world has changed significantly from the time acute-minded medicine met the challenges of communicable disease 100 years ago. Viagra pills The challenge now is chronic, viagra pills multi-factor diseases that acute-minded, viagra pills acute-trained physicians who try to force a round peg in a square hole, viagra pills despite their persistence at trying, viagra pills will fail to achieve.  And that’s not a debating point. Viagra pills It’s evidence-based, viagra pills and the numbers demonstrate it around the world. Viagra pills Urgent care thinking is not working, viagra pills people are suffering, viagra pills and our current acute-minded physicians are unable to say, viagra pills “I don’t know.” And, viagra pills either primary care docs should do the ethical thing and refer out to a qualified person, viagra pills or consider trying simple solutions, viagra pills rather than make the life of patients miserable with shots in the dark that have no evidence base for being used by doctors unqualified in the field in which they are using them.  What we’re going through right now in the treatment of chronic pain is no different from what was happening shortly after the internal combustion engine was invented. Viagra pills Lots of folks were still trying to repair Model Ts using horse-and-buggy methods. Viagra pills We have medicine and physicians that are acute-minded and that are convinced that all health problems are caused by single agents, viagra pills and they go ahead and treat our chronic diseases as if acute-minded medicine had an evidence base to stand on when the evidence shows their efforts to be wrong. Viagra pills The environment, viagra pills the times, viagra pills the lifestyle and the out-of-date medicine for the chronic need is the mix that has created the conditions that people with chronic pain will have to line up their priorities and decide whether they’re “sick and tired and I’m not going to let it happen anymore.” In the current situation, viagra pills pain patients have to keep one thing in mind: Abuse is what I permit. Viagra pills And, viagra pills then, viagra pills don’t permit it. Viagra pills Don’t yell and scream – mainly because it’s useless – just walk. Viagra pills Walk away from the unqualified and do what you can to get into the right hands, viagra pills as quickly as possible. Viagra pills Otherwise, viagra pills you’re the only one responsible for the abuse.


Viagra pills The pain implications of an older average age in a wealthier more indulgent times is simple, viagra pills our bodies will predictably be exposed to more wear and tear and develop more “systemic” diseases that disrupt multiple systems. Viagra pills Just on the physical side, viagra pills over time we are exposed to more bangs and whacks from vehicles made of plastic that we drive at speeds at which our unprotected bodies were not meant to travel. Viagra pills We use sports equipment designed for professional athletes, viagra pills and therefore we can predict before they even put on the equipment that non-professionals will get injured and will likely wind up suffering persistent pain for many years, viagra pills possibly until they die because they couldn’t not respond to the aspirational advertising. Viagra pills Our industrial environment has also changed. Viagra pills We now sit or stand or use specific body parts in unnatural ways for periods of time that the human body was also not designed to do. Viagra pills We were designed to be mobile, viagra pills not immobile, viagra pills and to use certain body parts up to a certain point and then to stop. Viagra pills But we don’t now because making a salary forces us to push the body beyond the tolerances of human physiology. Viagra pills Or we go to wars where every day brave men go beyond the tolerance limits of the human body. Viagra pills So disuse and overuse pain syndromes, viagra pills especially of the low-back now dominate the headlines. Viagra pills Finally, viagra pills even when we try to entertain ourselves, viagra pills we engage in single activities like jogging or weight-lifting thousands and thousands of times, viagra pills most of the time with above-average levels of resistance, viagra pills that lead to repetitive strain disorders. Viagra pills In sum, viagra pills we live in an era when we are reinforced for exceeding the tolerances of human physiology. Viagra pills And then we wonder why we have persistent pain that has been produced by a combination of conditions affecting multiple systems in the body and we fail to ask Why can’t my acute-minded doctor not “fix’ this problem right now? Of course, viagra pills we too are acute-minded so that explains the demand for “right now.”

Viagra pills FIRST THINK, viagra pills DON’T JUST WALK OFF THE CLIFF

Viagra pills Go back to the bullet points at the top. Viagra pills If you meet the criteria, viagra pills you probably have pain that is out of sync with acute-minded, viagra pills urgent care medicine that may have worked for communicable diseases but that medicine has not yet redone itself, viagra pills from top to bottom as it did last century, viagra pills to deal with a new challenge, viagra pills the noncommunicable diseases or what the World Health Organization now calls NCDs. Viagra pills And that means that you are going to have to become responsible, viagra pills accountable and liable for your the conditions of your own pain’s occurrence. Viagra pills You will have to decide whether you allow yourself to continue going to a physician who is not qualified to treat chronic pain, viagra pills and you continue to think that s/he is “my pain doctor, viagra pills” just because s/he prescribes some pain medications that have never worked for you, viagra pills but have made your doctor “comfortable.” You will have to decide after letting your doctor treat a treatment for 3 months and it fails to get you functioning again how vigorous an action you will take, viagra pills either with their medical board or with your State’s Intractable Pain Laws. Viagra pills Or, viagra pills you will learn how to treat the part of your pain that you are more qualified than your physician: the lifestyle, viagra pills habits and attitudes that are totally beyond your doctor’s area of practice and expertise. Viagra pills They know nothing about effective functional changes where you, viagra pills with some guidance, viagra pills can make changes that will modulate your pain. Viagra pills You will also have to decide how to think the way the Body does, viagra pills with the KISS formula (Keep It Simple Silly). Viagra pills That’s learnable, viagra pills and actionable, viagra pills and it modulates pain.


Viagra pills This website deals with pain that meets criteria as a non-communicable disease. Viagra pills That is, viagra pills chronic pain that is a product of a combination of factors, viagra pills not the single causes of acute-minded medicine and acute-minded diagnostic techniques. Viagra pills This website also deals with the reality that – international surveys tell us – 98% of chronic pain patients will never see, viagra pills nor will they ever be treated by a qualified pain specialist. Viagra pills The economics of healthcare make that a predictable impossibility for anybody but the richest chronic pain patients. Viagra pills Qualified, viagra pills credentialed, viagra pills board certified continuing care for chronic pain patients is dead. Viagra pills You’re on your own. Viagra pills You have to learn the skills for effectively self-managing the conditions of your pain’s occurrence and extracting whatever helps your particular type of pain from existing healthcare and that is likely the best that you will be able to get for your pain until you die. Viagra pills Moaning and groaning about “the healthcare system” hasn’t changed a thing in half a century. Viagra pills The money isn’t there to deal with any disease that is chronic because the numbers indicate that treating chronic diseases costs 8 times what it costs to deal with acute disease. Viagra pills They’re trying to force a round chronic peg in an acute square hole. Viagra pills And, viagra pills from your own experience, viagra pills you know it’s not working.

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