A website specializing in Lifestyle Modification of Chronic Non-Cancer Pain

COMPLEX PAIN – DEFINITION

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

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

– has lasted for more than a year;

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

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

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

– 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, more frequent, and more long-lasting;

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

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

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

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

– 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, (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.

HOW DID WE GET HERE?

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

OUT-OF-SYNC ACUTE-MINDED MEDICINE GOT US HERE

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, influenza, cholera, smallpox, sexually transmitted diseases, measles, malaria and everything we could pick up from viruses, bacteria and little animals that get under our skin and into our body). It’s great that experimental medicine met the challenge and developed, through experiment and skills learned by doing, a consistent way of identifying a single cause of an illness, isolating the presumed cause in the laboratory, then finding a specific agent that would kill it, 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. That’s what happened when the average age of the population was 25, communicable disease was the problem, and acute-minded treatment “fit” the need.

THE CURRENT SITUATION

Conditions drive the type of medicine needed. The problem is that an average age of 25 no longer exists. And communicable diseases are no longer a problem. And urgent care is no longer what is needed. The current condition is that the average age everywhere is increasing, 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. 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, like chronic pain, as if it had a single cause when research around the world indicates chronic pain has multiple causes? Worse. 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, continuing education credit or completed a pain residency, 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, and personally “feeling comfortable” come first? When you’re not qualified to treat, do what the Hippocratic Oath tells you to do:”I will leave this operation to be performed by practitioners, 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, meaning that general physicians efforts at treating chronic pain are worse than a roll of the dice. In a controlled study that we did for 6 years on the Scripps Memorial Hospital campus pain program, 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, or who got the integrated interdisciplinary reference standard for complex chronic pain. It’s too bad that health care left to its own devices hasn’t worked. It would have been nice to let doctors practice at their convenience, 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. But we didn’t and here we are, 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. The further fact is that  there simply aren’t enough qualified pain specialists to treat the 100+ million plus Americans afflicted with complex pain. Do you doubt that number? Don’t, because when 70% of the population has the risk factors for insulin resistance and diabetes, that means that 70% of the population has the risk factors for chronic pain. So what do pain patients do?

RIGHT! PATIENT, HEAL THYSELF

Pain today is the most frequent reason that patients give for going to doctors. Yet, acute-minded medicine that was designed to identify the single causes of symptoms doesn’t work. It’s been proven over and over again in every chronic disease. Acute-minded medicine is out of sync with the times and the chronic diseases afflicting us at this point in time. Acute thinking doesn’t meet the need. So why are we still insisting on using an outdated decision process, because there is no evidence that supports its use for any chronic disease. Acute-minded medicine, unless some readers have missed the point, does not address the lifestyle factors that all chronic diseases are caused by, 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. Single cause medicine, and treatment by solo practitioners, 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, over time produce diseases of wear and tear the symptoms of which acute treatment, does it need repeating, is useless at reversing.

The problem is that the world has changed significantly from the time acute-minded medicine met the challenges of communicable disease 100 years ago. The challenge now is chronic, multi-factor diseases that acute-minded, acute-trained physicians who try to force a round peg in a square hole, despite their persistence at trying, will fail to achieve.  And that’s not a debating point. It’s evidence-based, and the numbers demonstrate it around the world. Urgent care thinking is not working, people are suffering, and our current acute-minded physicians are unable to say, “I don’t know.” And, either primary care docs should do the ethical thing and refer out to a qualified person, or consider trying simple solutions, 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. Lots of folks were still trying to repair Model Ts using horse-and-buggy methods. We have medicine and physicians that are acute-minded and that are convinced that all health problems are caused by single agents, 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. The environment, the times, 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, pain patients have to keep one thing in mind: Abuse is what I permit. And, then, don’t permit it. Don’t yell and scream – mainly because it’s useless – just walk. Walk away from the unqualified and do what you can to get into the right hands, as quickly as possible. Otherwise, you’re the only one responsible for the abuse.

WHY DO WE GET CHRONIC PAIN?

The pain implications of an older average age in a wealthier more indulgent times is simple, our bodies will predictably be exposed to more wear and tear and develop more “systemic” diseases that disrupt multiple systems. Just on the physical side, 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. We use sports equipment designed for professional athletes, 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, possibly until they die because they couldn’t not respond to the aspirational advertising. Our industrial environment has also changed. 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. We were designed to be mobile, not immobile, and to use certain body parts up to a certain point and then to stop. But we don’t now because making a salary forces us to push the body beyond the tolerances of human physiology. Or we go to wars where every day brave men go beyond the tolerance limits of the human body. So disuse and overuse pain syndromes, especially of the low-back now dominate the headlines. Finally, even when we try to entertain ourselves, we engage in single activities like jogging or weight-lifting thousands and thousands of times, most of the time with above-average levels of resistance, that lead to repetitive strain disorders. In sum, we live in an era when we are reinforced for exceeding the tolerances of human physiology. 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, we too are acute-minded so that explains the demand for “right now.”

FIRST THINK, DON’T JUST WALK OFF THE CLIFF

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

MY AIM IS TO SHOW YOU WHERE THE MINE FIELD IS AND HOW TO GET THROUGH IT

This website deals with pain that meets criteria as a non-communicable disease. That is, chronic pain that is a product of a combination of factors, not the single causes of acute-minded medicine and acute-minded diagnostic techniques. This website also deals with the reality that – international surveys tell us – 98% of chronic pain patients will never see, nor will they ever be treated by a qualified pain specialist. The economics of healthcare make that a predictable impossibility for anybody but the richest chronic pain patients. Qualified, credentialed, board certified continuing care for chronic pain patients is dead. You’re on your own. 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. Moaning and groaning about “the healthcare system” hasn’t changed a thing in half a century. 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. They’re trying to force a round chronic peg in an acute square hole. And, from your own experience, you know it’s not working.

So, the goal of this website is to provide the attitudes, habits, and lifestyle skills that the pain that has been described above requires. I have chronic pain. I had pain for a period of 5 years where my teeth and my hair hurt. That’s a level of pain that the whole body is humming and there isn’t a moment of piece. I followed my own program, as have hundreds of my patients, and based on controlled studies with hundreds of patients I worked with on Scripps Memorial Hospital campus, with restoration of optimal functioning as the single-minded goal, optimal functioning can be restored in over 90% of our patients. There is an important role for the right pain medications. The reason is that, also from data from our patients, all patients who met the above criteria had to kick-start their rehab with the right pain medications, prescribed by qualified, board certified or credentialed pain management physicians, had to start taking pain medications in order to start their structured approach to rehabilitating their ability to function optimally. Today I take no medications but I am a fanatic about what I have to do to self-manage the conditions of my pain’s occurrence. That’s the goal of this website. It is a website where talk and reading books does nothing for you. You have to do pain self-management or it doesn’t work. Healthcare is what it is right now. Join me if you want help in overcoming chronic pain in a way that it frees you up to again functioning optimally under your own control.

We had 8+ pain and we overcame it,

Dr. Henry Adams