Dr. Henry E. Adams, AAPM Diplomate in Pain Management


I’m a practicing pain specialist who enjoys his craft and staying up with practical, inexpensive and rational approaches that optimize pain patients ability to function, return to work, and enjoy an increased quantity of life, which the data indicate then improves one’s quality of life.


All chronic, noncommunicable diseases (NCDs) interest me because we now know that they all are modulated by lifestyle, habits and attitudes. Once NCDs symptoms have persisted for more 6 months, that trio of factors that is under our own control leads to significant biological alterations throughout the body that do not respond to the usual acute treatment. The positive side of the coin is that because these disorders are modulated by lifestyle, habits and attitudes, all chronic disorders, including chronic pain syndromes, can be directly modified to the extent that we learn to modify the conditions of their occurrence. In all of our work with chronic pain patients we see that, once patients learn the conditions of their pains occurrence, they learn by skill memory how to control their pain and, by extension, how to optimize their ability to function, return to work, and have an improved quantity of life. Some patients need to continue taking medications, some will not, and others fall somewhere in between.  The negative side of the coin is that, since altering lifestyle,  habits and attitudes are all outside the area of expertise of physicians, patients have to learn how to sever their dependence on physicians and how to self-manage the conditions of their pains occurrence on their own. In studying chronic diseases so extensively, the World Health Organization has embarked on a campaign to teach patients with chronic noncommunicable diseases that patients must begin to take two steps: (1) wean themselves off of their general and specialty physicians because the causes of chronic diseases, lifestyle, attitudes and habits, are not an area of expertise of physicians, and data show that physicians not qualified in managing chronic pain do more harm than good when they try to treat chronic pain; and, (2)  patients have to take over the responsibility, accountability and liability of treating the habit and lifestyle conditions of their symptoms occurrence.

Therefore, even though attitude, habit and lifestyle modification are within my area of expertise, I’m interested in any approach that makes all providers useless to their patients as soon as possible. I believe that the type of treatment pain patients receive in the developed world should be capable of being understood and implemented by the poorest, illiterate person in a small village in any developing country. If not we are treating a First World disease with First World methods that require payment, and endless doctors visits, diagnostic tests, prescription medications, visits to the Emergency Room, and unnecessary surgery. And unemployment, divorce, loss of children, family and a life. The era of easy access to whatever unrestricted healthcare that patients thought they needed is over. The economies of States and entire countries are going bankrupt because healthcare services that were designed for acute (communicable) diseases and that could be treated by solo practitioner are totally out of sync with the current chronic noncommunicable disease need.

The era of unending care, especially care where providers don’t know what they’re doing, is over. It is what it is: there is no more money. And, in the area of chronic pain, and in an era where there is no more money, the skills cannot be obtained. That is, the skills needed to treat chronic diseases so that return to work and optimal functioning is restored, simply cannot be obtained. Patients are on their own now. Worse, the data is clear about this: physicians are doing more harm than good, particularly in the area of chronic pain. Existing physicians cannot treat the growing numbers of acute patients, and at the same time, become expert – and by doing not by reading – in treating chronic pain.

So it’s business-as-usual. Physicians continue to treat everything as if it were an acute disease. However, you cannot treat a chronic disease as if it is an acute disease, because you do harm by not treating appropriately and in a timely manner. The chronic disease becomes more complicated because now more systems are in disarray. And, when that happens, treatment needs grow exponentially and the costs to treat go out of control. You also cannot treat a chronic disease with a solo practitioner when what is needed is an integrated interdisciplinary team that is all on the same page pursuing the same goal of restoring the patient’s ability to return to work and enjoy fully restored quantity of life, with the patient – not the doctor – self-managing the conditions of their own symptoms occurrence and then knowing how to self-sustain the solution indefinitely with no further need for medical care.

I’m particularly interested in approaches that patients can do on their own simply without the need for special equipment; that have an underlying rationale that “less is better;” that prescribe simple solutions first (like “don’t eat that food if it makes you feel bloated” rather than prescribing 2-3 more medications for “feeling bloated”); that do not require that patients buy expensive books, or have drive hours to special buildings where they sit on a bad back immobile for hours at a time in group therapy, or drive for hours to doctors offices every 2 weeks indefinitely to pick up yet another prescription, or have to drive for hours to yet another diagnostic or lab test, or become an inpatient, or go to the ER, or have yet another unnecessary surgery. Most of all I’m interested in treatment that does not turn people into full-time patients, where their whole life is centered on their disease, their doctor, and the impression that they will never again have a normal quantity of life. My major interest is patients who are no longer addicted to their nation’s healthcare providers. Who can self-manage and self-sustain on their own. Why? Because pain patients have to face reality: no qualified access exists today in America for chronic pain, except what the individual pain patient can do on their own. Physicians can’t provide the qualified care, it’s not within their area of expertise. And the money does not exist to hire the number people needed with the right qualifications to treat the 100M+ chronic pain patients in America.  It is what it is. It is time to either sink or swim. Anything else is harmful for chronic pain.

Chronic Non-Cancer Pain, Definition

Chronic non-cancer pain (CNCP) is pain that:

  • occurs 24 hrs/day, 7 days/wk
  • disrupts work, social relationships, recreation and other critical aspects of daily living
  • has lasted for more than 6 months
  • may have a physical cause (like post-surgical pain) but usually there is no MRI-based, treatable structural cause
  • general, family practice, internal and specialty medicine have failed to restore patients ability to function
  • other bothersome symptoms also occur (sleep loss, GI problems, memory, concentration, motivation, interest in sex, decreased interest in going out, socializing, exercising, and others)

Worldwide research on this complex type of pain shows that the disorder is a product of a combination of factors, so an integrated interdisciplinary approach by providers with demonstrable  competence in treating CNCP are more effective at restoring patients ability to function than single modality approaches. A qualified combination approach produces several critical outcomes:

  • since the goal is the restoration of the person’s ability to function in a way that is self-sustaining, treatment specifically designed to achieve this goal becomes the first-line treatment and, done right, leads to markedly improved functioning
  • data from other researchers around the world, and our own research with hundreds of chronic pain patients also showed that as functioning increases, return to work occurs, and functionality becomes optimized, the magnitude and frequency of pain decreases
  • at the same time, our approach also produces significant decreases in the use of general healthcare services (including doctor visits, prescription drugs, diagnostic and laboratory procedures, and unnecessary hospitalization or surgery)
  • resulting in significant reductions in personal healthcare out-of-pocket
  • all out of the comfort of patients own homes, online, at markedly less cost than on-site visits to doctors

Worldwide, pain specialists and patients are looking for easier access to solidly grounded approaches to chronic pain that reduce the decision error so common in today’s conventional (acute care) approach to persistent pain of unknown origin. The new field of telemedicine provides remote, online access to top qualified, experienced pain practitioners that is rapid, convenient and inexpensive but far more effective than the classic office-based consultations offered by by general practitioners. What this approach does is take the error out of the decision-making  provided by the 98 percent of practitioners treating chronic pain, but who have no specialty training or credentialing in this field.

Solid Pain Data – Better Treatment Decisions

International pain research indicates that 42 percent (or 120 million) of Americans suffer from chronic non-cancer pain that significantly disrupts their ability to earn their living, enjoy normal social relationships with family, friends and neighbors, and not have to live the life of a full-time patient, often resulting in divorce, increased rates of health bankruptcy, chemical dependence and addiction, and an eight-fold higher rate of completed suicide than their counterparts in the general population who don’t suffer persistent pain. To address the issue using good science, the goal of pain research is to:

  • provide qualified chronic non-cancer pain diagnoses, prognoses and treatment plans whose key objective is the restoration of function
  • that provides tight control of the multiple factors of which this type of pain is a function
  • identify the conditions that most reliably increase function and decrease pain and healthcare utilization
  • and, clearly identify the conditions that reliably reverse it, and lead to recovery, relapse prevention and long-term self-management of the conditions of its occurrence

The goal is to clarify the specific combination of treatment factors, and their sequence, that they will need to insure restored functioning, reduced pain, and significantly reduced healthcare utilization.

Solid Data Shows What Factors Insure Effective Pain Treatment

To assess safety and efficacy, pain specialists routinely evaluate different treatment approaches as a way of confirming or denying what constitutes effective chronic non-cancer pain treatment. The research our group carried out on Scripps Memorial Hospital campus over 6 years constitutes the only randomized controlled trial that compared, head-to-head, the 3 key treatment approaches currently used for CNCP:

  • drug therapy alone by primary care physicians
  • drug therapy alone by anesthesiologists Board Certified in pain management
  • a combination pain program consisting of drug therapy by an anesthesiologist Board Certified in pain management plus lifestyle modification by a pain psychologist Board Certified in pain management, and with extensive experience effectively treating CNCP**

A search of worldwide research indicates that ours is the only structured research study of an integrated outpatient pain program that compared the relative effects of the 3 most- used approaches for treating CNCP, and that identifies the combination of specific factors that best relieve pain, increase functionality and decrease the need for healthcare services.

The core findings from our research that are of interest to patients with complex pain are that:

  • effective treatment of 5+ persistent pain that has lasted over 6 or more months is not possible without pain medications. For 5+ pain, opioids work best for pain that is not caused by documented nerve damage, and the likelihood of legitimately diagnosed pain patients becoming addicted – if the opioids are provided by a qualified provider or a qualified pain program – is essentially statistically insignificant  (meaning, virtually zero)
  • effective treatment is not possible with drugs alone. Data shows that opioids are wonderful pain relievers for the short-term, and when used as an aid to recovering function, but there is no proven effective long-term benefits return to work), and decreasing the need for healthcare services (in some, it actually leads to increased healthcare utilization)

Today we know that 98 percent of pain patients are being treated by providers with no training, credentialing or experience in producing the sequence of outcomes that lead chronic non-cancer pain to become eminently manageable over the long term.

This means that instead of randomly being exposed to the wrong treatments in the class solo practitioner’s office, using drugs only, pain patients can now have access to the standard of care for chronic non-cancer pain remotely, online, with a provider trained, credentialed and thoroughly experienced in restoring pain patients’ ability to function again in an optimal manner, conveniently, quickly, inexpensively, and from the comfort of their own home. This approach allows us to identify several things:

  • How much CNCP depends on what specific factors used in what specific combination
  • Whether a factor has a statistically significant effect on changes in CNCP
  • And if not, whether one can eliminate irrelevant factors without problems
  • Whether one factor accounts for more variance in CNCP than others
  • Whether and by how much each factor increases/decreases CNCP relative to other factors

In sum, this website addresses a very real-world situation:

  • Wise patients who have a rare heart condition get the best treatment they can from a specialist with: a) the right credentials, 2) extensive experience in the patient’s rare heart condition, 3) the capacity to provide customized, nuanced treatment as needed, 4) that has long-term rather than short-term benefits
  • Chronic non-cancer pain is no different. The wise pain patient is the one with the motivation and assertiveness to move on from ineffective or grossly limited treatment and to do what they must to get the right combination of treatment elements from the most qualified pain specialist they can find, in person or online.
  • Conclusion: as research on chronic diseases has consistently shown, diseases accounted for by multiple variables have significantly better outcomes when treated with qualified interdisciplinary approaches vs. drugs only. There are multiple reasons why drugs will continue to be recommended to patients that have nothing to do with can prove most effective for individual patients. Since these multiple variables cannot be controlled by patients, patients must empower themselves to take what demonstrably works for them. In chronic pain, that means that patients must get a qualified lifestyle component for their pain on their own. If available locally, get it locally. If not, get it remotely here on this pain specialty blog. Get informed quickly on key issues with the videos, audios or posts. Then get into a chronic pain support group right here with other well-informed, successful, empowered pain patients where you can improve your skills, get the practical tips you need, and get the qualified specialty direction you need on how to self-manage your life circumstances so that you restore as much of your functionality as possible, decrease medical service use, and decrease your pain… in that order. We look forward to having you, wherever in the world of chronic pain you’re from.

Dr. Henry Adams, AAPM Diplomate in Pain Management