A Dozen Things I’ve Learned About Pain Treating Marines With Chronic Pain

July 11, 2011 | Filed Under: Uncategorized | Comments(0)

Naval Hospital Camp Pendleton/Camp Pendleton, July 11, 2011

As most of my readers know, I’ve been here for almost a year treating Marines who returned from Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) with unresolved chronic pain. I do not see post-amputation pain mainly because that’s done elsewhere by specialists in amputation rehab. I see Marines who have pain that is no different than yours and, like you, whose physicians told them, “There’s nothing else our field can offer you.” That way of thinking wasn’t enough for me when I developed 7-8/10 level pain that practically made it impossible for me to go to work.

My goal in this post is to briefly lay out a dozen new things I’ve learned about chronic pain from treating my Marine patients.

1.  “Age” is a relative concept. Chronic pain isn’t caused by age. It’s caused when we purposely or unknowingly exceed the tolerance limits of human physiology. In Afghanistan, under the war conditions created by the Taliban, it takes 20 year-old Americans 7 months – the length of their tour of duty – to exceed the limits of human physiology and come back with chronic pain conditions that it takes the average American living under peacetime conditions until they’re age 45 to develop. If age really were a factor, we’d be no different than birds or fish, where things really do happen because of age. Since we’re one of the most adaptive organisms around it makes sense that it is the quality of the environment that leads us to exceed the tolerance limits of human physiology. That leads me to two thoughts. First, to be meaningful, we need to identify pain patients based on another determinant: their chronological or their physiological age. Take the case of my average Marine infantryman with back and upper and lower-extremity chronic pain. They may have a chronological age of 20, but their physiological age is 45. Then take the case of the Marines that go out on patrol and have a mortar, rocket or IED explode close to them and they develop a Transient Brain Injury (TBI). On their problems concentrating, focusing, and remembering more than past events, their chronological age may be 20, but their physiological is 75, no different than your grandfather with the first signs of Alzheimer’s. Marines with TBI will tend to improve over the next year if they get the right treatment on a consistent basis, where the 75 year-old will not, regardless of treatment or the continuing care they get. But clearly the Marine will not improve if treatment is fragmented, inappropriate or inconsistent. And, more often than not, it is because specialty physicians wind up being transferred elsewhere.

Final food for thought. Not too long ago fighter pilots began to exceed the tolerance limits of human physiology in flight. The speed of the planes and the speed of the reactions that were needed from fighter pilots exceeded the tolerance limits of human physiology. So we used technology, and today, effective air combat relies on sophisticated computerization to save pilots’ lives. Given what is happening in combat on the ground, isn’t it time to apply technology to the needs of infantrymen on foot patrols and develop the Cyborgs who will save Marine lives?

#2 “In 2011, Does Military Medicine Treat Chronic Pain Any Differently Than Civilian Medicine?”

Reduction in Type 2 Diabetes With Lifestyle Intervention vs Metformin

September 18, 2010 | Filed Under: Uncategorized | Comments(0)

A study in the New England Journal of Medicine (Feb. 7, 2002, 6/346:393-403) notes that some Type 2 diabetes risk factors – elevated glucose concentrations in the fasting state (FG) and after an oral glucose load, overweight and a sedentary lifestyle – are potentially reversible. They hypothesized that modifying these factors with a lifestyle intervention program or administration of Metformin would prevent or delay the development of diabetes.

The authors randomly assigned 3,234 non-diabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, Metformin (850 mg twice daily), or a lifestyle modification program with the goals of at least a 7% weight loss and at least 150 minutes of physical activity per week. Mean age of the participants was 51, and the mean body-mass index (BMI) was 34.0; 68% were women, 45% were members of minority groups.

Average time of follow-up was 2.8 yrs. The percent of those who got diabetes was 11.0 (if they relied on placebo only), 7.8 (if they took Metformin only), and 4.8 (if they used lifestyle approaches) cases per 100 person-years, respectively. Compared to placebo, lifestyle intervention reduced diabetes by 58%, and Metformin by 31% as compared with placebo. The lifestyle approach was significantly more effective than Metformin.

Implications: Lifestyle approaches are virtually twice as effective as a drug alone (58% vs 31%). Yet, despite this evidence-based treatment superiority – which is reported in virtually all studies of chronic diseases where lifestyle approaches are compared with drugs alone – physicians continue to push a drug treatment only. And, this, even if it adds to the side effects from the 2-3 other drugs doctors tend to routinely prescribe when treating the related symptoms of Type 2 diabetes.

Chronic non-cancer pain treatments reveal a similar pattern: for restoring their ability to function and reducing pain and utilization of medical services, drugs alone prescribed by non-specialists make pain worse, while specialists provide moderate short-term improvement with appropriately prescribed pain drugs alone. And both are significantly less effective than a combination drug-lifestyle modification program.

No improvement in chronic pain in 3 months? Time for a qualified second opinion

September 3, 2010 | Filed Under: Uncategorized | Comments(0)

Do you live in…?

  • Australia
  • Holland
  • Ireland
  • Latin America
  • India
  • Other EU countries
  • Portugal
  • Scandinavia
  • Spain
  • Switzerland
  • UK

If you’ve been getting pain treatment in your local national health service for more than 6 months and haven’t noticed any improvement, yes, it is time for a qualified second opinion by a pain specialist.

And, where better than the US, where more money is spent on studying chronic pain than anywhere else in the world, combined. And, on this site, where the data to support its approach was obtained from the gold standard of research, randomized controlled trials in multiple sites and the approach worked when tested with real chronic pain patients. Especially when you don’t have to travel to the United States to get it.

Our website is not one of those that abound on the Internet that give you the usual Internet generalizations about the 40 different drugs, and 60 different treatments that “doctors use to treat chronic pain.” The technical problem with such generalizations, and the studies that “support” them, never mention a specific functional ability that they’ve helped specific patients recover. And, since nobody has ever had the professional courtesy of giving you a concrete pain diagnosis, you likely have also never been given a solid prognosis for your specific type of pain and treatment conditions. Nor, I’m sure, has a specific treatment plan ever been discussed with you that had a specific time frame in which specific objective, measurable, behavioral changes were supposed to take place. Did you know that that’s what’s supposed to take place?

So, if your goal is to recover as much ability to function as possible, come to http://www.chronicpaindoctor.net today. Choose one of several options that can put you on the road to recovering function again, including a return to work, family and friends, and as normal a life as possible. Here’s what my wiser patients do and the benefits they reap:

– Come browse. Stay a while, and read some of Dr. Adams’ posts on pain. Look at some of the scientific articles on the site, which you’ll never find on the Internet.

– Don’t come just to find out what the state of the art is in America. Stay long enough to feel the substance of what you’re experiencing about chronic pain vs the product pitches and generalities so common on the Internet and, unfortunately, in many doctors’ offices. Get a different feel for what chronic pain really is, not because it’s “interesting” but because it makes sense that you’ll have to do certain things to overcome your complex pain condition. In short, become an informed pain patient.

– Or, for a small fee, listen to 3 pain-specialty-issue videos, of dozens on the website, and earn a 15-minute personal phone consultation with Dr. Adams. This is Dr. Adams’ way of volunteering time to help pain patients (wherever access is bad or treatment mediocre) find out and start doing what’s needed to start overcoming pain.

– Or, again, for a private consultation fee, reserve time with Dr. Adams  to discuss your own chronic pain concerns, or those of a loved one. Ask him to generate a statistically sound prognosis based on the patient’s pain history, precipitating events and current level of functional impairment, given the reality of your specific pain and real-world  treatment conditions. That combination of treatment conditions is the only way to determine functional outcomes in appropriately diagnosed chronic non-cancer pain.

Above all, get a qualified second opinion today. Do not continue to tolerate any more treatment by people unqualified to provide it. The more you do, the more complicated and permanent your pain will become. Find out at least what the right treatment should be for your pain condition here at this website, even if you aren’t able to obtain it through your national health service locally. At least find out what the gold standard is supposed to be to achieve effective, objective, measurable functional recovery.

Go to http://www.chronicpaindoctor.net today, from the comfort of your own computer. Start restoring a life that’s normal again. In the US, at: 559-478-1996. Internationally, at: SKYPE hadams723.

Chronicpaindoc.net offers new support for national health service pain patients

August 29, 2010 | Filed Under: Uncategorized | Comments(0)

Pain clinics have closed, pain specialists and carriers that pay for chronic pain rehab programs have disappeared, and those prescribing pain drugs are overwhelmingly general practice docs with no specialization or credentialing in pain management, which puts you at risk. Patients want useful advice from qualified, experienced pain specialists who can help them get back as much of their own, or family members’ ability to function as possible, yet no easily accessible pain specialists are available anymore. The modern solution is having access when you need it to a top specialist in pain management whose treatment goal is optimal, long-lasting functional recovery as soon as possible. What is really modern about this is that your specialist is available to you remotely, faster, cheaper and is far more effective at  functional recovery than anything you can find locally.

Dr. Adams’ mission to provide qualified remote functional recovery to pain patients anywhere who need fast, inexpensive and effective advice, guidance and support based on solid data from an evidence-based practice for chronic non-cancer pain of unknown origin. Dr. Adams provides time to his electronic pain patients 3 ways:

– SPECIALIST VIDEOS: Listen, on site, to any one of dozens of chronic pain questions that are frequently asked of Dr. Adams. There is a token $19.95 fee for listening, on site, to each video.  The fee allows one to listen to the video as often as they want for 24 hrs.

– IN-PERSON CONSULT WITH DR. ADAMS: Listen, on site, to any 3 videos (at $19.95 each) and reserve a free 15-minute consult with Dr. Adams on any pain issue you want. If you want to earn another 15-minute consult, you have to listen 3 different videos.

– IN-PERSON CONSULTS WITH DR. ADAMS: Make an appointment to consult in-person with Dr. Adams on personal pain issues. Fees for in-person consultations are $75 for every 15-minute increment.

From the comfort of your own computer, today, right now, browse the site, listen to videos that address personal issues, or arrange an in-person consultation with Dr. Adams and get started on recovering as much functionality as you can.

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

The status of treatment for chronic non-cancer pain: July 2010

July 25, 2010 | Filed Under: Uncategorized | Comments(0)

Henry E. Adams, Ph.D., Coalinga State Hospital, July 23, 2010

In the almost two years since the October 2008 global financial crash, access to effective care for chronic pain patients has gotten significantly worse.


  • 37 million Americans now have access to health care that didn’t have it previously.
  • in 2011, 78.5 million Baby Boomers will start entering Medicare at a rate of 3.5 million per year until 2030. We all know what the financial health of Medicare is, so the prospect of improved pain care occurring is low.
  • both of these conditions will put an enormous professional and financial strain on American health care and there are no financial resources that can radically alter the crisis situation that is already under way.

  • as the number of patients needing care has increased, the number of physicians expected to treat them is decreasing, due to the growing cost of sustaining a pain practice and the disincentives created in Washington by not developing meaningful cost-of-living formulas for reimbursing physicians treating America’s patients.

  • third-party payors won’t cover the costs of treating chronic diseases of any kind – they are still rejected on the basis of their being “pre-existing conditions,” which they will fight to avoid covering, so there is no way to obtain the pain programs that work best to restore patients’ ability to function and return to work.
  • lack of access to appropriate care, for a combination of reasons, has produced a state of desperation for pain patients, due mainly to the uncertainty of getting the type of care that optimizes restoration of their ability to function as normally as possible.
  • at the same time, due to legal and bottom-line reasons, US physicians choose to work as solo practitioners, a practice approach that is contrary to the needs of chronic diseases, including chronic pain, where the treatment goal is treating a complex disorder and optimizing rehabilitation of lost functions.

  • where previously, qualified multidisciplinary pain programs and credentialed pain specialists could be found in some of the major cities, today it is almost impossible to find either one anywhere. Some say the use of opioid is being jeopardized by the DEA’s goal of insuring deterrence. Yet, the facts indicate that where the prescriber is qualified in pain, the risk of regulatory action is low.
  • the implication of these trends – which the signs are that it will rapidly get worse – is that pain patients are going to have to learn to self-manage the conditions of their pain’s occurrence on their own, using the most effective advice they can get from specialists credentialed and experienced in successfully restoring pain patients to higher levels of functioning, and return to work.

  • patients should note that the Internet is not where solid scientific findings are found. The reason is that material in scientific journals, congresses, conferences and technical books is copyrighted and copyrighted material is rarely made available on the Internet to the general public. Chronicpaindoc.net makes available summaries of this type of material as well as issue-videos and private consults with Dr. Adams. The site has also noted previously what the most effective way is to find the most recent developments in the treatment of chronic non-cancer pain.

Actualícese Sobre el Dolor Crónico No-Maligno

March 9, 2010 | Filed Under: Todos los Articulos | Comments(6)

A seguir, bajo “Audios en Español,” el doctor Adams, calificado en Manejo del Dolor por la American Academy of Pain Management, ofrece una serie de audios en español para el paciente con síntomas de dolor que: 1) ha persistido 24 horas al día, con solo pequeñas fluctuaciones, por más de 6 meses, 2) no responde al tratamiento convencional proporcionado por médicos generales, 3) para el cual no existen hallazgos concretos que indiquen una causa específica para el dolor, y 4) cuya característica principal es la incapacidad en, sobretodo, regresar al trabajo. EL mayor problema para el paciente con dolor crónico es que, en el 98 porciento de los casos, solo podrá obtener tratamiento de parte de médicos no calificados en el manejo del dolor o sin ninguna experiencia clínica en el dolor crónico no-maligno. El propósito de este sitio es ofrecer la perspectiva de un especialista en esta área para orientar sobretodo al paciente español en el tratamiento integrado que mejor resultados ha dado internacionalmente, y que el paciente, con la ayuda de un médico local que le recete los medicamentos que le faciliten su rehabilitación, puede, en relativamente poco tiempo aprender a auto-manejar efectivamente, a tal punto que puede regresar al trabajo.

Si después de los audios, aun tiene dudas o preguntas, el Dr. Adams ofrece Consultas Privadas, las que se cobran a $100/US cada 15 minutos, en el 559-478-1996. Llame hoy, sin cobro, para que el Dr. Adams le diga brevemente los datos que él requiere que Ud. tenga a mano cuando llame para su consulta.