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

If you still aren’t being treated with a combination drug/life style/habit modification program, you can use the following First Aid to help you begin to mold some control of the conditions of your pain’s occurrence.

1. If you have medication that has helped in the past, use it. Do not try to “Bear it.” It doesn’t work. Pain physicians in our program always tell patients that medication should not be taken as needed, because “you can’t chase pain – you’ll always be too late to catch pain before it goes over the top.” So our pain physicians recommend using a dose that would be in the background, not that makes you drowsy, but gives you the ability to function better than if you had taken no medication. Don’t forget, in a qualified pain program , the aim is to restore as much of your functionality as soon as possible so you can get back to working and leading as normal a life as possible.

2. Find a credentialed pain specialist fast:

(a) In larger cities, look up university hospitals; they often have pain programs.
(b) If not, look up Physicians, Anesthesiologists in your local area phone book and start calling until you find one who is Board Certified in pain management.
(c) If that fails, go to the American Board of Pain Medicine website and click on Diplomates. Type in your State, then click Specialty of Origin, and Anesthesiology. Then start calling them.
(d) As another option, go to the American Board of Anesthesiology website, and click on Verify a Physician’s Certification. Then type your City and State and click Search. Start calling them.

3. An assertive attitude is critical in this type of pain, so start working on it.  First stop the panic, it doesn’t help. I know the desperation one can feel when this pain starts climbing, I’m a chronic pain survivor. But panic just makes it worse. If you have no medications that help, then do what’s needed, go the Emergency Room. Take any medical records that you have that deal with your pain. If you don’t, you may be dealt with like an addict, especially depending on the extent of your state of panic. Next, do not go helpless. Your Body needs you, so take charge and get it the best help you can find. Helplessness adds other symptoms that you don’t need. You have take charge. Finally, if you’ve been seeing the same doctor for more than 3 months and you’ve gotten no noticeable increase in your functionality, you have to muster the courage to fire him and find one that is, first of all, qualified and will pursue your goal rather than your doctor’s personal goal. Just being polite with your doctor is not effective treatment for your pain. You need to be assertive (meaning, calming stating what you want, several times if needed, but calmly).  And, if a doctor who has been treating you for more than 3 months insults you or accuses you of being an addict and that doctor lacks any qualifications in pain management don’t be afraid to report him to his Medical Board for practicing outside of his area of practice for more than 3 months and not making an appropriate referral to a qualified pain doctor or pain rehab clinic.

4. Commonsense is also critical in any chronic disorder, use it. If you have a chronic low-back pain syndrome and sit for hours at your computer and your back hurts afterward,  get the point that your body is telling you, “Don’t allow yourself to be immobile for the amount of minutes that it takes for you to begin to feel the first signs of discomfort.” If you have to sit for long periods of time, be sure to have a gel-pack ready when you get back home. Prop up in a comfortable chair, put the gel-pack directly on the skin; it’s a bit painful at first, but in 5 minutes it’s wonderful, cheap, effective analgesia. Use it no more than 15 minutes. And, if you have burning pain, don’t use ice, it can make possible nerve pain worse.

5. Trial and success works; trial and error does not. Remember the details of what worked for you. You are the one who knows best what works for your specific pain, as it happens under specific conditions in your unique life situation, not a doctor, a spouse or a well-intentioned neighbor. Focus on conditions of your pain’s occurrence and what real-world conditions you have to create to get even a little bit of relief on a consistent basis. Don’t forget to screen your current doctor before you start going to just any doctor who says they’ll “try” to help you. Screen your doctor first. What you want is someone credentialed in pain management or pain medicine and who has extensive experience treating chronic non-cancer pain patients on an outpatient basis, and are not “interventionalists,” who put in the morphine pumps and the spinal column stimulators. Both of these treatments, including surgery, are strictly last resorts. If your goal is recuperating as much of your ability to function as possible, even pain doctors have to do more for you than just prescribe pain drugs to help you restore your ability to function, especially get back to work. Pain relieved by drugs alone does not guarantee restoration of function. So identify your goal, find a credentialed pain specialist and start screening them for demonstrated competence in chronic non-cancer pain. If you only have access to a doctor of general medicine, you must someone who is qualified to treat this type of pain. If you don’t, data indicate that your pain will get worse, and create an even broader range of problems for you than just pain. First Aid is what it is, an effort to relieve a crisis. And, for everything, however minor, that works, reinforce yourself with a, “Good job!”

6. Those who have experienced serious CNCP give the best advice. Talk to people with the same type of CNCP you have. Especially those whose break-through pain is very infrequent. Over years of trial-and-success, these types of pain patients will usually have good tips to give you. If your functionality, and pain relief, haven’t moved in 3 months, make an appointment with me for personal advice on an Online Pain Management Consultation.

Dr. Henry E. Adams

AAPM Diplomate in Pain Management

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

1- Why? Because it’s simply a practical decision that you must make.  Say you had serious chest pain for more than 6 months that reduced your ability to function and forced you to quit working.  What would you do?  You would immediately look for a CERTIFIED cardiologist. It’s no different with pain. When pain lasts more than 6 months, you also need to find someone who is CERTIFIED in your most recurring symptom. Here it’s pain, so find someone certified in pain management fast simply because that improves the likelihood of your having your ability to function again restored so you can get back to work as soon as possible.

2- What next? Check that the person you chose to treat you is indeed CERTIFIED specifically in pain management. Do not accept “I’ve gotten training in pain management.” Ask to see the CERTIFICATE in pain management. Most doctors of general, internal and family medicine who are easy to find are NOT certified, many anesthesiologists ARE certified in pain management but the certified ones are hard to find, and some neurologists ARE certified but the certified ones are hard to find.

3- Set your own concrete, measurable objectives before seeing the pain specialist. Do that first so no bias enters your decisions yet. For example, “I want to return to work, at least part time, within 90 days.” Or, “I want to be shopping and cleaning my house at least twice a week again within 30 days.” This is something concrete on which you can get the treatment you want AND evaluate the effectiveness of the doctor treating you MAKING IT HAPPEN.  As with products, what you want answered is, Did the product deliver on its claim?

4- What next? If the pain doctor you have selected works alone, the likelihood is you will only be treated with pain medications or some more invasive technique. If you have 5+ (0 is the least, 10 is the worst) pain, the likelihood is that you will get one moderately strong pain medication around the clock and one to use “as needed” for breakthrough pain. Our data indicates that all patients with 5+ pain require some medication to get enough relief to begin a program intended to restore their ability to function. The question you have to ask is, After the pain medications, what proven steps am I going to insure I get to restore my ability to achieve my goal of “returning to work at least part time within 90 days?” If you get an answer like, “I don’t do that,” look for another doctor with provable experience restoring functionality. Don’t be bashful. Ask the doctor what specific methods he personally used to restore patients’ ability to function and return to work. Or, if s/he refers you to someone who does, ask them the same question. Physical therapy, by the way, is not a way to restore functionality and get you back to work.  It’s purpose is to improve your range-of-motion, flexibility, strength in specific pain disorders, and not as a general treatment for pain.

5- What next? Keep your eye on your specific “outcome.” What you wanted to achieve in 90 days – “get back to work at least part-time” or “shopping and cleaning my house at least twice a week again within 30 days” – in other words, your measure of the validity of the provider’s claim that they can deliver that outcome. And, with no additional costs for more doctor visits, diagnostic tests, drugs, going to the ER or being hospitalized so that specialists can “see if we can find what’s wrong.” Most patients with 5+ pain have already had extensive work-ups that “rule out organicity,” so there’s no reason to beat a dead horse.

6- Anything else? Yes. If you’re only getting pain meds, and your pain hasn’t stabilized in 3 months, don’t forget there are no “functionality-restoration drugs” on the market, so your objective is not being addressed. The drugs that are on the market are licensed to reduce pain, period. What to do? It can take weeks to find the right drug and for it to stabilize your pain enough that you can begin restoring your ability to  get back to work. If you’re being prescribed more than 1 drug, it can take even longer because of combined drug effects and it not being clear what precise chemical factor really accounts for the pain: Is it Drug 1, 2 or 3, or your coping skills, or your unique life situation or the combination of all of the above? Of course, coping skills and managing your own life situation – even though they do account for functionality – are outside physicians’ area of expertise. They know “under-the-skin stuff, not the stuff that earns you a salary. Whatever physicians propose in the area of functionality, technically, is decision error simply because it’s outside their area of practice. Any doctor who throws that package of treatments at you really doesn’t know what they’re doing in pain management. That’s a “shoot and pray” approach and that’s risky. So beware. Your prescribing physician should talk to you about drugs, not about how to lead your life. If s/he does,  they’re “prescribing” outside their proven area of expertise.  So, unless they’re willing to take financial responsibility for their non-drug advice, take it with as much of a grain of salt as you would comments that I might make about your need for heart surgery and, especially, about your mitral valve. It’s not for me to say!

7- Anything else? Two more nuances to watch. If your doctor wants to give you still another “new” drug and you want to know what the risks are, and s/he says, “The benefits outweigh the risks,” watch out. Ask: “Would you give me a copy of the research that supports that in my particular case.” If you don’t get an article, it might be a good idea to start looking for a certified pain specialist who prescribes AND works with a program that has a positive track record of restoring functionality, and they have numbers to support it. Or, better yet, ask the doctor if they would accept financial responsibility for any serious side effects from the “new” drug. If they look at you in dismay, it’s time to start looking for a new, doctor who really believes in his ability to understand what the exact actions of the “new” drug will be on your pain and, particularly, any other medications that you’re also taking, especially for other conditions.

In today’s healthcare crisis, the likelihood is you’ll be stuck with someone who CANNOT deliver, in 3 months, improved ability to function and return to work. Today, the Internet makes it possible to  locate a specialty doctor who might agree to prescribe your pain meds at your own city where you live, and your functionality restoration program remotely on the Internet with me.  Always first check the specialty status of the person giving you advice about chronic pain. Then check their ability to deliver on their claims within a specific period of time. In my case, check the American Academy of Pain Management, go to Find a Professional, then enter California, then Psychology and when you see my name you’ll know I’m credentialed in Pain Management, and am a Member in good standing of an Academy that confirms the skills to help you achieve your goals or to appropriately refer you. The ultimate test is do a 3-month test to see if the person who treats your pain can deliver on their claims. If not, walk… quickly! If you don’t, you risk worse, longer-lasting pain.

KEY STEPS

1. Prepare – get informed as you would about anything else that’s new to you. Get answers to core questions. I have several types of media here – posts, audios and videos – that can help you make effective decisions if you have a chronic pain condition and, if so, how to get the most effective treatment according to state-of-the-art research. A good deal of that media is free while some of the audios and most of the videos of me addressing specific treatment issues carry a nominal fee that helps us maintain the site. I also provide a limited number of personal consults to those who believe that will help them too. However most visitors get the treatment guidance they need to begin to, first, connect with the right type of treating physician for the right pain meds and, second, start the behavioral and lifestyle changes you personally will have to make to rehabilitate your ability to function and return to work as soon as possible, learn to self-manage the conditions needed to maintain yourself functional over the long term, and to begin to reduce pain in a stable manner and maintain it over the long term. If it hasn’t come across yet, let me state it clearly: This is a working chronic pain specialty site for patients who are willing to work to restore their functionality, using the same effective approach that I would offer you, as a credentialed pain specialist with years of experience and randomized controlled trial data to support the effectiveness of my approach, in a  regular face-to-face office visit.

2. If you need venting – about how terrible your pain is, or how terribly doctors have treated you up to now, or about how the government should be doing something about the terrible treatment pain patients are getting – there are many “chronic pain support groups” on the Internet under that title where you can do just that. Here, if you vent briefly and get to making a “pain point,” or asking a specific question about chronic pain, your comment gets posted. If it’s just venting, likelihood is your comment won’t get posted. And if it’s not posted, all it means is that it’s probably time to switch from venting to working practically towards gaining control of the life conditions and behavior associated with your pain’s occurrence. So, if after venting a bit, you’ve decided you’re ready to work, come back, we’d love to have you and your practical observations

Don’t forget I’m a survivor of chronic non-cancer pain, and today I’m functioning better than I  was when I was half my age. However, I follow my own program fanatically, and that keeps me from having pain. So when I speak about pain I speak not as an academic but as a survivor. If I recommend anything it will invariably be because I have seen evidence that the approach actually deliveres increased functionality.

3. Prepare your own case. Prepare it as if you were going to Court. You’re here to work, so do me and others who are here to work with and for you, the courtesy of reviewing your case and understanding the “objective findings” behind your pain. Make a medications chart. For that, get all the bottles of prescription medication you’ve taken for pain since you started having moderate to severe pain (5+ on a 10-point scale, where 10 is the worst pain). All of us metabolize chemicals differently, so your response to medication is unique and we need to know how. Make 3 columns: Helped Noticeably, Didn’t Help, Not Sure. Put each drug in its respective column. Next gather all your Operative Reports, if you’ve had surgery and put them in one folder. Do the same with all your imaging studies (MRIs, C-scans, X-rays). Do the same with any other special procedures, like Nerve Conduction Studies, or any other diagnostic procedure, as well as all recent laboratory results. Also prepare a list of any Family or Personal History of any chronic, inflammatory or congenital disease. Finally, make a timeline, starting with the earliest possible date, detailing when, where and what happened and how, of all broken bones, motor vehicle, sport or industrial injuries, lengthy exercise routines and finally all surgeries. Now you know, and I will be able to get an accurate picture, of who you are as a pain patient, and why.

4. Practice being brief and focused on pain issues and successes. It’s tough to work at building something that helps you succeed royally at something important to you. I call it “going for the gold.” It’s like the training Olympic champions engage in. They’re focused and focused on success rather than failure. Here there’s no such thing as “learning by trial and error.” There’s no such learning technically. The way it really works is “learning by trial and success.” So, here you’ll hear very few negatives, and even less focus on how doctors and patients failed, but on the small, positive steps taken by doctors and patients in succeeding, if only in tiny steps. I really want to hear about successes you’ve had in controlling the conditions of your pain’s occurrence on a daily basis. I don’t want to know how many times last week you had pain, nor do your fellow pain patients. We will want to know everything you have to say about how many times last week you didn’t have pain, and why and how you did it.

In short, the entire site, including me, is aimed at helping you learn how to attain optimal self management of the conditions of your pain’s occurrence in your own life situation. Why? Because there is no healthcare “system.” There never was and there is none now. A “system” requires management, and there’s been no evidence for half a century of any control over the nation’s healthcare expenditures. The numbers speak; no evidence of control means no evidence of “system.” And the government’s passive role:  to simply monitor the numbers, as they go up, and up and up. So all patients are really on their own, and the more you’re in  personal control, the better. That’s at least proof of a “system.”  So, join me, and people with pain with the mindset that I’ve just laid out for your consideration, and  start your fascinating road back to optimal restored functionality, return to work, less pain, decreased dependence on medical services, and personal empowerment. Welcome.

Dr. Henry Adams, AAPM Diplomate in Pain Management

21-VI-09

Dr. Henry Adams, Dipl. in Pain Management, AAPM, Member/Medical Staff Coalinga State Hospital

Healthcare, it is said, is going through a revolution called “Evidence-based medicine,” which is defined as follows:

– Evidence-based medicine (EBM) aims to apply evidence gained from the scientific method to certain parts of medical practice. It seeks to assess the quality of evidence supporting specific treatments (or lack thereof). According to the Centre for Evidence-Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” EBM seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best control possible of outcomes in medical treatment, even as debate about which outcomes are desirable continue. (Wikipedia)

What this means is that, after hundreds of years of medicine being “an art” in which every physician’s personal opinion was equally valid, the complexity of technology and the complexity and cost of treating the chronic diseases currently going around the world, governments and Courts have decided, requires far stricter standardization. That standardization, experts decided, could best be achieved by basing clinical decisions on on something on which everyone can agree, namely that the quantitative bases of the scientific method allow for the establishment of reliability and validity standards that effectively reduce risk in our clinical decisions. Put simply, EBM is simply “good science,” the practical effect of which is that by doing “good science,” one significantly reduces “error” in our decisions which, in turn, decreases risk while increasing the likelihood of positive outcomes for the end-recipient of all these efforts, the patient. What that means in chronic non-cancer pain is that you the patient now have the means of increasing the likelihood of selecting clinicians with a high likelihood of increasing your functional capacity, your ability to return to work and control your pain while decreasing your dependence on costly medical services. Now, clearly, whenever we can make decisions this way, we wind up making much more risk-free decisions, which increases the likelihood of restoring functionality, return to work, decreased pain and decreased costs of – if the “evidence” doesn’t support their use – unnecessary physicians and medical services.

Therefore, what EMB does is to give patients – especially those with complex disorders like chronic non-cancer pain where the risk of error, because of the multiple mechanisms and systems involved, is exponentially greater – with a means of determining when risk is greater or less depending on key elements that clinicians “bring to the party” and weeding out as much “error” as possible in the treatment process.

Below is an example of “good science” that helped our pain patients get optimal care:

1. The management of chronic non-cancer pain is like any other sub-specialty. Sub-specialty education, training, experience, certification and a successful track record is needed to be able to provide “evidence” that can “stand up in Court.” E.g., if we have heart symptoms that seriously disrupt our ability to function, work and enjoy our usual lifestyle, the wise decision is to go to a clinician with the sub-specialty education, training, experience, certification and positive track record of returning heart patients to functionality, work and decreased dependence on cardiologists than when they started. This, clearly then, is a clinician who can take their opinion, behavior and track record to Court and be accepted by a judge as an “expert” capable of providing “expert opinion” and evidence that a gate-keeping judge would allow to be put before the jury. Patients who were able to apply this way of thinking were able to eliminate:

– Non-specialty physicians lacking documentable expertise in pain management and CNCP

– Non-specialty clinicians working in chronic pain programs lacking documentable expertise in pain management and CNCP

– Single modality (drugs only) treatments lacking randomized controlled trials (RCTs) to support them

– All treatments not supported by RCTs as being effective for 5+ pain

– All non-certified clinicians lacking extensive experience with the full range of CNCP disorders.

What remains is what wise patients try to achieve locally when they screen clinicians:

– A physician Board Certified in pain management or pain medicine, experienced in prescribing the full range of pain drugs, including opioids, with a minimum of 5 years experience in CNCP, and who has worked as a member of a team in a functionality restoration program

– A psychologist certified in pain management, experienced in the full range of CNCP disorders and approaches, with education, training, experience and a positive track record of restoring functional capacity using operant behavioral modification of habits and lifestyle and responsible for coordinating a team of credentialed clinicians in an integrated functionality restoration program

There are numerous other steps that we will periodically post. In the meantime, this step alone got most of our CNCP patients into treatments that had a high likelihood of restoring their functional capacity, helping them get back to work, and decreasing their pain and their dependence on costly medical services.

Dr. Henry Adams

20-IX-2008