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

Background

In 2011 I took a vacation from http://www.chronicpaindoctor.net to go work at Naval Hospital Camp Pendleton (NHCP) with Marines returning from Afghanistan. Camp Pendleton is the Marines main base an hour’s drive up I-5 from San Diego. NHCP is where the Navy implements its duty to provide the care Marines need as a result of their combat responsibilities. I took the job for 3 reasons: 1) to add to my knowledge about pain, 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, 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.

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.

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

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

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

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, family and internal medicine. A few additional services in specialty medicine, like Ob/Gyn and Pediatrics, exist which, in combination with the primary care services, are available to anyone who is a beneficiary of Tricare, the military’s health insurance. 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. Therefore, those chronic complex disorders that do not “fit” the primary care acute care model, referrals to “out-of-network” providers who are qualified to treat these disorders are rarely made. 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. Again, the services needed to treat the chronic complex pain disorders that many Marines develop were never adequately treated for 18-24 months, 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. Clearly engaging a pain patient in 18-24 months of inept, failed treatment does nothing to provide stable enough pain relief, restored function, and a return to full-duty status, all of which are the explicit duty of Navy doctors to provide wounded Marines. 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.

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, which leads to worsening of condition and a complex chain of further costly healthcare services in all pain patients. 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. 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, or about half the time that Marines in chronic pain are exposed to failed or inept acute approaches to chronic pain.

The Steps NHCP Uses to Evaluate Chronic Pain Complaints

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

– All Marines are first evaluated by their BAS MOs (Battalion Aid Station Medical Officers), family medicine residents not yet licensed to practice as independent physicians. Since BAS MOs work and live with and are deployed with the battalion, they know individual Marines best and the likely conditions of their symptoms occurrence. Most complaints at the BAS level are acute and are resolved by usual care from a family medicine approach. However, 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, chronic pain issues will emerge. 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, referral is then made further up the ladder;

– Primary care (physicians licensed in general medicine, 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, but it may be extended, or literally forgotten, for another 6-9 months. As with the BAS MO, this is a similar treatment to which a Marine with an under or untreated pain disorder will fail to respond. Referral is now made to specialty medicine;

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

– In several cases, 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. However, 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. 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, once the prescription ended, s/he might or might not renew, completely change the treatment, or be deployed and the Marine require transfer to a temporary BAS MO who would start this entire process all over again.

– By this time, specialty medicine would usually begin to discuss preparation of the Marine’s Medical Board, terminating his/her career in the Marine Corps. This without the chronic complex and disabling pain disorder ever being competently diagnosed, effectively treated (and confirming the diagnosis) and having this entered in the Marine’s AHLTA medical chart to document, 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.

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

The Result of “Business As Usual” At NHCP

In other words, 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, prescription medications, diagnostic and laboratory studies, the ER, hospitalization and unnecessary surgery. To this must be added becoming totally disabled, unemployed, divorced, with loss of children, in medical bankruptcy, living alone, being highly prone to developing multiple chronic diseases, intractable pain (see http://intractablepaindisease.com), along with a likely addiction to alcohol and prescription or street drugs.

Finally, 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. I chose to stick by the ethical standards of the AAPM and did leave.

Marine Myths about NHCP

NHCP knows and treats everything. No it doesn’t. NHCP only has the evidence-based skill-knowledge set for primary care – or the perspective of general, family or internal medicine plus a few specialty medical services. That’s it. Marines should not expect more. 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, NHCP lacks the MOS to treat, manage or rehab a Marine’s chronic pain disorders. The likelihood is that a Med Board will be the outcome for those with chronic pain.

Specialized rehab programs for chronic pain exist at NHCP.  They do not. There are many rehab programs in hospitals around the country. The classic ones are Cardiac Rehab, and Diabetes Rehab, 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, and (b) turning over to the patient the responsibility of self-managing the conditions of their pain’s occurrence.

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

The Med Board process is no big deal. Not really. 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, diagnosable condition that made him/her “unfitting” for duty. That their disorder rendered them “unfitting” never could be confirmed because they were never exposed to the appropriate treatment for chronic pain, which when done right, could have confirmed if their pain disorder really rendered them “unfit” by disappearing. Instead, 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, treatment and management approach to pain and your chronic pain failed to respond to their mistaken expectations.

If a provider at NHCP says I don’t have chronic pain it’s so.  Not so, not today when evidence-based pain management is what we practice, rather than philosophy and the unsupported use of words. 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. If the Marine’s chronic pain responds to the qualified version of chronic pain treatment within the expected period of time, there is confirmation of the pain condition and the primary care doctor’s diagnosis is therefore false. If there is no response to the chronic pain treatment, there is no confirmation of the pain condition and the chronic pain specialist’s diagnosis is therefore false.

It’s easy for a neurologist to see the real causes of pain. No so. 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. As the patrol came over a rise, enemy rocket fire started coming in over the Marines, and the Lance Corporal started running down a hill that was inclined to the right. As he ran he stumbled on a rock and as gravity took him towards the right, still with the mortar barrel over his shoulders, he fell hard with all his weight. As he fell he put out his right elbow to break the fall and, in so doing, the barrel was forced towards the right front and tightly against his right trap which he fell against with all his weight. When he was able to get up the pain was sharp and throbbing over his right shoulder and neck. He reported to the BAS MO, was given rest and mild analgesics. 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. 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. 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, work, and social life got worse. 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. He couldn’t do any exercise, he had no appetite and he lost 15 pounds. The neurologist told him he was going to be “med boarded” since his symptoms didn’t improve, he couldn’t qualify for any of his Marine required activities, and his Command was ready to support his being med boarded.

Since NHCP can provide no qualified treatments for chronic pain, all his Navy doctors could say concretely was that this young Marine did not have the neurological, psychiatric, or orthopedic conditions they hypothesized he might have. There is no way of confirming with hard evidence of either Navy physicians’ impression of the condition or provide no qualified treatment, 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.

CONCLUSION – THE EMPEROR HAS NO CLOTHES 

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. This was not the case at NHCP on closer inspection:

– There is no qualified pain treatment at NHCP;

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

– There are no continuing education courses on chronic pain for providers at NHCP;

– There is no integrated interdisciplinary chronic pain program at NHCP;

– Med Board diagnoses for those with chronic pain are probably in error

– 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);

– There is no credentialed chronic pain specialty leadership for the Wounded Warrior Battalion.

The Marines I worked with were a wonderful group of men I got to know and appreciated enormously. They deserve a more than the “business-as-usual” primary care effort they have been given. 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. Hopefully, legislators in Washington will implement the urgently needed chronic pain rehab programs these brave young Americans deserve.

 

Dr. Henry Adams

AAPM Diplomate in Pain Management

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