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

(Collected during chronic pain support groups 2000-2006)

1.     There is no greater love or admiration than that felt for the person who can show you how to reliably relieve your pain.

2.     In self-managing your pain, you got to be careful if you don’t know where you’re going because you might not get there.  (Adapted from saying by Yogi Berra)

3.     Blessed are those who, having no personal experience to draw on about CNCP, just can’t stop giving us abundant evidence of that fact.

4.     “Do. No try.” (Yoda, in The Empire Strikes Back)  [Large poster hung in the pain support group room]

5.     If you’re going through Hell, at least be as effective and consistent as you can so you can get out as quick as possible and with least burns.

6.     To those who demand “outcome studies” before taking action on pain, as Einstein said, “Not everything that can be counted counts, and not everything that counts can be counted”

7.     In helping CNCP patients overcome pain, the average doctor does “what I can,” genius makes pain control happen.

8.     If you can do the common things in science in an uncommon way, you will command the attention of the world.

9.     Breakthrough pain is that unpleasant jolt you get when you get distracted from doing things wisely, consistently and correctly enough to remain functional.

10.  Not only is there no God, try getting authorization for a refill for a pain med on a Sunday.

11.  Want to make an enemy? Tell your GP, who thinks he’s doing pain management, that he really doesn’t know what he’s doing.

12.  A bad pain doctor is one of those people who would be greatly improved by Death.

13.  If you still haven’t learned that you have to go to pain specialists to get effective pain management, for sure you’ll find a non-specialist who will tell you, “Let’s try this.”

14.  Do legislators really believe that it is an insurance card that causes severe unremitting pain, and that the time for treatment is when the insurance company tires of sending you denials?

15.  Few things are harder on surgeons’ Egos than to have a patient tell them they still have pain after the surgery.

16.  If Life were as error free as surgeons would have us believe, we’d all still be living in Paradise.

17.  If you don’t believe what we say about the risk of going to non-specialists, the best way to test their effectiveness is to do exactly as they say and in 3 months count how often you now go to work compared to when you started.

18.  Happiness is chronic pain at a level 4 when for 15 years it was at a level 8.

19.  When you have chronic pain, a real friend never asks you, “How’s your pain today?

20.  With doctors who are not qualified in pain management, you can get more with a polite request for pain relief and a gun than you can with just a polite request for pain relief.

21.  In response to a colleague suggesting I get an assistant to help me conduct the pain workshops:  “I guess it is time I stepped down and let a less-experienced doctor who never had chronic pain take over.”

22.  There are some experiences in Life that should not be expected twice of any human being. One of them is listening to doctors who aren’t certified in pain management pontificate about how their pain patients’ pain is “all in their heads.”

23.  “It’s time,” the Walrus said, “for chronic pain patients to stop begging for qualified pain management that restores their ability to enjoy as normal a Quantity of Life as possible.”

24.  Today, expect insurance carriers to only behave compassionately once they’ve first exhausted all other alternatives.

25.  There are two laws for success in the politics of health care: to win votes, disregard the data and talk all the nonsense you can; to lose votes, try to do the right thing for a deserving constituency.

26.  In America today, if a clinician is effective and compassionate, we have to ask, Are we in the right country?

27.  Today, anyone can become a businessman, doctor or thief. The problem is how many doctors insist on trying to be all three.

28.  Since 2000, molecular research showed that chronic pain alters DNA. In 2010, any physician who still says that “chronic pain has no function,” has met the diagnostic criteria for Mental Retardation.

29.  Functionality increases, and pain decreases, in direct proportion to the consistency with which we self-manage the conditions of our pain’s occurrence.

30.  Chronic pain patients do not need “improved Quality of Life” but “more Quantity of Life.” The first is for terminal cancer patients, the second is for empowered pain patients.

31.  A pain-loser sees the difficulty in every opportunity; a pain-winner sees the opportunity in every difficulty.

32.  The only thing necessary for pain to become severe and unending is for the pain sufferer to either do nothing, or to do whatever they do inconsistently.

33.  Chronic pain can be both exhausting and depressing. The winner’s answer is:  “I’ll do what I have to, to start doing what’s normal for me… you take the antidepressant, doctor.”

34.  Losers chase magic bullets their whole life and achieve no long-term pain relief.  Winners change their lifestyle and bad habits the way they have to in 3 months and wind up enjoying manageable pain the rest of their lives.

35.  A chronic pain survivor is nothing without consistency and, as in everything else, the consistency is nothing without hard work.

36.  Never stay in bed if you’re in serious pain.  After 24 hrs, muscles will tell you, “You don’t want my services?  Bye, I’m taking a vacation, and I may never come back again.”

37.  Overheard at Workshop 1: “I don’t know why my anesthesiologist prescribed Dr. Adams’ pain program, but I’m pretty sure it’s not because he’s convinced drugs and injections are the answer.”

38.  A procrastinator is a device for turning manageable pain into irreversible pain.

39.  I’m in favor of keeping weapons of mass destruction out of the hands of fools. Let’s start with keeping pain drugs out of the hands of those doctors who think they’re “magic bullets” so they can avoid making a referral to a pain specialist.

40.  Dr. Adams, Workshop 2: “Once you eliminate the contribution lifestyle, bad habits and chronic risk factors make to pain, what remains is ’eminently manageable.'”

41.  Comment from a workshop participant: “By taking Dr. Adams’ chronic pain program, I found it can be extremely empowering to try what I thought was impossible.”

42.  In America, the true measure of a great physician is how he treats someone with no health insurance.

43.  In American medicine today, the current approach to treating chronic pain is evidence that there is more stupidity than there is hydrogen in the universe.

44.  The Law of Failed Back Surgery: “Once is coincidence, twice is a pattern, three times means you’d better run because they’re trying to kill you.”

45.  To listen to your Body as you would a best friend is the first step towards experiencing less pain.

46.  Reassurance, encouragement and support – the fundamental tenets of clinical medicine – have nothing to do with the mechanisms of behavior-change that are needed to make chronic pain more tolerable.

47.  Overhead from a workshop participant:  “As a technique for dealing with people who are being a pain-in-the-neck about my pain, I’ve heard about changing the subject, but never just excusing myself to go to the toilet.” (Recommended in the workshops as the single best way to change the subject)

48.  If you gaze long enough into Pain, Pain will tell you what the conditions are of your pain’s occurrence and, changing those conditions, Pain will leave you alone to enjoy the Quantity of Life that you earned.

49.  Every CNCP patient learns basic ways to overcome their pain over time. Those who are more successful at keeping their pain at tolerable limits simply have a greater sense of commitment to their efforts.

50.  Obsessive-compulsive: a person more interested in being personally responsible for doing whatever reduces their pain than in talking about wanting others to be responsible for their pain.

51.  Will and consistency are guarantees of pain reduction.

52.  In the self-management of CNCP, the wise do a lot and talk little, while fools talk a lot and do little.

53.  The only clinician who can make valid statements about the treatment of CNCP is the one with the track record of effectively reversing it. All others are talking off the top of their head or protecting a fragile Ego. Seek out and stick with the first and run from the second.

54.  Beware! He who cannot tell you what CNCP is in words you can understand will likely have similar problems communicating with your pain.

55.  Dctors who don’t know CNCP are always “trying” this or that. If you hear, “Why don’t we try this,” get your sneakers on, politely thank the doctor for his efforts. and run out the hell out of his office. Chances are your pain will improve more from running than from returning to that “Why-don’t-we-try-this” doctor’s office.

56.  When non-pain doctors’ single-minded approaches to pain fail, a few lifestyle, habit and risk factor  changes  can go a long way to reducing pain.

57.  To transform serious pain to tolerable pain: 1) stabilize the pain or make a referral to a specialist who can; 2) get your patient into a qualified pain program that restores their ability to function, uses just-enough pain meds to enhance their rehab; 3) empower the patient – make them responsible for the conditions of their pain’s occurrence ; and, 4) make yourself useless as soon as possible.

58.  Overheard at a meeting of the Scripps Pain Committe: “The more excuses patients give about why they’re not starting the pain program, the lower their functionality, the more their use of pain meds, and the more frequent their use of medical services. And the more likely you will get sued or the patient will commit suicide.”

59.  Overheard between Dr. Adams and a non-pain doctor: “You’re too old to be trying to treat a chronic disorder alone. You should know by now what you need to do as part of a team to relieve chronic pain that doesn’t respond to conventional treatment.”

60.  Over 25 years ago, Dr. Norman Cousins, in his book Anatomy of an Illness, described how watching Marx Brother movies 3 times a day helped him overcome an illness diagnosed as fatal. Cousins made it a point to enjoy a hearty belly laugh every chance he got… and, his chronic disease remitted. Comments?

61.  Hope, purpose and determination are not merely mental states. They are translated into patterned behaviors that translate into brain circuitry that comes back as molecular events, which directly affect pain and every integrated system of which pain is a function.

62.  A brain – to modify the famous metaphor of Socrates – should be the delivery room for the birth of actions that relieve pain — a place where environment, action and physiology come together and relief becomes a reality.

63.  Action is like a piece of rope; it takes on meaning only in connection with all the things it holds together and that, over time, as it did 4.5 million years ago continue to give us relief from pain.

64.  Death is not the greatest loss in life. The greatest loss is what dies inside us when we live in persistent pain and, particularly, that we permit be done to us by doctors who never had pain, never studied pain and never effectively created the conditions that reduced the suffering of our patients.

65.  For want of a consistent combination program for pain relief, a life was lost.

66.  “A routine, a routine, my kingdom for a routine of pain control that works.”

67.  Regular belly laughs – and the conditions of their occurrence – is the single best means of producing the world’s best pain killers… your own endorphins… and of keeping use of the synthetic stuff to its effective minimum. Don’t forget, your own painkillers produce no side effects, no liver damage and need to even think of lawyers.

68.  Pain is not the enemy; living in constant fear of it, and not living, is.

69.  Don’t defy the diagnosis; try to defy the excuses you’ll come up with to not do what you need to  dis-confirm it.

70.  If a smile comes to another person’s lips because of you, then you have created the conditions for less pain.

71.  Try to use the word “wonderful” in response to all the things that surround you, and your pain will become noticeably less.

72.  Is it possible that love, faith, laughter, confidence, consistency and a fighting spirit can reduce pain even though physicians can find “no objective findings” to confirm them? Of course it can!

73.  It is not necessary to go off on a tour of great cathedrals in order to find Deity. Look within. But, you have to be able to sit and let go a bit to be able to achieve that state.

74.  It makes little difference how many university courses or degrees a person may have.  If they cannot take positive steps to help someone who is in pain, all that education was for naught.

75.  Life is an adventure in forgiveness. Forgive yourself for the stupid things you did to subject your body to persistent pain. Now do the things you have to, to finally give your body the habits and lifestyle patterns it needs to enjoy less pain.

76.  Laughter may or may not activate endorphins, reduce blood pressure and enhance the immune system.  What is  clear, though, is that laughter is good medicine for pain. There are no adverse reactions, no long-term side effects and it’s the cheapest medication on the market. The more you laugh, the less the pain, the better you function and the greater the Quantity of Life you thought you had lost.

77.  Pain Mantra:  The more severe my pain, the more important it that I use all my resources – the right meds, awareness of the uniqueness of my pain and the conditions of its occurrence, my Anti-Inflammatory Way of Eating, and what are the right habits and lifestyle for me – and I will reduce the conditions of my pain’s occurrence.

78.  I became aware that to increase my ability to function and reduce my pain, I would have to be more than a passive recipient of care from a doctor with no specialty training in pain and no personal experience with chronic pain. My many excuses for not doing what I had to had to end or the pain would clearly end me. (Ankylosing spondylitis patient, Workshop 2)

79.  The assumption that the patient should take charge of their own pain management is the single most salient characteristic of pain survivors. It is the cornerstone of the best multidisciplinary treatment approach there is.

80.  Pain Patient Heal Thyself!

81.  Pain Patient Beware The Generalist Who Swears That Your Pain Will Get Better If You Will “Just Try This!”

82.  Pain patient; run rapidly from “Let’s Try This” doctors, for they know not what they do.

83.  The single best solution to ineffective medical care for your pain is in your feet. Run, Don’t Walk!

84.  Aqua-therapy patient: “88 to 92-degree water! Plus pushing against resistance. The closest thing to heaven!”

85.  Hate your pain. In fact, hate it so much that you feel driven to avoid all the conditions of its occurrence. Then you can again begin to have a Life.

86.  Do the Chronic Pain Diet consistently for 6 months; along with all the other consistent things you’re supposed to do. Then talk to me about pain, if a level 3 pain is really “pain” relative to what you had gotten used to.

87.  Keep a log of all the things you could NOT do before you started our program. It will help you appreciate better, 6 weeks into the program, how much better you’re really doing. And, that’s science rather than empty claims.

88.  Let thy food be thy medicine, and thy medicine be thy food. (Hippocrates, Father of Medicine)

89.  No illness that can be treated by diet should be treated by any other means. (Moses Moimonides (12^th Century physician)

90.  Unless the doctors of today become the nutritionists of tomorrow, the nutritionists of today will become the doctors of tomorrow. (Alexis Carrel, M.D. (1900)

91.  The doctor of the future will give no medicine, but will interest the patient in the care of the human frame, in diet and in the cause and prevention of disease. (Thomas Edison)

92.  There are no incurable diseases, only incurable people.  (Dr. John Christopher)

93.  Getting well is easy. It’s getting sick that takes years of dedicated hard work. (Dr. Richard Schultze)

94.  All truth goes through 3 stages. First it is ridiculed. Then it is violently opposed. Finally, it is accepted as self-evident fact. (Schopenhauer)

95.  If the only tool you have is a hammer, you tend to see every problem as a nail. (Abraham Maslow)

96. Never mistake good intentions for effectively and quickly restored functionality.

97. If the person treating your pain is unable to deliver observable, measurable, objective results in 3 months, do not walk out of their office, RUN.

98. The devil is in the details in restoring functionality. The daunting task is in converting dime-a-dozen reassurance, advice and support into demonstrable, long-lasting control of the conditions of your pain’s occurrence.

99. Beware of Interventional Pain Management before its time. It’s a last rather than a first resort.

100.  Like it or not, the likelihood is that anyone with 5+ pain will have to take the right pain meds to kick-start their functionality restoration program. And the likelihood also is that the “right pain meds” will not be provided by someone who is not credentialed in pain management or pain medicine, and does not have extensive experience in actually restoring the functionality of chronic pain patients.

John Loeser, M.D., and J.J. Bonica, M.D., are two of the leading figures of chronic non-cancer pain (CNCP) management in the US. Dr. Loeser has been writing, treating, teaching and researching chronic non-cancer pain for the half a century that the field has been trying to make chronic non-cancer pain management better grounded in its own science and, thereby, make it more relevant, accessible, effective, safer and less expensive for patients. The citation is as follows: Loeser, John (2007). “Foreward” in Schatman, Michael E. and Alexandra Campbell, Eds. Chronic pain management: guidelines for multidisciplinary program development. NY/London: Informa Healthcare, p. iii-iv (Pain Management Series, 3)

The idea that chronic pain is a medical problem was born with the pioneering work of John J. Bonica, M.D., at the end of World War II. Chronic pain entered the world of academic medicine when Dr. Bonica was appointed the founding Chairman of Anesthesiology at the University of Washington in 1960. The term, multidisciplinary pain clinic (MPC), was invented by Dr. Bonica, originally to describe an approach to the diagnosis and treatment of chronic pain patients by a group of physicians who interacted with each other as well as with the patients. In the 1960’s, also at the University of Washington, Wilbert Fordyce, a psychologist in the Department of Rehabilitation Medicine, recognized that a behavioral approach to the treatment of chronic pain patients could be more successful than injections, pills or surgery. He started a behavioral pain management service in Rehabilitation Medicine and brought his principles of pain management into the multidisciplinary pain clinic. Other psychologist broadened the Fordyce approach to include cognitive-behavioral strategies and increased its effectiveness. In 1983, Dr. Fordyce and I started a 20-bed inpatient and outpatient multidisciplinary pain clinic that was independent of any single academic department. This served as the prototype for multidisciplinary pain clinics throughout the world, in part because of our active teaching programs and openness to visitors. Physicians of many specialties, psychologists, nurses, physical and occupational therapists and vocational counselors were all integral members of our team.

Many other health care providers also played important roles in the development multidisciplinary pain management; the Commission on Accreditation of Rehabilitation Facilities (CARF) adopted our model as the accreditation standard for multidisciplinary pain clinics. Multidisciplinary pain clinics were developed throughout the world, often with varying content and emphasis to fit the needs of the patients they treated and the providers they had available. In countries with rational health care systems, this form of patient diagnosis and treatment seems to have prospered, as it has been recognized as more effective, less hazardous, and less costly than traditional approaches to treating chronic pain patients. Based squarely upon a biopsychosocial model rather than the prevalent biomedical model, multidisciplinary pain management has been seen as a threat to biomedicine and the industry’s imperative to consume expensive health resources.

In the United States, with a non-system of health care and the dramatic introduction of economic factors into health care decisions, MPCs have not fared as well and the number of programs has decreased steeply in the past ten years. There are many factors that have contributed to the relative demise of MPCs.

First, a labeling issue: Any group of two or more health care providers can call themselves a multidisciplinary pain clinic and is capable of deceiving the public as to what they offer insofar as diagnostic and treatment options. This is a common occurrence and has brought considerable disrepute to bona fide MPCs.

Second, decisions about what forms of health care are to be offered are not made uniquely by doctors and their patients. Instead, insurance companies and large hospitals and academic medical centers ignore both the moral imperatives to treat chronic pain and the available outcomes data on treatment efficacy and often will not fund MPCs. For large, American hospitals, especially those associated with a medical school, revenue generation is the major determinant of what services the institution will offer. MPC is not seen as a value compared to cosmetic surgery.

Third, payment to providers is skewed in favor of procedures and surgeries, putting great economic pressures on those who provide a personal service without a procedural intervention.

Fourth, proceduralists have done a much better job lobbying funding agencies and the public as to the utility of their interventions than have those who run MPCs.

Fifthly, there is no single optimal plan for how to run an MPC and what its content, duration of treatment and team members should be. This has made it difficult for funding agencies to evaluate programs and compare costs and efficacy.

Finally, organized medicine has never accepted the validity of multidisciplinary pain management and there are many impediments to its implementation in the medical community.

This book is designed to combat many of the problems that confront multidisciplinary pain management in the United States today. A stellar group of contributors has addressed the problems of building and maintaining a multidisciplinary pain clinic. The emphasis is upon outcomes, not personal anecdotes. Multidisciplinary pain care is the best treatment we now have for the rehabilitation and relief of suffering of chronic pain patients. Chronic pain patients always have psychosocial factors that influence their disability and suffering; pills and surgery do not address these at all. This volume will be an important tool in the restoration and continued development of multidisciplinary pain management in the United States and the remainder of the developed world.

John D. Loeser, M.D.

Professor of Neurology and Anesthesiology

University of Washington Medical School

Seattle, Washington, U.S.A.

Pain Management

There are 4 specialty practice areas in pain management, identified below by discipline:

There are 4 specialty practice areas in pain management, identified below by discipline:

Anesthesiology:

– An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both the hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. You need to ask what type of pain management services they specialize in. Interventional anesthesiologists are a “last resort” pain management option, specializing in implanting spinal column stimulators (SCS) or implantable morphine pumps (IMP) for in cases of intractable (irreversible) pain determined by MRI or other physical findings that have been identified by specialists in the tissue, tumor or body part to cause the pain and determined by the specialist to be irreversible. Referral is the usually made by the specialist to an interventional anesthesiologist for consideration of an SCS or IMP. Pain Management anesthesiologists I have worked with are hospital-based practitioners who do operating room based anesthesia and then saw patients with chronic non-cancer pain. Anesthesiologists, in my experience, deal with a broader base of pain patients. Pain management anesthesiologists treat pain with: strong pain medications (opioids or narcotics), trigger point injections, epidurals, infusions and, a few, in “last resort” cases, with spinal column stimulators or morphine pumps. If anybody can stop pain on the short-term it’s anesthesiologists. Long-term restoration of functionality, however, is not their area of practice. .

Neurology

– A neurologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. Neurologists I have worked with were office-based practitioners, saw inpatients and outpatients with complex pain conditions, especially complex neuropathic and headache pain cases. Neurologists, in my experience, deal with a narrower base of pain patients, so they are the option when your pain has determined to be due to nerve damage. Neurologists will mainly use strong pain medications (narcotics) to relieve pain. Restoration of functionality is not within their area of practice. .

Physical Medicine and Rehabilitation (Physiatry)

– A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Physiatrists I have worked with specialized in cases of serious traumatic injuries that required complex drug and physical therapy management often with the use of orthotics and other devices. Many of the cases I saw with physiatrists were paraplegics or quadraplegics from major traumatic injury. Physiatrists use physical rehab approaches, and pain medications. Restoration of instrumental functions is outside their area of practice.

Psychology (Pain Management Psychology)

– A sub-specialty psychologist who provides a high level of care, usually as a consultant to physicians specialized in the treatment of chronic non-cancer pain, usually working in a hospital-based setting. This type of psychologist is credentialed in pain management, has extensive experience in clinical medicine, in treating the full range of chronic pain disorders, is trained in quantitative research. and may direct outpatient chronic pain programs or be a principal investigator in controlled chronic pain research. I know about a half-dozen credentialed pain management psychologists in the US, and none abroad, so they are extremely rare breed and very difficult to find. Pain psychologists treat pain in combination with physicians who are prescribing pain medications and want to provide their patients, and themselves (for DEA purposes), the benefits of a comprehensive approach to pain management which insures pain patients on powerful pain drugs are engaging in deterrence behavior that reduces the likelihood of addiction.

The main professional sources to locate pain management specialists are:

American Academy of Pain Management

This is the best resource for finding pain management specialists. By their discipline you can  determine the type of treatment you will get. Pain psychologists are only found here, and they provide: 1) chronic pain education program; 2) attitude change support groups; 3) long-term chronic pain support, individually or in groups; 4) they are the best ones to help patients with restoration of functionality, particularly the return to work.

On the Academy’s website, column on the left side, go to:

Find a Professional and click on it. Then:

– Choose the State

– Choose the profession (we recommend “Pain Management” because you have a greater chance of finding someone)

– Leave Name blank. Click on Search and get a list of Pain Management specialists in your State

– Diplomates are credentialed in Pain Management, Fellows are not

– Call those nearest to you and ask what their credentials are in Pain Management and if they treat chronic non-cancer pain

American Academy of Pain Medicine

On the column on the right side, go to:

Find an AAPM Member

Click on: Physician Finder

– Choose the State only

– Leave all other options blank

– Click on Search Now for a list of AAPM Members

– Call those nearest to you and ask what their credentials are in Pain Management and if they treat chronic non-cancer pain

American Society of Anesthesiologists

Anesthesiologists often head Pain Management programs. However, their Website does not have a way of finding Anesthesiologists certified in pain management by State. Yet, every State has a Society of Anesthesiologists. Search by State for the State Society of Anesthesiologists in your State. Call the main office and ask if they have a Directory of Members who are Board Certified in Pain Management. Then call each one and ask the Receptionist, “Is the doctor Board Certified in Pain Management? Is there a comprehensive pain program s/he recommends in our area? Is s/he experienced in treating chronic non-cancer pain?”

UCompareHealathcare (http://www.ucomparehealthcare.com/drs/pain_management_physicians/).

This Website provides listings of pain management physicians by State, which is the page that appears when you click on their above address.

– Click on the State and get a listing of specialists by City.

– Unfortunately, they do not provide the phone number but make you get a “free report” to supposedly enable you to get their phone number

– There is no information on what they specialize in, so be sure to ask, “What are the doctor’s credentials in pain management? And, what type of pain management treatment exactly does s/he specialize in?

RESOURCES-11-04 – Download PDF (700kb)

“In the land of the blind, the one-eyed man is king. And, in 5+ level chronic non-cancer pain, whoever can consistently restore functionality according to patients’ priorities, controls chronic pain as we know it.” Grand Rounds, Scripps Memorial Hospital Campus, Schaetzel Conference Center, 2004

Around the world, those who study chronic non-cancer pain agree on the following:

That patients with moderate to severe (5+) pain have had their pain, on average, for 7½ years before they find the qualified multidisciplinary treatment that is the gold standard for restoring the functionality that most patients want restored. Furthermore, functionality is a clearly observable, measurable, objective standard, so why do so many studies talk about increased “quality of life” in regards to chronic non-cancer pain? It’s interesting semantics that patients need to understand lest their treatment objectives be changed without their awareness.

Medications are “licensed” by the FDA for specific uses. Therefore, medications intended strictly for cancer pain can only be legitimately marketed to cancer patients. And, the language of cancer pain must be used to stay on the safe side of the FDA, who can be pretty strict about misapplications of a licensed drug. Now, a key outcome in cancer pain is increased “quality of life,” meaning that someone who is facing life and death – and for whom going back to work, socializing, doing housework and getting a higher degree to improve one’s chance of promotion on the job is pretty irrelevant stuff – and is just happy to get an “increased quality of life,” which really means “suffering a bit less from cancer pain.”

However, once the drug is on the market, any physician can choose to use a medication “off license,” or for some other use than the use that was “licensed” by the FDA. Therefore, a drug company wishing to increase use of its cancer drug would be wise not to directly challenge the FDA by changing the wording of its key outcome – or its “improved quality of life” claim – and just put the advertising out there in the right journals and hope that general physicians, who are the majority of those who prescribe “off license,” will think that “improved quality of life” might be what their chronic non-cancer pain patients could benefit from, without worrying about splitting hairs over what cancer and non-cancer pain patients really see as their tangible treatment objective.

Now, since chronic non-cancer pain patients are not dying and do very much want to go back to work, socialize, do housework again and improve their chances of an increased salary and all that future-oriented stuff, the “quality of life” is not what they want as a key outcome of their pain treatment. In fact, in repeated studies with non-cancer pain patients, the tangible, future oriented things are precisely what they want more of, and those really constitute “quantity of life,” which is quite a different bird from “quality of life,” which is just a matter of feeling a bit better about your suffering and, therefore, about your prospects of dying or not, or again, your overall “quality of life.”

What is the implication for chronic non-cancer pain patients? Obviously, keep your eye on the ball. If your treatment objective really is to go back to work and all those good activities that constitute your “functionality” and “ability to function as normally as possible,” then do  NOT allow a physician to mix metaphors on you. If a physician tells you, in offering you a pain medication, that “it should increase your quality of life,” do two things. First, remind her/him that you’re not dying and that you want an observable, measurable, objective measure of improvement relevant to your life, like going back to work and all those other activities you want restored. In other words, you want “increased quantity of life,” in a reliable, predictable manner over the long term, not some vague, subjective “quality of life” that is no different than telling your boss that you want an “improved quality of salary” rather than that you want a “12 percent increase in salary.” And, second, you had better start looking for another physician to prescribe your pain medications, because the one that couldn’t tell the difference between “quantity” and “quality of life,” you really don’t want treating your pain any more.

See the difference? And that’s the difference between effective and ineffective treatment for chronic non-cancer pain, that you can, and must make for yourself… if you want restored ability to function!

Dr. Henry E. Adams

1-IX-2009

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.

Dr. Henry Adams, Diplomate in Pain Management, AAPM

“When the world is destroyed, it will be destroyed not by its madmen but by the sanity of its experts and the superior ignorance of its bureaucrats” John Le Carré

SITUATION ANALYSIS

In 2005, when I was directing the outpatient chronic non-cancer pain program on the campus of Scripps Memorial Hospital in La Jolla, CA, I wrote a  draft of a book that was going to be distributed to pain patients in my pain program. Although I had to postpone publication of the book, writing the manuscript forced me to research a lot of government data that, already in 2005, showed that the collapse of American  healthcare was already taking place. The inescapable negative data included the following:

– In 2008, healthcare expenditures exceeded $2.4 trillion, were projected to rise to $3.1 trillion by 2012 and, by 2016, to $4.3 trillion. The absolute numbers and the rate of growth were to become even greater as 77 million Baby Boomers would begin entering Medicare between 2011-2030. What those numbers say to anyone with a little  understanding of numbers, is that the healthcare strategy used since Richard Nixon and intended to provide “cost containment” could NOT possibly work because whenever costs continue to climb  regardless of what you do, it means that your basic strategy needs to be thrown out. What incentive does anyone have to pursue a strategy whose numbers tell is absolutely wrong?

– In 2006, America spent 4 times more on healthcare than it did on national defense.

– In 2008, the US spent 17% of every cent it made  – its Gross Domestic Product – on healthcare. That percentage, the estimates are, will climb to 20% by 2017.  Today, the US spends more total and per capita on healthcare than any other country in the world. Not because it wants to, but because there is no will to control the major costs which are “eminently” controllable.

– That fails to take into account the numbers that make it absurd to say that the solution is  that Americans  “buy” health insurance so they can access to health care when needed:  1)  12 -14 million Americans are currently unemployed and have no regular source of income with which to “buy” that insurance;  2) 77 million Baby Boomers are coming into Medicare between 2011 and 2030, will be 65, will be living on a fixed income, and won’t have the money to “buy” the health coverage that will cover the chronic diseases that naturally occur with aging; 3)  70 million Americans who live at or below the poverty level, are disabled, or 75 or older, and all of them can’t work and can’t “buy” health insurance. That adds up to the fact that 1/3 of all Americans cannot “buy” insurance, such that everybody has access to the same quality and quantity of care when and how they need it.

– Most recently, the numbers gathered on primary care physicians charged with caring for the rapidly growing needs of an America burdened with chronic diseases that require more, and more varied care reveal that: 1) the supply of primary care physicians is dropping rapidly as the demand for services for chronic diseases also rises rapidly; 2) the government in its wisdom has cut primary care physicians’ Medicare reimbursement by 21%, which has driven even more to stop providing care to Medicare patients who will need to get more, and more varied care, with the shortage of primary care physicians,  from far more expensive specialists.

Conclusion: 1) we have more people now needing more, and more varied health care due to the economic, demographic, and lifestyle patterns molded by this nation than ever before; 2) we also have less people than ever before,  proportionately, who are able to competently care for those who need it; 3) one third of all Americans do not have the consistent income that will reliably accompany cost of living changes and give them the ability to “buy” healthcare in any ongoing manner such that they will have access to the continuing  standard of care they will need to maintain wellness and optimal functionality, including the return to work; and, 4) the “healthcare-as-market” hypothesis is invalid, unusable and bankrupting individual Americans and the nation, as evidenced by over half a century of total lack of control of healthcare costs.

BACKGROUND: Over the years that I’ve been treating pain patients, I have literally read hundreds of articles from around the world on treatments for chronic non-cancer pain. I don’t do this for entertainment I do it because I have to, to maintain my certification in pain management active. In short, I’m expected to keep myself up to date for my patients. One of the most frequent issues I hear from pain patients concerns their fears about taking “powerful” pain medications.

My purpose in this post is to sum up everything I’ve come across from around the world, and from our pain program’s own randomized controlled trial (RCT) that involved more than 400 legitimately diagnosed chronic non-cancer pain patients who reported a minimum of 5 (out of 10) level pain in our pain program on the campus of Scripps Memorial Hospital between 2000 and 2006. We compared 3 treatments with pain medications to assess under what conditions was functionality most effectively restored.

THE TEST OF THE PUDDING:

– First we looked only at primary care physicians and what and how physicians who are not certified specialists in pain, and were not part of our program, prescribed pain drugs to patients with 5+ level pain and what outcomes they posted at the end of 3 months;

– Then, we looked separately at certified pain management anesthesiologists who were part of our program and what and how physicians who were specialists certified in pain prescribed pain drugs to the same type of patients and what outcomes they posted after 3 months of treatment; and

– Finally, we looked separately at a combination of a certified pain anesthesiologist and a pain psychologist expert in operant behavioral and lifestyle modification – the “pain program” treatment – and what and how that combination of those two types of specialists in our program, with their specific interventions, wound up using pain drugs and what functionality outcomes they posted at the end of 3 months.

I’ve gone into the details of this RCT elsewhere. The key finding was that drugs alone do very little to restore 5+ patients’ functionality. The combination treatment was the only one to produce statistically significant change in relevant (to the patient) functionality. Primary care physicians had no impact on functionality; certified pain anesthesiologists had some, non-statistically significant impact on functionality. And the combination program had highly statistically significant impact on restored functionality. There’s no secret to this. It’s a matter of controlling the potential error in the treatment. If you can’t see it, you can’t control  it, so it constitutes random error. And since physicians can’t “control” the conditions that  increase or decrease functionality, they’re essentially not treating functionality directly so random error is to be expected in a drug-only treatment, especially  if the prescribing is in the hands of people not specialized in the control of pain.  That’s just commonsense.  So, in the same way that I can’t control the conditions that lead to metabolic changes in diabetes,  whatever I do, I’m not treating diabetes, regardless of any good intentions I may have. It’s simply not my area of practice.  And, functionality (or highly nuanced, higher-order, highly integrated behavior) is simply not physicians’ area of practice.

IS DRUG-FREE TREATMENT POSSIBLE?  Let’s follow the implications of the data and see what the numbers say about whether 5+ pain patients can do without pain drugs and show significantly greater functionality?

The short answer is, it depends on what the treatment conditions are. What is also obvious from this study is that not one 5+ pain patient was able to start restoring their functionality without the help of appropriately, specialist-prescribed pain drugs PLUS highly specific lifestyle and habit change conditions aimed at restoring very specifically defined functionality for each patient.  In short, neither drugs-alone nor lifestyle/habit-change alone works alone. A drugs-only approach restores little if any functionality, and a functionality-only approach, without drugs, also fails to restore functionality. Our findings simply were consistent with what we find in the worldwide literature on chronic diseases:  a combination approach (drugs PLUS behavior/lifestyle modification in expert hands) is the Gold Standard for restoring patients’ ability to again function as close as possible to normal.

So the answer is clear. No patient who did not take specialist-prescribed pain drugs was able to decrease their pain enough to focus on doing what they needed to subtly modify their behavior and lifestyle and begin to restore their functionality. The way it’s done “right” is that pain drugs are used to create just enough pain relief to begin to increase what constitutes priorities in the topography of each patient’s functionality. As functionality increases and comes under control of the patient’s normal life circumstances again, the need for medication drops and, in about 6 months, most patients can begin to titrate down from their beginning doses of pain drugs.

So, can 5+ pain patients go without taking pain drugs and increase their ability to function normally?  No, they can’t. All those who posted statistically significant changes in their functionality scores needed pain drugs to begin restoring their functionality. There is no mystery to this because 5+ pain leaves one – from experience – very “ditzy.” You can’t focus, you can’t concentrate, you can’t remember details of what to do to have success in consistently controlling the conditions of your functionality’s occurrence.

Dr. Henry Adams

21-II-09

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