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

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.