Realizing that chronic pain patients deserved a more effective path, my new practice partner, John Massey, MD, and I began developing a comprehensive approach to helping patients recover from challenging life situations like major back surgery. We had seen that many of the medications we’d been relying on could be more of a problem than a solution, so we were no longer content to use them, alone, to manage a patient’s pain. In fact, we’d seen that many of the people who took the most medicine still suffered from the greatest amounts of pain. We wanted to help people manage their pain more effectively, which would likely mean they would be taking less medication.
For example, when we saw a patient with chronic back pain who had been confined to a wheelchair for five years, we thought about ways of getting him out of the wheelchair and helping him overcome his fear of the pain, so he could lead an independent life. Rather than acting as symptom managers and adjusting his medication dosage with each visit, we began to address lifestyle changes and other comprehensive approaches that could help him get better.
We then started telling all of our patients we wanted to give them tools that would help them manage their pain more successfully, function better, and lead better-quality lives—tools that would help them sustain these improvements over the long run, as well.
Yoga Workout For Back Pain Photo Gallery
After speaking with local doctors, physical therapists, and other healers, we put together a program that included physical exercises, meditation, art therapy, nutrition, tai chi, help with detox, and much more. Each patient was educated about pain in general, as well as his or her condition, and given a structure to use in building a specialized lifelong program. Because each person’s pain problem was unique, we adapted the training to his or her specific needs and provided a wide array of tools and techniques. For example, one person with back problems can’t bend over and tie his own shoes, while another with a painful shoulder can’t reach overhead to blow dry her hair. The same conceptual approach will benefit both patients, but each needs unique therapies and exercises to overcome specific deficits. It’s quite a challenge to treat a condition like chronic pain, which has 100 million different versions, using methods that can be reproducible and reliably effective!
It was difficult to convince our patients, their doctors, and the insurance companies to cooperate, but afer a few years, people started to take note of the success stories coming from our clinic. We eventually discovered that the patients who took the least amount of medicine, or none at all, did better, improved their functioning in daily life more, and were more likely to return to work than those who took the strongest pain killers. They were more self-empowered to manage their pain and less dependent on doctors like me. They were also more likely to see improvements in their personal relationships.
But there was still resistance to the idea that a “whole person approach,” geared to helping people become more active, healthy, and wellness-focused, works the best in overcoming chronic pain. Luckily, science-based outcome studies, along with our own data, continued to support what we were trying to do. In 2006, a study published in the Journal of Pain demonstrated that comprehensive pain programs such as ours “offer the most efficacious and cost-effective, evidence-based treatment for persons with chronic pain.”1
Packaging the “Secret Sauce”
Within a few years of implementing our new approach, Dr. Massey and I saw tremendous results.
Our patients were getting off their medications and improving the quality of their lives. Other doctors began calling us, asking if they could come study our methods, as did some insurance companies and healthcare investors. More importantly, we saw patient after patient creating happy endings to their stories. Many overcame their pain, and many more were able to reclaim their lives.
Yet, if there is so much evidence showing that an integrated approach to chronic pain is much more successful than the standard approach—including that presented in the Journal of Pain study— why are so many Americans still suffering? The reason is simple: There are powerful forces supporting the use of treatments that not only don’t work, but stand in the way of those that do work. Pharmaceutical companies, medical device manufacturers, insurance companies, national policymakers, and others, including some patients, are pushing hard to keep this failed system in place, an issue I’ll explore in chapters to come.
In the meantime, it’s important to understand that while we all want a “magic bullet” to wipe away our pain, it won’t take the form of a medicine or some new kind of surgery. Instead, the true “magic bullet” is the understanding that chronic pain is a brain-based disease, and that relief will only come from working to heal this “pain brain.” Only when the brain is physically restructured and restored to health can the process of pain relief take place. This may be the opposite of what doctors have been telling people for decades, but it is backed by the latest science emerging from the lab. The true “magic bullet” for chronic pain is the understanding that both the problem and the cure lie within.