The Reality of Pain Management

For the past 20 years, I have been in academic and private practice. I have taught medical students, residents in training, as well as fellows completing their pain management fellowships. My partners and I started a private pain practice in 2007. We have seen it grow into to 6 locations and are currently seeing 300+ patients per day. We continue to train medical residents from other medical specialties so they can learn about pain management. We have been involved in performing almost every type of pain management procedure available. We lived through and practiced during the opioid epidemic and have learned many lessons.

 

 

 

It has been about 2400 years since the death of Hippocrates the Greek physician whose oath “to do no harm” every medical student must take. Since then, what have we achieved as far as advancements in medicine? We still do not have a cure for the common cold although we have eradicated a few infections through antibiotics and immunisations. Most diseases unfortunately are not curable, we simply choose to treat the symptoms of the disease rather than the disease itself. Almost every medication outside of antibiotics, is purely for symptom control. All of the wonder drugs that make the pharmaceutical industry billions of dollars unfortunately does not cure any disease. In fact, why would they want to cure disease? There is much more money and profit in managing a disease rather than curing it. Why would you want to lose your customers?

 

 

 

Through simple observation, you might notice that we are no longer a healthy appearing society in the West. Countries with once healthy populations are now plagued with the same diseases plaguing the West once the western diet finds a foothold. Diabetes, heart disease, and obesity are at epidemic levels now. The diagnosis of “metabolic syndrome” (aka obesity, high blood pressure, diabetes, and abnormal cholesterol) fits into almost 45% of my patients. These factors are all amendable to dietary modifications. There has been a massive increase in the number of diagnoses of autoimmune disease as well. Wastebasket diagnoses such as fibromyalgia and chronic pain syndrome are coming into my clinic and record numbers. What do you do for patient that states they hurt from the top of the head all way down to the bottom of their toes? These are the types of patients we are seeing more often in our clinic.

 

 

First of all, your goal should be to do anything to avoid becoming a chronic pain patient. This starts with living a healthy lifestyle early in life. Avoid smoking, excess alcohol, learn what healthy eating really means. Once the degenerative changes set in, there is little that can be done to cure chronic pain. We have medications that dull the pain for a few hours however when the medication wears off, the patient is right back to where they started. We try our best as physicians by giving the patient’s medications for pain. Unfortunately, over time the patient becomes tolerant to the medication and becomes less and less effective. Opting to use stronger versions of the same class of medications leads to dependence and potentially addiction. We have a few injection therapies that can give patients relief for up to a few months. Most of the latest technology treatments have turned out to be busts. In our practice, spinal cord stimulators for patients who have chronic spine related pain has a failure rate greater than 70%.

 

 

 

 

 

As a society, we are becoming a sicker yet technologically smarter population. We may be able to extend peoples lives to an older age however the quality of life needs to come into question. In the past 50 years we have seen a rampant increase in the incidence of metabolic syndrome and autoimmune diseases. Perhaps we need to start looking at our bodies down at the cellular level. In hypothetical terms, if each individual cell in our bodies were given the proper nutrients to thrive, we may not have as much chronic disease as we have today. We need to start looking at the food we are eating. We have to start looking at the food that the food we are eating ate as well. The way that we farm, the way we raise animals for meat, the chemicals used as pesticides must all come under greater scrutiny. It is my feeling that the Western diet and therefore the western way of farming and raising animals for meat needs to be looked at much closer. We need to understand the damage that added antibiotics, hormones, and pesticides are doing us. The microbiome, the term that describes the living organisms that live within our bodies, are being destroyed. We need a healthy microbiome to remain healthy and fight disease. We need to look closer at inflammation and causes of inflammation. We need to understand more about mitochondrial (the energy producing organelles in every cell of our bodies) function and disease.

 

Fortunately, because of the failure of western medicine to cure disease, many renowned scientists and biohackers have started to pave the way for us to understand how to actually cure rather than treat some of these diseases. By thinking outside of the “tell me your ill, I’ll give you a pill” schema, they are finding ways to treat disease which have the pharmaceutical industry worried. Did you ever question whether or not cholesterol is really bad for you? Why is it that up to 50% of people with heart attacks and strokes have normal cholesterol levels? Who really gains from having most of the population on a statin drug? Are grains really healthy? Who gains from people eating grains everyday? Have you ever questioned who coined the term “breakfast is the most important meal of the day”?

 

Within this blog I hope to explore many of these new ways of thinking and incorporate some of their ideals and methods into the practice of pain management. Come along on the journey and let’s learn together!

 

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