The Clinic » Programs of Care » Pain Program of Care
One of the most common reasons that people needlessly suffer from pain for years is that they have been given the wrong diagnosis. It is amazing how often a patient will arrive with multiple MRI results, having undergone 2-3 surgical procedures and using multiple medications without any clear idea of what is causing their pain. Even more surprising is how often they tell us that our physical examination is the first one they have had of its kind. This failure to diagnose the reason for pain is so pervasive that clinical trials evaluate treatments for vague diagnoses like 'chronic low back pain'.
The most often cited example concerns herniated discs. Many people believe they are suffering from this problem based on an MRI - even though up to 40% of people have herniated discs - but do not experience pain. A detailed history and careful physical examination will usually reveal the origin of your pain. There is no evidence supporting their 100% accuracy, but this is because medical doctors are not properly trained to diagnose musculoskeletal disorders. This might sound controversial, but most physicians would agree.
While some people have chronic pain because of an injury that has not been diagnosed or treated, in many cases there is another reason. That reason has nothing to do with the injury - it is because the body cannot heal. This concept is critically important concept is unfortunately not taught in pain medicine - or any other medicine.
The body has an innate ability to heal itself. Over time, many nagging stresses can drain its ability to do so. This explains why most people with back pain have many brief episodes of pain before their problem becomes chronic. The first few times may have lasted days, weeks or months, but eventually the problem becomes chronic.
The key to success is finding these stresses. A detailed evaluation will include a search for food allergies, heavy metals and other toxins, digestive problems, hormone imbalances, vitamin and mineral deficiencies, sleep problems, physical inactivity or poor nutrition. This does more than just treat pain - it improves every aspect of your body and mind.
The first part of your treatment will be based on the cause of your pain. We have experience with a wide range of techniques that target specific tissues. This goes beyond traditional physiotherapy, which is often unsuccessful because the most common treatment modalities provide only temporary benefit. A partial list of the approaches that we may recommend includes:
• manipulation of bones and joints
• soft tissue release
• massage therapy
• craniosacral therapy
• orthotics
• medical acupuncture
• prolotherapy
• trigger point injection
• peripheral nerve blockade
• epidural injection
• neural therapy of scars
We also direct patients to people who can help with posture, stress management, targeted exercise and other specific therapies.
Some people come to us in desperate need of relief from daily suffering. Many are unfortunately already physically or psychologically addicted to prescription drugs. Whenever possible, we strongly advise that these be stopped. While opioid analgesics generally have few serious risks, they affect memory, concentration, and emotional state. They also interfere with the autonomic nervous system that is the body's major stimulus for healing.
Our first priority is to make sure that our patients do not suffer. As pain improves, medication is decreased slowly over a period of several weeks or months. We do prescribe opioids for people who need them, but because of the medico-legal risk and the potential for abuse, this is done within the parameters of a written agreement that patients must sign and follow.
The good news is that there are other ways to treat pain. Their effect is often not as immediate or dramatic as drugs, but they are safer and often good for the body. Some examples include:
• Anti-inflammatory foods like cherries, olive oil and avocado
• Devil's claw, curcumin, glucosamine, chondroitin and specific B vitamins
• Topical therapies like Zheng Gu Shui or prescription creams and gels
• TENS, magnets and other modalities that affect nerve transmission
Another key aspect of our program comes from the field of psychology, but it was introduced to the world almost 3000 years ago by the Buddha. It has nothing to do with religious faith; it is a profound truth about the human mind. The secret: the suffering you experience does not just come from what you feel. It also comes from how you react to what you feel.
If you react with fear or anxiety, avoid doing things that hurt, try to ignore it or make it go away, those emotions will trigger the release of chemicals in your brain that make pain worse. If you are able to go on living, feeling the pain reacting to it as little as possible, this will not happen.
This may be a profound truth, but it is easier said than done. We try to guide you to this way of thinking, and like to direct patients to a structured mindfulness-based stress reduction course to introduce a variety of mind-body techniques. This transformation of the mind is classically brought about through meditation. Some people will go on to attend group meditation, practice on their own, or progress to Vipassana or other intensive retreat.
We are proud to say that in some cases we can completely cure chronic pain. This is not always possible in complex cases, but virtually all of our patients experience a major improvement in their ability to function and their quality of life.