I was relaxing this weekend and cleaning up stacks of papers that have been piling up over the last six months. I ran across this letter a patient had shared with me from her prior surgeon. She had undergone a major low back surgery and came to me with unrelenting … Read More
I have a patient who is a muscular 43 y/o welder. He injured his back on the job about four years ago. After undergoing a laminectomy for low back pain, his pain actually increased. When I first saw him a couple of years ago, his complaint was unrelenting low back … Read More
The culture of medicine is immersed in high standards, ideals, and perfections. Society demands perfection from physicians. It is manifested in many ways. The legal system, hospital staff privileging, no mercy for personal mental health issues, harsh criticism from our mentors. Consequently, as others judge us, we are idealistic regarding … Read More
Debbie was a 45 y/o woman who I had been working with for about four years. She was diagnosed with a severe bipolar disorder at age twelve. Unsuccessful Surgeries About 10 years ago, she had a lifting injury at work and developed chronic low back pain. Over a series of … Read More
It’s important for you to understand how powerfully and quickly pain circuits are embedded into the nervous system. It’s accomplished in the same way one learns anything—by repetition. Pain impulses flood your brain much faster than and athlete, artist or muscian a learned skill of an athlese more numerous than … Read More
Anger is as important as anxiety when it comes to chronic pain management. Some people are able to come to grips with anger and process it in a healthy way. For others, a lack of control over anger erodes their quality of life. Forget about physical pain for a moment. … Read More
Understanding the importance of sleep and its effect on the perception of pain was my initial insight into the neurological nature of chronic pain. Incorporating adequate sleep into my treatment of pain was my first step in the evolution of the DOC Project. I felt I had a whole new … Read More
There is a sequence of events that results in chronic pain. It is complex and not linear. The first step is to acknowledge a source that can originate from soft tissues, a structural abnormality, or the brain can “short circuit” and spontaneously generate pain. It is also critical to understand … Read More
I learned about the importance of sleep somewhat by chance. It was covered in my medical training. I read a book, The Promise of Sleep. It was an autobiography of William Dement, who started the first sleep lab at Stanford. I became interested in the effects of sleep on chronic … Read More
Objectives: Understand the complexity of chronic pain and how it evolves from acute to chronic. The factors to consider are the source, sensitization, memorization, and the “modifiers” of anxiety, anger, and sleep. Breaking chronic pain into its component parts allows them all to be systematically addressed and it becomes a … Read More