CHAPTER 1 · THE POWER OF VALIDATION: Was that one or two tons of bricks that was just lifted from my shoulders? This chapter summarizes one of the most important principles taught to the authors by their patients: genuine validation of the chronic pain experience by the healthcare provider lays the foundation for successful treatment and recovery. Successful validation changes not only the mind, but the body as well. Ignorance and lack of appreciation for the importance of validation by healthcare providers is the primary reason for treatment failure and harm to patients.
CHAPTER 2 · A TALE OF CHRONIC PAIN: Presents the story of a middle-aged mother and housewife who suffers from debilitating migraine headaches. Describes how the health-care system, through ignorance, indifference, mismanagement, and greed, contributed to her pain and suffering while, at the same time, touting itself as providing the highest quality of care. The system failed her and yet it was she, the patient, who was blamed for being "non-responsive" to treatment. The authors describe how this kind of "cover-up" is manifested by the actions of healthcare providers, insurance companies, attorneys, and even many so-called chronic pain specialists.
CHAPTER 3 · THE ANATOMY OF PAIN 101: What is pain? Where does it come from? What goes wrong to produce it? Chapter 3 addresses what chronic pain sufferers should know about their own bodies, from ruptured discs to phantom limb pain. Having trouble translating that medical report? Check out this chapter.
CHAPTER 4 · THE WORK-UP: One of the most important precursors to effective chronic pain management is the establishment of an accurate diagnosis. What's causing the pain? Why is the person suffering? We see far too many individuals in our clinic who suffer from "pain of unknown etiology;" unknown because someone namely the doctor failed to do the necessary homework or to make the appropriate referral. As a result, these people had received, at best, generic treatment programs that actually made matters worse. This chapter reviews the nuts and bolts of the work-up process, including the history and physical examination as well as diagnostic testing.
CHAPTER 5 · THE DOCTORS KNOW BEST... OR DO THEY?: Misdiagnosis, mismanagement, ignorance, superstition, indifference, greed, and anger toward the patient: many chronic pain sufferers have been exposed to one or more of these, right in their doctor's office! Although no doctor is perfect, the very training and medical culture that lends itself to curing disease can also contribute to harming the individual with chronic pain. This chapter exposes what unenlightened doctors are thinking about when dealing with chronic pain sufferers and illuminates why they make the same mistakes over and over again. It also delineates ways in which the patient can protect him or herself against substandard care.
CHAPTER 6 · IT'S ALL IN YOUR HEAD...AND OTHER POPULAR FAIRY TALES: Describes the experience of millions of Americans suffering from the "soft" chronic pain diagnoses (i.e., those without "objective" medical cause such as fibromyalgia). Often approached from a position of medical arrogance and superstition, these conditions are widely misunderstood and mistreated. This ignorance adds insult to injury when the patient is blamed for his or her own suffering. This chapter also discusses what science tells us about mind-body connections.
CHAPTER 7 · NARCOTICS AND THE FEAR OF ADDICTION: OR MUCH ADO ABOUT ALMOST NOTHING: Think twice about your doctor's referral to that 12-step program to get off of pain pills. This chapter discusses the conventional wisdom regarding narcotic use for chronic, non-cancer pain and then turns it on its head. It defines tolerance, physical dependence, and psychological addiction while sharply delineating reality from myth in light of recent research. Also addressed are the individual's right to adequate pain management and the physician's moral and ethical obligation to alleviate pain, even if it means prescribing narcotics on a long-term basis.
CHAPTER 8 · PAIN MEDICATIONS: Lists the various classes of pain medications and describes the pros and cons of each. How you take your medications can be as important as which kinds you take. Chapter 8 explains the advantages of proper medication scheduling in treating chronic pain.
CHAPTER 9 · THE PSYCHOLOGY OF CHRONIC PAIN AND ILLNESS: The authors critique the traditional practice of applying the concepts of psychopathology (i.e., mental illness) to the problem of chronic pain. Although obsolete and superceded by more scientifically validated theories, practices, and procedures, it is done all the time. And tremendous insult is added to the unwary pain sufferer's already devastating injury. This chapter takes the reader through the evolution of psychological approaches to chronic pain and shows him or her when to exercise caution and when to embrace behavioral methods. Simple, humorous examples illustrate important concepts, arming the reader with an accurate, yet entertaining, roadmap for maneuvering through the chronic pain minefield. In addition, the mind-body link is further explicated in the form of research findings and case examples.
CHAPTER 10 · PHYSICAL INTERVENTIONS: The vast majority of chronic pain sufferers have never undergone an interdisciplinary evaluation. Research clearly shows that this type of coordinated approach to treatment is the most effective for individuals who have been significantly debilitated by chronic pain. This chapter describes the interdisciplinary approach and what to look for when evaluating treatment programs.
Also, many pain sufferers have become phobic about "therapeutic" exercise because of a widespread "no pain no gain" philosophy among physical therapists and doctors. This chapter addresses the difference that a little behavioral programming can make in maximizing treatment gains. Also, it illuminates the therapeutic value and process of learning to regulate pain through biofeedback.
CHAPTER 11 · CHIROPRACTIC TREATMENT: Long regarded by the medical profession as quackery, chiropractic has proven to be a safe and effective approach to treating pain. This chapter provides a brief history of organized medicine's assault on chiropractic and then moves into the ways in which it can be successfully integrated into the treatment plan.
CHAPTER 12 · ACUPUNCTURE: In this chapter, we poke holes [sorry] in the common misconceptions and fears about acupuncture. Contrary to popular belief, it is not an antiquated approach based on eastern philosophy and superstition. It does not constitute a massive placebo effect. Rather, it has been used successfully for thousands of years in China and modern scientific studies are validating its efficacy. The bottom line is that acupuncture can be an important part of successful pain management.
CHAPTER 13 · PASSIVE MODALITIES: Some doctors and therapists criticize the use of passive modalities (e.g., massage, ultrasound, heat) on the grounds that they "only" provide comfort and do nothing to cure the underlying problem. Well nuts to that! When used in the right combination with active treatments, passive approaches can make the difference between success and failure. Besides, providing comfort temporary though it may be they have tremendous value to people that hurt all the time.
CHAPTER 14 · SURGERY AND OTHER DESPERATE MEASURES: Think long and hard about that fifth back surgery. This chapter cites and discusses the statistics regarding unnecessary back surgery in this country. Patients are at risk unless armed with the facts. It provides an overview of the appropriate work-up for pain including the history, physical examination, and diagnostic testing. Chapter 14 lists types of surgery for pain conditions along with their indications and contraindications, risks and benefits. Finally, it provides guidelines for choosing a doctor in general and a surgeon in particular.
CHAPTER 15 · THE MANAGED CARE EXPERIMENT: The health insurance industry loudly touts cost containment without compromising quality of care. To be sure, HMOs, PPOs, and a bewildering array of other such insurance-related spin-offs are making remarkable strides in improving their capacity to generate revenue. Just don't get sick! This chapter describes what injured workers and others with chronic pain can expect from a cynical, profit-driven, insurance industry that holds the financial keys to their well being.
CHAPTER 16 · THE DOCTOR'S DILEMMA: In making sense of one's experience while maneuvering through the healthcare system, one should be aware of the forces driving clinical decision making. This chapter describes, from a doctor's point of view, how the forces of economics are rapidly replacing the Hippocratic Oath as the guiding principle and the implications of this tragic turn of events for the chronic pain patient, now and in the future.
CHAPTER 17 · STACKING THE DECK IN YOUR FAVOR: So you're saddled with chronic pain and you want to make the most of your life on earth. How do you do that? The fact is that too often the pain controls the person rather than vice versa. It determines what the individual does, where he or she goes, and how often. How do you regain control of the pain and your life? As the reader will discover, life style habits, including exercise, nutrition, and stress management, are vital pieces of the puzzle. But so is appropriate attention to the three components of each and every one of us: the mind, the body, and the spirit. To assure success, it is important to find ways to nurture each vital part. This chapter is designed to provide practical advice on how to get back into the driver's seat and become the master of your own destiny.
APPENDIX A · A CHECKLIST FOR HIGH QUALITY PAIN CARE: This checklist presents questions relating to important elements to consider when evaluating members of your pain management team.