My 5 Rules for Treating Pain

I've been in this field now for over 30 years, so I’ve seen thousands of patients in my clinic. From this experience I’ve come up with my five rules for treating pain, which I use to this day. 

Rule #1:  Pain is a Description, It is Not an Entity

Pain is a personal experience. Pain is something that is not anecdotal, it is real. 

I can have a fibromyalgia patient describing pain, and a patient with a major injury, real visible pain. Pain is a description, and sometimes the description is the best thing that we have.

I have to take that description as validity. You can't see, touch, feel, or measure pain. 

The patient's subjective interpretation of pain is very real. That's what they have, and they're going to tell me.  Everybody is a little different.  I call it the personality of pain. Pain has a lot to do with the limbic system, and it has a lot to do with central nervous system processes.

Rule #2:  You have Got to Have a Diagnosis

The diagnosis is critically important. I need a pathway, and the pathway takes you to the foundation. The foundation is where I can build your treatment profile and treatment plan.

Low back pain is not a diagnosis, it's a description. 

A diagnosis is something like degenerative spinal disease. Degenerative spinal disease may result in low back pain.

Rule #3: If the Healthcare Provider Does Not Believe In the Diagnosis, They Should Refer It Out

If the healthcare provider doesn’t believe in the diagnosis or in the disease entity, they should refer it out. Some examples might be:

• fibromyalgia interstitial cystitis
• chronic fatigue
• headache
• irritable bowel

If they don't believe in it, they can't treat it effectively, so they should refer the patient out.

Healthcare providers have to get over the fact that they can't fix everything.

Good healthcare providers know instinctively that referring out is okay.

Rule #4: Know Thy Meds

Know five classes of medicines. That's going to be:

1. NSAIDS or anti-inflammatories
2. Opioids: hydrocodones, oxycodones and morphines
3. Gabapentinoids: lyrica, gabapentins, Neurotin with the brand name Lyrica
4. Muscle Relaxants
5. Novel 

These are five major categories, and healthcare providers should have at least five specific drugs in each category.

They should keep expanding the medicines they know in each category. They will have options they can draw from.

Rule #5 Don’t Chase Pain

As a healthcare provider, I really want to help, but from a realistic standpoint, I can't always do that. I can’t chase pain. 

From a compassionate standpoint, I want to get you all better. But from a realistic standpoint I want to improve your function and quality of life. 

Pain is one of the most difficult things to treat because it is a personal experience that is translated into function and quality of life. There is a necessity of meds, treatments and movement forward to the best possible outcome.

That's my five rules. I'll be expanding on those more in this series, so stay tuned!