Hope everyone is having a great holiday! It's my plan to resume blogging at least weekly after taking a 7 month hiatus that was partly caused by my real world schedule ratcheting up and partly because no one was reading or at least commenting about the blog. However, following the "build it and they will come" philosophy, I plan on resuming posting regularly. But, I have decided that the postings will not be restricted to only pain topics. People in pain (PIPs) have lives apart from pain that I can also address and I will as the mood and events strike me and seem important. It was always my intentionfor this blog to be integrated into PIPs lives, and nonpaintopcis are part of that. We'll see how this works out in 2009.
Dr. Tim
Monday, December 29, 2008
Monday, April 7, 2008
BACK PAIN, MEDS, AND NONCOMPLIANCE
I listened to a phone call between a patient and our secretary last week. The patient wanted to come in a week before she was due for a refill of her Methodone and Dilaudid as she would be on vacation the next week. She was informed that this was fine, but that she would need to bring in her two bottles of narcotic to confirm that she had a week's worth left. She was told that this was standard policy. We did not refill patients early if they ran out of their narcotics early. The patient was outraged. She stated that this had never been required before and demanded to know why she was being singled out. She railed against the possibility that we did not believe her. She yelled at our secretary that we were being unfair, unreasonable, and unprofessional. She demanded that she be able to speak to the office manager, and aggressed against her as well - for almost 20 minutes. Eventually, she refused to come in early if we could not trust her, and stated she would see us after her vacation. Clearly, she expected to remain a patient even after her tirade.
These interactions happen all the time in a typical pain clinic, but patients almost never see them. Everybody is special, everybody is trustworthy, everyone should get special treatment. Patients should be able to structure their treatments, refills, etc., any way they want. Everybody thinks we should break the rules just for them. This patient demanded that we refill the two strongest narcotics in the history of the world 7 days early out of 28 simply because she wanted us to. The common sense, minimally important request to bring in her bottles outraged her. Objectively, this was not a big deal - if she had the last week of her meds. We'll never know since she felt too outraged and betrayed to bring her meds in and so will fill her script after her vacation - the clear implication being, it will be our fault when she goes through withdrawal.
This patient's behavior was completely inappropriate, aggressive, and rude, and demonstrated grossly poor judgement. She yelled at the secretary and office manager for 30 minutes combined and expects to remain a patient of this clinic. She would probably threaten malpractice if we terminated her over this incident, which in fact we have every right to do.
Your doctor is not your mother, father, best friend, or priest. We don't have to care why you're being noncompliant, or inappropriate, or having a bd day - just that you are. The purpose of rules is to prevent us from having to figure out if you're telling the truth or not - that's for criminal courts and parents. We're neither. And we absolutely have the right to terminate your care if you act out. Always. The next time, you get angry because the doctor or staff won't bend the rules for you, remember this blog. And knock it off.
Dr. Tim
These interactions happen all the time in a typical pain clinic, but patients almost never see them. Everybody is special, everybody is trustworthy, everyone should get special treatment. Patients should be able to structure their treatments, refills, etc., any way they want. Everybody thinks we should break the rules just for them. This patient demanded that we refill the two strongest narcotics in the history of the world 7 days early out of 28 simply because she wanted us to. The common sense, minimally important request to bring in her bottles outraged her. Objectively, this was not a big deal - if she had the last week of her meds. We'll never know since she felt too outraged and betrayed to bring her meds in and so will fill her script after her vacation - the clear implication being, it will be our fault when she goes through withdrawal.
This patient's behavior was completely inappropriate, aggressive, and rude, and demonstrated grossly poor judgement. She yelled at the secretary and office manager for 30 minutes combined and expects to remain a patient of this clinic. She would probably threaten malpractice if we terminated her over this incident, which in fact we have every right to do.
Your doctor is not your mother, father, best friend, or priest. We don't have to care why you're being noncompliant, or inappropriate, or having a bd day - just that you are. The purpose of rules is to prevent us from having to figure out if you're telling the truth or not - that's for criminal courts and parents. We're neither. And we absolutely have the right to terminate your care if you act out. Always. The next time, you get angry because the doctor or staff won't bend the rules for you, remember this blog. And knock it off.
Dr. Tim
Monday, March 31, 2008
BACK PAIN AND PAIN MEDS
Every pain program I consult to, and there are dozens of them, is monitoring medications, especially narcotics, much more closely that ever before. You are expected to fill your meds on time, not early, and be responsible with them. Your doctor is neither the police, nor your parents. Having a good reason to be out of meds early is not the same as being on time. Whether you overconsumed, lost them, or they were stolen matters less than you think. Whether or not we believe your story matters less than you would think. Everybody gets one or two or even three free passes and then your doctor will probably confront you. No matter the reason, you are not a good candidate for strong pain meds if you cannot manage them. This morning a patient was outraged that she had to bring her meds with her to an appointment where she was filling her narcotics a week early so she could go on vacation. She was angry that we did not "trust her." The angrier she got, the more inappropriate. If she had the last week of her meds, why was it such a big deal to bring in her meds? Why does she think that the rules don't apply to her, that she is so special, she should be above everyone else? At best, she's being narcissistic, at worst she's using aggression to cover up being noncompliant with her narcotics. This happens all the time, the kind of interaction most patients never see but affects how pain doctors practice medicine. Be responsible with your meds, and if you run out, don't think your reason is important. It's not.
Dr. Tim
Dr. Tim
Wednesday, March 19, 2008
LIMBREL - A NEW ANTI - INFLAMMATORY
Limbrel is a relatively new prescription anti-inflammatory that is FDA approved for osteo-arthritis, but used off-label for a variety of inflammatory problems. Limbrel is not classified as a drug, but rather a medical food product. It inhibits the COX (cyclooxygenase) and LOX (lipoxygenase) enzyme systems. It is the first and only medical product that balances both COX-1 and COX-2 metabolism equally. It consists of flavocoxib, a blend of flavonoids from the two plants Scutellaria baicalensis and Acacia catechu, both well recognized for their aniti-inflammatory and anti-oxidant proerties. Anti-oxidants aborb free radicals in the joints that have been found to break down cartilage over time. Patients report effects within 4-10 days of taking the product. Side effects are minimal. Ask your doctor if he/she thinks Limrel might be effective for you.
Friday, February 29, 2008
BACK PAIN SURVEY OF TREATMENT SATISFACTION
A national, SpineUniverse survey of patient satisfaction with a range of back pain treatments yielded interesting results. Herbal remedies, over the counter pain medications, and acupuncture produced the greatest patient disatisfaction. Prescription pain medication, massage, exercise, and weight loss produced the greatest patient satisfaction. Less than half of the patients who underwent spine surgery were satisfied with the outcome of their surgery. If you are considering spine surgery, you may want to reread that last sentence. It is interesting to note that prescription pain medication and massage are treatments that are done to you. You have no real control over the outcome. Exercise and weight loss, both behavioral strategies are treatments that you do to and for you. You have complete control over them - but they are more work for you. You don't get to just passively lie there and be worked on. They are free, painless, and available to everybody. They also make every other treatment more effective. To read about the complete survey, go to:
http://www.spineuniverse.com/article/back-pain-3167.html
http://www.spineuniverse.com/article/back-pain-3167.html
Wednesday, February 6, 2008
BACK SPASMS AND PAIN CONTROL
I had another back spasm earlier this week. The first in several years. It happened while I was typing an article about back pain. I don't care what Freud would say. My back locked up and I could hardly move. I'd say 8-9/10 pain. This time I laid on the floor and did the neutral spine exercise (Tim's Trick). The spasm eased in a minute or two but I stayed where I was for a half hour. I was left with the familiar, hot stiff ache that lasts for a few days to a few weeks.
I remembered:
How hard it is not to walk like the tin man
How serious I can get when I hurt
How much I avoid any jerky movements
How difficult it is to stand perfectly straight
How painful it can be to drive
How much I have to vary my activities
How to roll out of bed on my stomache - and how weird it looks
How easy it would be to take time off work
I'm mostly back to baseline aches and pains - my normal. I feel truly blessed that my spasms are infrequent. I have patients who go through this a couple times a week. That's a hard life. Perspective.
Good light,
Dr. Tim
I remembered:
How hard it is not to walk like the tin man
How serious I can get when I hurt
How much I avoid any jerky movements
How difficult it is to stand perfectly straight
How painful it can be to drive
How much I have to vary my activities
How to roll out of bed on my stomache - and how weird it looks
How easy it would be to take time off work
I'm mostly back to baseline aches and pains - my normal. I feel truly blessed that my spasms are infrequent. I have patients who go through this a couple times a week. That's a hard life. Perspective.
Good light,
Dr. Tim
Monday, January 14, 2008
BACK PAIN, NO INSURANCE, LITTLE MONEY
Back pain patients across the U.S. obtain phone consultations with me to achieve pain relief and a common reason is because they lost their health insurance, they hurt, and they can't afford to go to the doctor. What's the most cost effective way to get back pain relief with severe financial limitations and no insurance?
1) Take a low dose, over the counter, anti-inflammatory, like Advil. Inflammation is a pain trigger for almost everyone. Instant pain relief is not the goal, decreasing inflammation is.
2) Take a multivitamin, drink 6-8 glasses of water per day, eat multiple small meals.
3) Practice good sleep hygiene. Take a sleep aid from time to time. Go to bed and get up at the same time each day. Avoid long naps during the day. See # 6.
4) Consider taking St. John's wort, available at most grocery stores, which will increase your Serotonin levels and can improve your mood and your pain tolerance.
5) Do gentle back stretching exercises from daily to multiple times per day.
6) Get in the water (pool) and begin getting some non weight bearing, nonimpact exercise. If this is not possible, try a stationary bike - something to get your blood moving.
7) Vary your body mechanics from walking to sitting to standing to lying down every 10-30 minutes.
8) For $6.00, you can download a copy of my pain book, ABC's of Pain Relief and Treatment: Advances, Breakthroughs, and Choices with hundreds of treatment and self management suggestions.
9) For $19.95, you can consult with me for 15 minutes after completing an intake form. I can give you specific suggestions based on your unique situation.
1) Take a low dose, over the counter, anti-inflammatory, like Advil. Inflammation is a pain trigger for almost everyone. Instant pain relief is not the goal, decreasing inflammation is.
2) Take a multivitamin, drink 6-8 glasses of water per day, eat multiple small meals.
3) Practice good sleep hygiene. Take a sleep aid from time to time. Go to bed and get up at the same time each day. Avoid long naps during the day. See # 6.
4) Consider taking St. John's wort, available at most grocery stores, which will increase your Serotonin levels and can improve your mood and your pain tolerance.
5) Do gentle back stretching exercises from daily to multiple times per day.
6) Get in the water (pool) and begin getting some non weight bearing, nonimpact exercise. If this is not possible, try a stationary bike - something to get your blood moving.
7) Vary your body mechanics from walking to sitting to standing to lying down every 10-30 minutes.
8) For $6.00, you can download a copy of my pain book, ABC's of Pain Relief and Treatment: Advances, Breakthroughs, and Choices with hundreds of treatment and self management suggestions.
9) For $19.95, you can consult with me for 15 minutes after completing an intake form. I can give you specific suggestions based on your unique situation.
10) Learn the back pain relief strategy of the neutral spine. Lie on the floor with your legs up on a chair facing you so your things and your calves form a 90 degree angle. this makes your low back straighten, similar to what happens with traction. try this several times per day for 5-15 minutes.
Back pain relief on the cheap!
Dr. TimWednesday, January 9, 2008
BACK PAIN, EXERCISE, AND COMMON MISTAKES
The biggest mistake made by people with back pain is to not exercise at all, even after a course of physical therapy. Immediately after the therapy ends, so does any attempt at exercise. This is often the result of the underlying approach to exercise in which people with persistent back pain try to strengthen their back with exercise, increase their pain dramatically, and then stop exercising altogether, having learned that exercise hurts. The years pass with episodic attempts at exercising the injured back, usually in physical therapy, with only increased pain to show for their efforts.
The second biggest mistake people in pain make is to focus all their exercise efforts on their painful back or legs and ignore the rest of their body, which gets as weak as their back over time. With persistent pain, focus on your noninjured body parts first and only months later your injured back. Get some aerobic exercise through a stationary bike or in the pool - not so much that your pain increases. Then focus on strengthening your noninjured, non-back body parts so they can compensate for your injured back - not so much that your pain increases. Only then should you exercise your with the main goal of maintaining range of motion through gentle stretching - not so much that your pain increases. This is the most effective strategy for rehabilitating a persistently painful back. You should be doing some type of exercise 1-2 times every day. Are you?
The second biggest mistake people in pain make is to focus all their exercise efforts on their painful back or legs and ignore the rest of their body, which gets as weak as their back over time. With persistent pain, focus on your noninjured body parts first and only months later your injured back. Get some aerobic exercise through a stationary bike or in the pool - not so much that your pain increases. Then focus on strengthening your noninjured, non-back body parts so they can compensate for your injured back - not so much that your pain increases. Only then should you exercise your with the main goal of maintaining range of motion through gentle stretching - not so much that your pain increases. This is the most effective strategy for rehabilitating a persistently painful back. You should be doing some type of exercise 1-2 times every day. Are you?
Monday, January 7, 2008
BACK PAIN MISUNDERSTANDING AND POOR TREATMENT
Recently, I was asked why I created this blog with almost daily posts. The two main reasons are at the core of back pain relief and treatment and may be worth reading.
First, I know that the longer you've had back pain the more likely it is that what you do to help yourself is more important than what the doctors do to help you. This is a terrifying, frustrating, wonderful reality that places the responsibility for pain relief squarely in your hands. I know that numerous treatments for back pain will make the pain worse, not better. I know that the treatments for persistent back pain must be different than those for short term or acute back pain. I know that thoughts, feelings, and behaviors can open or close pain gates and make back pain bettter or worse. I know that people in pain must be educated about medical treatments for pain and communicate more effectively with their doctors in partnership. And I know that even if you are receiving the best possible medical treatment, you probably have more back pain than is necessary for the amount of tissue damage present. You can absolutely hurt less.
Second, after providing webcam and telephone assessment, treatment, and coaching across the U.S. and other English speaking contries for several years, I have learned how bad much of the medical care is for back pain patients across the U.S. and the world. I have learned that most people in pain are not treated in multidisciplinary pain management clinics, are not being treated by pain physicians and pain psychologists, have not been educated thoroughly about their back pain, and deal with the various conflicting agendas of their treating doctors.
Thus was born the need for this blog. My career has been dedicated for a quarter century to relieving medical pain and suffering. This blog is a logical, if unpaid, extension of that dedication for a worldwide audience. If you haven't been treated for several years in a multidisciplinary pain clinic including biofeedback and pain psychology, you can conclude that you have more pain than is necessary or inevitable. If you don't have a thorough understanding of "multifactoral back pain" with hundreds of strategies for self management, you have more pain than you should. If you are not in an agressive partnership with your pain doctor, you hurt more than you have to. If you don't understand that pain relief is largely your choice once you have the knowledge, then you can hurt less.
Some pain is inevitable; how much pain, and how much suffering, is something we can discover together. I promise to work hard for you. You have to work hard for you too.
Dr. Tim
First, I know that the longer you've had back pain the more likely it is that what you do to help yourself is more important than what the doctors do to help you. This is a terrifying, frustrating, wonderful reality that places the responsibility for pain relief squarely in your hands. I know that numerous treatments for back pain will make the pain worse, not better. I know that the treatments for persistent back pain must be different than those for short term or acute back pain. I know that thoughts, feelings, and behaviors can open or close pain gates and make back pain bettter or worse. I know that people in pain must be educated about medical treatments for pain and communicate more effectively with their doctors in partnership. And I know that even if you are receiving the best possible medical treatment, you probably have more back pain than is necessary for the amount of tissue damage present. You can absolutely hurt less.
Second, after providing webcam and telephone assessment, treatment, and coaching across the U.S. and other English speaking contries for several years, I have learned how bad much of the medical care is for back pain patients across the U.S. and the world. I have learned that most people in pain are not treated in multidisciplinary pain management clinics, are not being treated by pain physicians and pain psychologists, have not been educated thoroughly about their back pain, and deal with the various conflicting agendas of their treating doctors.
Thus was born the need for this blog. My career has been dedicated for a quarter century to relieving medical pain and suffering. This blog is a logical, if unpaid, extension of that dedication for a worldwide audience. If you haven't been treated for several years in a multidisciplinary pain clinic including biofeedback and pain psychology, you can conclude that you have more pain than is necessary or inevitable. If you don't have a thorough understanding of "multifactoral back pain" with hundreds of strategies for self management, you have more pain than you should. If you are not in an agressive partnership with your pain doctor, you hurt more than you have to. If you don't understand that pain relief is largely your choice once you have the knowledge, then you can hurt less.
Some pain is inevitable; how much pain, and how much suffering, is something we can discover together. I promise to work hard for you. You have to work hard for you too.
Dr. Tim
Thursday, January 3, 2008
BACK PAIN TREATMENT IS A NEGOTIATION BETWEEN PARTNERS
Back pain treatment is not and should not be a one sided dictation from the top of the mount. You and your doctor are partners in pain working together to achieve the greatest pain relief and increased function. Every treatment decision your doctor makes is based upon his medical expertise, his understanding of your back pain, and value judgements he makes about you related to costs, benefits, and risks of treatment. You must learn about the eleven step hierarchy of back pain treatment. You must learn from and educate your doctor about your back pain treatment, diagnoses, causes, and triggers. You must educate your physician at every appointment about the costs and benefits of the treatments you are receiving and the risks you are willing to take. You should make suggestions for treatment as you vigorously explore "cutting edge" options for treatment and pain management. Don't rely on your doctor to come up with new treatments, that's what the internet and other people in pain are for. Communicate effectively. Ask for what you want. Decline treatments you don't want. Take notes, write down questions and answers. Research topics you have discussed with your pain doctor. If your doctor has a problem with your partnership, or you have a problem with any other aspect of your doctor's treatment, you have the right to find a new doctor. Always. And your doctor has the right to terminate you as a patient. Always. Ultimately, both parties can walk away from a negotiation.
Tuesday, January 1, 2008
BACK PAIN AND NEW YEAR'S COMMITMENTS
Welcome to 2008! You can have less back pain at the end of this year than you do right now. What can you do to hurt less? What can you do to get more stuff done, to enjoy life more? What will you do?
I hate New Year’s resolutions, but I love using natural events in my life as metaphorical springboards for positive change. It seems a waste of a chance for growth not to use the turning of a new year as an opportunity to move forward in a positive way. Let's not make resolutions, let's make commitments, let's make a transformation in our personal pain paradigm. Let's take action. At this time, you can check yourself for the new year.
Are you being honest with yourself and those around you about your back pain and limitations? Are you being independent in seeing that your needs are met and that your life is progressing the way you want it to even with pain, or have you succumbed to physical and emotional dependence upon someone else? Are you exercising courage in challenging your back pain and all the idiosyncratic fears you have? Have you developed a Mastery Map for conquering your fears and pushing the envelope outward? Are you being creative in your approach to challenging pain, limitations, and life hassles, or have you surrendered to the familiar no matter how ineffective? Have you developed a plan for decreasing pain, increasing activity, and improving your quality of life? Do you want to develop a plan or are you settled into more of the same? Will you initiate the plan (s) you make for pain and suffering? Or will you stay on the couch? Will you persevere in the service of a carefully crafted plan, or will you succumb to “I do everything my doctors tell me to”?
There are no magic formulas for feeling better. Just a lot of risk and hard work. But it is possible and almost inevitable that you will feel better if you really try. If you do the same things this year you did last year, the best case is that you will feel the same at the end of the year. Take action. You can assess the efffectiveness of your pain coping. Take action. You can learn to decrease your pain. Take action. You can feel better. Take action. What are the three most important changes you know you should make to feel better? Take action.
We will be here for you all year. Go Blue.
Dr. Tim
I hate New Year’s resolutions, but I love using natural events in my life as metaphorical springboards for positive change. It seems a waste of a chance for growth not to use the turning of a new year as an opportunity to move forward in a positive way. Let's not make resolutions, let's make commitments, let's make a transformation in our personal pain paradigm. Let's take action. At this time, you can check yourself for the new year.
Are you being honest with yourself and those around you about your back pain and limitations? Are you being independent in seeing that your needs are met and that your life is progressing the way you want it to even with pain, or have you succumbed to physical and emotional dependence upon someone else? Are you exercising courage in challenging your back pain and all the idiosyncratic fears you have? Have you developed a Mastery Map for conquering your fears and pushing the envelope outward? Are you being creative in your approach to challenging pain, limitations, and life hassles, or have you surrendered to the familiar no matter how ineffective? Have you developed a plan for decreasing pain, increasing activity, and improving your quality of life? Do you want to develop a plan or are you settled into more of the same? Will you initiate the plan (s) you make for pain and suffering? Or will you stay on the couch? Will you persevere in the service of a carefully crafted plan, or will you succumb to “I do everything my doctors tell me to”?
There are no magic formulas for feeling better. Just a lot of risk and hard work. But it is possible and almost inevitable that you will feel better if you really try. If you do the same things this year you did last year, the best case is that you will feel the same at the end of the year. Take action. You can assess the efffectiveness of your pain coping. Take action. You can learn to decrease your pain. Take action. You can feel better. Take action. What are the three most important changes you know you should make to feel better? Take action.
We will be here for you all year. Go Blue.
Dr. Tim
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