Morning everyone! 

Welcome to another edition of the Doctor’s Note, where we talk about what’s on our minds when it comes to your health. 

Last week we talked about back pain, and this week we’re going to talk about pain in general. Chronic pain.  

As a Family Practitioner and now Integrative Medicine Specialist for the last 35 years, what I realize is that people come to the doctor for one of two reasons when they need help (besides the routine medical visits). 

They’re either in pain or they’re tired. 

So, let’s talk about the pain part. 20% of Americans will suffer from chronic pain during the course of their lives. 

Risk factors include: 

  • Being a woman
  • Being older
  • Living in poverty
  • Being unemployed when you previously had employment

Pain is the number one cause of disability, and the total cost of disability is more than diabetes, heart disease, and cancer combined. 

The number one cause of chronic pain is back pain. Headaches are the second most common cause of chronic pain. 

Drugs help only half of people who suffer from chronic pain, which is really discouraging. 

As you may know, pain medications have given pain a really bad name. This is because of the addictive nature of opiates. Our country, and especially our region, has a terrible problem with opiate abuse. 

People who don’t actually need pain medications have ruined it for the people who truly do need them. It’s really difficult to get your Family Practitioner to give you more than 1-2 days of an opiate. In fact, they legally can’t unless they are a Board Certified Pain Medication Physician. 

The thing about opiates is you can get addicted to them in two weeks. Opiates have ruined many careers, family lives, and everything else. I’ve seen doctors become addicted and lose their licenses and careers. Opiates work for 2 weeks, and then they don’t work for pain. They become addictive and give a euphoria. 

There are other ways to treat chronic pain. 

In fact, we have to find other ways! And thankfully we do have other ways. 


Treating Chronic Pain 


Chronic pain is pain that lasts weeks, months, and sometimes years. It happens a lot as you get older. Arthritis is a big cause of chronic pain, especially as we get older. 

We need to reserve opiates for acute pain, not chronic pain. Note that there are some exceptions like cancer pain.

Here are some other ways to treat chronic pain. 

NSAIDs – My favorite NSAIDs are the newer generations like Mobic and Celebrex. You still don’t want to take them too often. You have to be careful with whatever medication you take. One tip that I’ve seen work really well is taking an NSAID with 1 Tylenol. Taking the Tylenol with the NSAID makes the NSAID work a little better. 

Joint Injections – Joint injections work really well for pain. I’ve used Cortisone for years. The thing about Cortisone injections is you don’t want to do too many of them. It can bump up your sugars and cause hyperactivity. It also can produce wear and tear on cartilage and wear your tendons out. It’s simply not great for you long term. 

For chronic back pain, epidural injections can work. Also, fecet joint injections and possibly nerve ablation. And then back surgery as a last resort. 

Remember a lot of back pain is a result of a weak core. So, core exercises work really well for bad backs. 

Toradol – You can use orally (short term) or intramuscularly. It’s good for any acute pain, and it’s non-narcotic. Toradol is an NSAID and works well for bad pain. You have to be careful if you have kidney problems. One thing that turned me onto Toradol was injecting it into the joints and muscles. It breaks the pain cycle up. You can inject it into the knee, shoulder, back, elbow, and trigger points, etc. It’s safer than injecting cortisone, and may work better. 

There are headache medicines for migraines that work effectively. If you suffer from migraines, be sure to ask your doctor about new medications for migraines. There’s also a once a month shot for prevention of migraines. 

Of course there’s Physical Therapy, Chiropractic, and Acupuncture that work for pain. Obviously, surgery is a last resort, but is often curative for pain. 

Think about your nutrition. As we’ve talked a lot about in these Notes, there are inflammatory foods that can cause disease and inflammation. So pay attention to what you’re eating, as it can cause inflammation and thus pain. 

Bad posture also leads to chronic pain. Sitting too much and not moving. Sleeping on a bad bed and in poor sleep positions. 

I just ordered an infrared sauna, which is unbelievable for pain. It’s also a detoxifier. Hot tubs and jacuzzis are great. Sometimes ice works. You can alternate ice and heat. 

Metformin – I’m always touting Metformin. It’s good for weight loss, anti aging, and prolonging life. I go to a lot of anti aging conferences, and almost all of the speakers talk about how they themselves take Metformin to bring insulin down. Insulin is such an important hormone for longevity. It may be the most important hormone there is, which we can get more into in another Note. But Metformin also reduces pain and inflammation.

Another medication we use for chronic pain is Gabapentin. It works best for neuropathies, which is nerve pain. Sometimes we use Cymbalta, which is an antidepressant. It actually works better for pain than for depression. 

Obesity is bad for joints and backs. Losing weight can really improve chronic pain. 

Eat better. Move more. Sleep well and keep your stress levels down. Chronic pain almost always leads to depression. That’s why we use antidepressants for pain. 

The key here is don’t accept it. There’s a lot of neat things you can do about it without getting on serious pain medications. And remember that everybody’s pain tolerance is different. Pain is a signal that something is wrong. Don’t ignore chronic pain. Get it worked up.