I specialize in complex intractable pain of all types particularly RSD, Complex Regional Pain Syndrome (CRPS). I also see persons with treatment resistant Major Depressive Disorder or those with Bipolar Depression, and children with Juvenile Bipolar Disorder Fear of Harm phenotype. Some people may respond even though they have failed all commonly used medication. There is a large overlap in medications I use for pain that also may work for mood disorders. My interest is in neuro-inflammation and the use of medications that research shows can intervene in the brain on inflammation at the level of the innate immune system. Most of them are generic medications that we know of (so far), and must generally be prepared by a compounding pharmacy. Inflammation has been found in chronic pain and in depression, in mice.
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Treatment resistant and intractable means patients have failed almost all known procedures or medications before they see me. The medications I prescribe are based on recent research much of which has been published since the turn of this century. These are often old medications FDA approved decades ago for other purposes, now being applied “off-label” for pain or depression or both. New uses based on new mechanisms: glia, cytokines, neuroinflammation, microRNA’s – concepts that most physicians still have not heard of because they are new, because no new drugs have yet to appear from this research. This new research explains why some old medications work and they explain some mechanisms by which opioids create pain. I have posted a few case reports which you can find using the search function within this site. Against all odds, I frequently see many profound responses, but no one sees 100% response to any medication, no matter how new.
I am board certified in Neurology, with a primary interest in intractable pain, treatment resistant depression, glia and neuro-inflammation, neuroimmunopharmacology. Please read my posts on May 26, 2009 on low dose naltrexone, dextromethorphan, ketamine and January 2011 on neuroinflammation and the innate immune system in brain and spinal cord to understand some of the new concepts in medicine on which I base my approach. There is much overlap between pain systems and major depression systems, in medications and mechanisms in the brain. Quite often what works for pain will work for depression.
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MD Anderson Cancer Center – Cancer Pain & Symptom Management
UCLA Anesthesiology Interdisciplinary Pain Clinic
UCLA Epilepsy Clinic
Cancer Pain & Symptom Management – MD Anderson Cancer Center, Houston TX
Multiple Sclerosis Research – West Los Angeles Veterans Administration Medical Center, West Los Angeles, CA
EEG – Harbor UCLA Medical Center, Torrance CA
Stanford Sleep Center
Hahnemann University Medical School, now Drexel University College of Medicine
University of California Berkeley
I am on staff at Scripps Memorial Hospital La Jolla
See banner at top for address and telephone.
● To inform, educate and treat……..
My mission is simple – to control pain, improve well being and restore function.
Achieving that goal begins with personalized integrated programs in diagnosis, treatment, education and prevention.
I support the Reflex Sympathetic Dystrophy Syndrome Association, RSDS Association, a nonprofit organization that has funded pain research since 1984. Please join me here in supporting their efforts in education, research, and treatment of neuropathic pain. Their website has a fine library of research publications on pain. I have no personal affiliation with them, but they are in the forefront in their support of best science.
Please contact me if you are interested in having me speak with your group about pain management.
● You are not alone in managing pain
I work with a full scope of advanced specialists to provide effective care. I am on staff at Scripps Memorial Hospital in La Jolla where I have an office on the Scripps campus.
New diagnoses may be made during a detailed evaluation, which often leads to relief and improved quality of life.
● You have the right to have your pain taken seriously.
● I support the American Pain Society and the Principle of Balance which is:
To ensure that pain medication is available for persons in need and to prevent abuse of prescription pain medication.
● Understanding & Partnership
I provide pain sufferers and caregivers with information and guidance that will better equip you to work in partnership with me and with your team of physicians to effectively manage your pain and prevent side effects. That may involve treating other conditions such as sleep disorders, fatigue, depression or anxiety and neurological conditions.
I take addictions and drug diversion seriously. You are asked to prevent diversion and lock your medication. The Drug Enforcement Agency (DEA) recommends periodic urine screens.
Most pain medicine can be given SIMPLY by the mouth or applied to the skin, including medication for over 90% of cancer pain. Medication is more effective as part of a comprehensive individualized treatment strategy:
physical therapy, cognitive behavioral therapy with a psychologist,
acupuncture, yoga, Qigong, music, lifestyle changes – pacing activities,
stress management, relaxation, meditation.
Learn to use the power of the mind to reshape your pain. What you know, do and feel can influence your perception of pain.
To understand how the mind alters pain, please read this publication:
Some may benefit from injections or procedures to block pain pathways, others may require surgery.
● I Evaluate the Whole Person
I evaluate the whole person, beginning with the disabling results of long-term pain, as well as all factors that perpetuate pain. Pain assessment, diagnosis and selection of the most effective therapeutic modalities are important for success in pain management. Pain can have severe consequences for your life and relationships. Can you sleep, work, concentrate, exercise and participate in social activities? How does it affect your mood? Please review the links to books and audio-visual materials on this site.
Chronic pain is often much more difficult to treat than cancer pain. It is tragic that < 1% of the NIH budget goes for pain research, though 10 to 20% of the population in the US suffers from chronic pain, an estimated 60 million Americans, and the conditions are more prevalent among the elderly. Persons of all ages that I see tend to be more debilitated, often with anywhere from 3 to 11 different identifiable pain syndromes.
Many, including physicians, mistake pain as a symptom, failing to understand the reorganization that has occurred in the central nervous system due to neuroplasticity; and they overlook the associated comorbidity causing insomnia, weight gain due to medication or inactivity, depression, anxiety, spiritual and financial burdens. The lives of families and friends are diminished along with the person who has pain.
● You have a right to pain relief in all these areas.
By appointment only, closed Tuesdays. Please give 48 hour notice before cancellation, or a charge will be incurred.
Affiliated Hospitals: Scripps Memorial Hospital La Jolla
Languages Spoken: English
To Find My Home Page, click here: Welcome to my Weblog on Pain Management!