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 for decades. 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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You must live locally in San Diego or Orange County. I am continuing with my previous patients from other countries. I prescribe many medications, occasionally opioids but not often. To those who call only about ketamine, I never prescribe ketamine alone. To understand why, read what I’ve written here since 2009. It’s about inflammation, treatment using compounded medications that are usually not covered by insurance so figure $200 to $250 each month or lots more. Many of the medications are compounded, some are at any pharmacy. COSTS: Everyone is different, doses are far higher, more frequent for those with CRPS pain. For Depression, costs far lower. For those who have intractable pain or depression, the inflammation may possibly be controlled, into remission, not cured. The entire treatment paradigm is based mostly on one thing. Reducing inflammation. It has to be different because my patients have failed all the usual, and bear in mind opioids cause inflammation, doing the opposite of what should be done. The science is highly supported worldwide. The opposite paradigms my patients have failed.
Now read the two links in blue on this page (3 different posts, two dates) to understand a little of what and why about these medications. Patients who have already scheduled with me will then need to print out all 7 forms at top FORMS. Use the form #2, Release of Medical Records form to fax to all your doctors so I will have records the day you see me. Do not request records until after you have scheduled.
If you live outside the area, I would be happy to teach your MD if he/she wishes to call me to schedule 3 hours time for a fee. It is not my job to convince any MD to change a paradigm. I will not be able to return your call if you live outside the area. I am happy to speak to any treating MD.
**Please see the most recent posts next to my photo at top left column, and the search function above that photo.**
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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.
This is an educational site. Comments are welcome but it is not for email. I am not able to respond to those who post comments for appointments. please **call** using the telephone number at top of this website.
To those who ask advice —it is not legal for me to give medical advice without a consultation. If you wish advice, please call the office to schedule an appointment.
This is an educational site read by people in more than 117 countries in just the 12 months leading to August 2014. It takes many hours a month to research, write and sustain.
If you find any joy and value in it, please consider adding a comment to tell others how this information has helped you. Your experience with a supplement or medication may help by teaching others.
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!