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There is a young woman 3000 miles away who will soon be bitterly disappointed. This therapy will fail. It will be her choice to fail because she does not want to taper off Dilaudid and high dose prednisone. She has discarded physical therapy long ago, but needs it. She narcotizes her brain with Dilaudid and high dose prednisone and has given up on life the last 6 years.

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Let me be very clear. It will fail unless you get off those drugs. I will not start new ones because I guarantee you will be bitterly disappointed. All these weeks of work and what progress coming off? Send me reports regularly. What kind of doctor sits back and watches this?

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It’s a sin to take part in guaranteeing failure. I cannot allow my conscience to do that. As time goes by and you stay on failed drugs, there is a shrinking chance this treatment could help. I said last year, get off the narcotics. They do not work for CRPS. It is a delusion to think they work: you have been housebound 6 years. Love yourself. Give science a chance. Science shows how they create pain. It also shows how to modulate inflammation they have created in the brain.

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Just because the medical system doesn’t evolve with science, does not mean you continue known harm.

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It’s magical thinking to believe you can do the opposite of what science has been teaching us.

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Calling all angels to help her. Tell her your experience. Say a prayer. Keep her in your heart. And if you can, watch the movie Pay It Forward streaming now on Netflix. You will love it. It will open your heart. Everything about it is great, the acting, music, dialogue, story, really great. Every time you think it will be dopey, it gets better.

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So be honest. It ain’t easy living with nerve pain. It is possible no treatment will work. Some things may partially work. But there are things worth doing right. This is one of them.

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I will not participate in a sham. Do not nurse stale delusions. There are reasons to choose opioids. CRPS is not one of them. Be fearless. Meditate on the heart of a lion.

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To succeed requires great inward resolution. This is not the time to leave town. Either begin the work as directed, begin the P.T. immediately or recognize you are undermining that too. You know October will postpone everything even more.

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No one can help you. You must help you. This is what we taught every patient at UCLA Anesthesiology Comprehensive Pain Center in the 1980’s.  It is still true.

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Our entire medical system has been poisoned and deluded by the multi-billion dollar opioid factories supported by FDA, Congress and NIH. They prove it by decades of action. They have done nothing for your reality.

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Addendum September 2, 2016

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I am being attacked for posting the above. This article is not about dialogue. Go to some other site. This is educational.

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There is no dialogue because you can pick any doctor in the country who will give you opioids. But when you tire of chronic severe pain despite all those opioids, and your’re ready to try something else, some case reports of remarkable people have been posted on this site. Remarkable. I’ve never seen anything like it. But it’s not uncommon. What are the chances of that when they’ve failed everything? And yes, I do prescribe opioids to a few patients. There are indications. Opioids kill. Bodies age. What if they need acute painful surgeries? When will we get something better. I think ketamine is. It is shamefully underused in favor of drugs that trigger pro-inflammatory cytokines in the brain and that causes more pain.

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We will never move pain control forward until we begin to work with the science that’s immensely changed the way I can help patients become pain free or at least markedly better. Not every patient — I see very complex, extreme pain conditions. I will keep this site on the level of science, education and real breakthroughs. These complex medications I prescribe have been a huge breakthrough. My patients have failed everything before they see me. If they are still on opioids that never helped, I ask them to taper weeks or months before they see me. You cannot continue to make war on the system when you are aiming to make peace. To restore balance. To modulate the inflammation.

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My First Ketamine Patient 

Ketamine in Outpatient Use

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I had the wonderful memory tonight of my first patient. I actually handed ketamine to someone to use at home for pain. This was about 2000, 2001. She was a very enlightened clear soul who had 7 or 8 spine surgeries with 30 years of sciatic and back pain rated 10 on scale of 10. Failed all known procedures in the greater L.A. area. Then she got a painful neuropathy evolving in less than 2 weeks, burning pain below elbows and knees.

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I had been reading ketamine publications for 3 years and had a whole big stack of them. The most exciting thing I’d ever seen for almost every known pain, central pain, all pain. I attached that article on this site May 26, 2009. A review by Cousins, one of the world’s most highly rated pain specialists.

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I couldn’t bear not being able to help. I interviewed many psychiatrists who began the experiments with ketamine at NIMH in 1991, called as many researchers as I could, and a neurologist who had done work in this area ketamine/brain. He was just appointed head of an institute. He precisely spelled out the arguments against those who fear do not use due to brain issue in primates. I am very cautious with patients. No one was doing this. In fact I did get harshly attacked for giving someone ketamine.

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I instructed a very slow start. Two weeks later, she called me and said she thought she had died. I will never forget I was parked in the doctor’s parking lot, exact time, sunny morning, one of those perfect clear days of early summer when it’s not too hot, my breathing stopped. “But I hadn’t been pain free in 30 years and I didn’t remember what it felt like.”

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It is rare to get 100% with ketamine.

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The patients I see are complex. They have failed everything. The things they have been through and renowned specialists they have seen, even ketamine coma does not last. It is a short lasting drug. How much time do you want to spend on procedures vs convenience of using a medication when your body needs it. Even that is idealized.

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Chronic pain, especially nerve pain, is most difficult to treat. It is never all about medicines. Never. You must learn tools to give the power of conviction to your mind that you can be strong. You cannot afford to fall apart because that makes pain worse. Tools you use or else pain. Once we know, we can take action. Same with muscles that have been inactive for years. Tools we all learn – the entire family together can be taught what it takes for physical therapy. We cannot help all people. They need family help to bathe and dress.

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For CRPS especially, we want to prevent spread, mirroring, appearing in the other limb and areas. I like to think of it like a football game. You’ve failed everything known, that makes it potentially harder. But you’ve gotta win this game. You have one guy running down the field with a football, how many guys are you going to send after him? What if 3 or 4 guys only partially help? Add that up and you may have extra 30 or 40% relief. Hit is hard, selectively chosen glial modulators and others with mechanisms on these pathways, get it to zero – or give it the best chance to get it near zero pain. That’s the first goal.

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Nothing is perfect. Nothing in medicine is perfect. It is still an art, not a science. But it is a gift to be able to use these tools that I’ve put together the last 15 years. And thrilling to see the science come out explaining even more the power of the innate immune system, the glia. Had the practice of medicine evolved, we’d have developed the timing of the circadian clock in these cells to prevent postoperative chronic pain, or minimize sending the inflammation into overdrive. Opioids damage the balance of inflammation in a system already exploding with pain. It would be a miracle if “they” ever stop reaching for opioids first. Do they even understand they are doing the opposite of  relieving pain, or care that better choices exist? Perhaps, but it would take a multi-zillion dollar study. Pain is only taught in 3% of medical schools. It loses money for the schools.

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