A Day Without Pain

The road to wellness.

5 Surprising Lessons I’ve Learned about Chronic Pain

Throughout my career as a physician, I had always believed that pain was based in anatomical structural abnormalities or disease processes that damage the nervous system—a broken ankle, a surgical incision, back pain from a herniated disc, diabetes, or neurological disease. I thought it was all treatable with the right medication, procedural intervention, or operation. Read More

As a responsible person with

As a responsible person with a physically-based chronic pain condition, I read columns like this and can't relate. There are many like me. We're responsible with medication and may not even take a narcotic at all. We injured ourselves playing sports, we got in car accidents, we developed things like arthritis and gout. Cartilage breaks down, tendons tear, bones break. There isn't a strong emotional and psychological component.

If you want to help true chronic pain patients, don't lump us in with people who may or may not have ever had pain to begin with on their way to becoming opioid abusers.

There are well-established non-narcotic medications commonly used for chronic pain. Can you list them?

chronic pain

Thank you!
I am frightened - and angry - that this "doctor" lumps all people with chronic pain with those who have drug dependency!
It is *not* a fact.
Go back to school, doctor! Learn!
First, learn the Hippocratic Oath - "Do no harm."
Your attitude - your belief - your writings - do harm of us with chronic pain. You spread the fallacy that "it's all in our head, even though it's *real to us.*"
NO, doctor -- it's real, PERIOD!
And you are just plain wrong.

Chronic Pain

Thank you!
I am frightened - and angry - that this "doctor" lumps all people with chronic pain with those who have drug dependency!
It is *not* a fact.
Go back to school, doctor! Learn!
First, learn the Hippocratic Oath - "Do no harm."
Your attitude - your belief - your writings - do harm of us with chronic pain. You spread the fallacy that "it's all in our head, even though it's *real to us.*"
NO, doctor -- it's real, PERIOD!
And you are just plain wrong.

ASI predicts pain sensitivity

Sensitivity to pain and anxiety are highly correlated. It is not the anxiety that predicts pain, but the sensitivity to it. The sensitivity is associated with beliefs about the consequences of anxiety and pain.


the author of this piece said,

".... In my experience, chronic pain is about 20 percent sensory, and the rest, the other 80 percent, is emotional."

well...I can not speak for people with other conditions but I have had four episodes of gout in the last 4 years.

I have also had an herniated disk since 2010.

The excruciating pain of gout can only be at least 99% sensory, you have to experience it to understand.

While I was rolling on the floor in pain and crying like a little boy - me a muscular 52 year old man who no one would describe as effiminate or a whimp - you could have told me i had just won 50 million at the lottery or better yet , a genie coming out of a bottle could have granted me my wish; to find love with the most beautiful and kindest woman on the planet and the pain would have maybe been reduced by one percent at best.

I suppose the fact gout comes back about once a year ( in my case ) qualifies as chronic?

As I said I can not speak for people with other conditions but I think the author has got it backwards;

pain is 80% sensory and 20% emotional.

but then again, to be fair, if I'm not mistaken about 30 percent of the general population "falls" for the placebo effect so maybe for them pain is really 80% emotional?

But I will say it again, The impossible to describe intense pain of Gout is really not affected by any human emotion, even if goddesses from a magical world came to me and offered me eternal sex and made me king of their world my gout would still hurt like hell.

ok ok this last one may have been overkill

Emotional pain is real

Great article. I especially like the part about the goal being functionality instead of remission. It certainly applies to my work with bipolar disorder.

Highlight flareups

Author should have distinctly mentioned that this article probably does not apply to flareups. The physical pain, especially for gout, is really unbearable.

Great article, though. I have chronic back pain and I have realized over the past few months that functionality is very important and it would be best to adjust to some marginal level of pain that will always be there.

I also like the note about pain killers and the short durations that they have to be limited to.

difficult topic well discussed

I dont believe that the author is lumping people into a group........he is simply saying that pain, in his experience, has many factors that contribute to the over all pain experience and that emotions play a much more significant role. Chronic pain is defined as pain that persists for 6 months or longer.......... If you take an honest look at how your pain effects your life, can you say that your condition has no emotional impact? That emotional impact is the true suffering nature of chronic pain. Factor in anger, anxiety, depression with responsible medication use and you ultimately have the recipe for increased pain sensitivity. Some people can easily make the connection and others have a more difficult time. The below is from an article I read recently. Goes to show how powerful the mind can truly be. Blood work was done to prove these findings. New ways of thinking can be difficult about an old problem are not always well received.

"A new study published by the Public Library of Science reveals that meditation can actually have measurable effects on stress. The study found that in comparison to a control group of people who had never meditated, a group of regular meditators actually suppressed twice the number of genes that induce stress responses such as high blood pressure and inflammation in the body.
Long term effects of the expression of stress-related genes can have very harmful effects on health, including high blood pressure or chronic pain. Those who meditate regularly are thus at a greatly decreased risk for developing these problems.
The study also found that once the control group began a regimen for meditating, which involved about 10 minutes a day of calming mental activities, they too began suppressing stress-related genes. Studies like these demonstrate the profound effect the mind can have on the body, a concept often overlooked by scientists."

In Response to "difficult topic well discussed"

I can appreciate the response to this post titled, "difficult topic well discussed".

I would think the most common response is to challenge the idea that stress has anything to do with chronic pain. Well, here is a video on WebMD which specifically speaks to the effect stress has on chronic pain.


A difficult topic well discussed

First, thanks for your responses. I appreciate your interest in this fascinating topic. I will be addressing some of the issues raised in future blogs posts, so bear with me. Chronic pain is a disease process affecting the nervous system, regardless of where the pain is generated (e.g., back, neck, joints). There is evidence on MRIs that over time the brain changes. It is impossible to conceive that when you are in pain, there is no effect from emotions and thoughts, which are generated in areas of the brain close to the pain centers. The point of the blog was to clarify that pain generated from emotional and cognitive responses to the sensory experience IS NO LESS REAL than bone on nerve pressure. The fact that emotions are driving the pain experience doesn’t suggest in any way that you are “wimpy” or less of a man/person for having these emotions. They are simply part of our human neurobiology.

As for the pain associated with gout, I would consider the periodic flares to be acute manifestations of a chronic condition—acting more like acute than chronic pain.

In my experience with opioids, the issue is not about “responsible” use or the “legitimacy” of the pain, and certainly not about good or bad. It is simply a suggestion that if the opioids you are taking make you better functionally, then their use is appropriate. There is no evidence that this occurs with people on opioids long-term, and there is more information about negative effects, overdoses, and deaths.

Non-narcotic medications include anti-inflammatories, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, anti-seizure medications, and topicals. More to come…


Dr. Mel

I fully understand the

I fully understand the concepts of meditation to help relieve *some* aspects of the physical pain sensations I have on a daily basis. It helps -- to an extent. I have also gone to counseling at the pain clinic I attend -- it is required. The social worker was impressed with me and my attitude towards my willingness to address my pain with different physical and mental modalities, and to accept the possibility that I will always have some pain. Furthermore, she was impressed that I was not only willing, but, actually worked on a plan to develop another goal for work to support myself, should I not be able to teach anymore due to my physical limitations. (That plan didn't pan out for the same reason -- physical inability due to pain.) All of that being said, I still rely on multiple pain relievers to modify, but not extinguish, my pain. There are days I can barely lift my cup of coffee!

I have multiple issues. Neuropathy in my feet, legs, hands and fore arms, of unknown causes; a previous back surgery, (that was successful), but more back issues including sciatica, arthritis in my spine, hands, feet, knees and shoulders, and and injury that multiple physical therapies over 10 years have failed to help, deep within the muscles between my shoulder blades. I also have water on the knees, and torn menisci on both knees along with severe arthritis in both.Furthermore, I have tendonitis.

My pain doctor burns the nerves in my neck to help prevent the pain signals from going to my brain. However, he cannot reach the top part of the spine; it is too close to the brain. He injects my shoulders and between my shoulder blades to relieve the pain there, too. I may be due for knee replacement, though one doctor says no, stating I am too young at 57. My pain doctor wants me to get a second opinion from another knee specialist he knows.

I am on lidocaine patches and tramadol for the pain, topamax for the headaches I get as a result of the back pain, and baclofen for the neuropathy. I also take 2 alieve extra strength. I take these medications *every day - multiple times a day.*

And I still get no relieve from pain.

My doctor once gave me opium patches. I was too afraid to take them, (my son is a heroin addict). I gave them back to him, unopened. I was on another, (stronger), patch, but, it gave me a reaction, so I had to stop using it. I have been on Amitryptolin - it caused a HUGH spike in my blood sugar and pressure in my eyes. I had to get off of it. I've been on SNRIs before, (for smoke cessation), and will NEVER take them again! They made me absolutely hyper/CRAZY! In my opinion, they are DANGEROUS, and doctors do NOT give enough thought about the warnings before giving them out. (Try taking it yourself before handing them out like candy, doc!)And the anti-seizure meds make you a zoombie -- I've been on them, too.

I accept that I will always have some pain. What I do not want to accept is that the pain will always be so severe. I have lost over 65 of 180 days of the school year, (I'm a teacher), for the last 3 years as a result of pain. I have been advised by my union to go on disability as a result.

I am only 57 years old! I should be at the top of my career! I have much to offer students and new teachers coming into the profession! I'm not ready for disability....So, for me, what is left?

I am seriously considering what I once feared most. I have no other choice if I don't want to be put on early disability. If that happens, I will be dependent upon the government -- and put into the pool of poverty as a result. At least there is a *chance* for me to continue to give to society with the use of the opium patch.

The alternative is to be a burden on society; one who is openly scorned and mocked by the public and by our "public servants."
That scorn, along with the pain I will be forced to live with as a result of public health care, is NO way to live! I, personally, would rather die. And, no, I am *not* "depressed." I am fighting to LIVE my LIFE!

My pain is real. It is *not* in my head. And I have done everything I can to deal with it. I will not accept the idea that I am to be lumped in with drug addicts, nor that my pain is "real to me." It's REAL!

Response to Debbie

Debbie, if I may, I would first like to say that I am very sorry for what you are experiencing. It sounds like a lot of suffering that so many people do not have to experience and can not relate to. Your story makes me appreciate the gift I have, but it also saddens me to hear that you are experiencing a condition that seems to be torturous at times. I admire your optimism, however. I will remember this post.

I feel I may be able to clear some things up here. Semantics often get in the way of what could be a more productive conversation, and less of a debate and I believe, that is the reason for the disconnect between what Mel's points are and the way some respondents are interpreting them.

When many people say something is "in your head", they are implying it is imaginary, what is on someone's mind is not real and conjured up. That is not what Mel is implying here at all. What he is saying, is that indeed, your pain is very very real. And the receptors for that pain exist in your brain and they definitely are causing you a lot of pain. However, this area of our brain that processes pain is not the only part of our brain, and there are things we can do to minimize that pain via psychological efforts and other modalities that relieve things like stress and anxiety, that also effect our brain and increase the amount of "real pain" that we are already feeling.

Your positive attitude and lack of self loathing I would imagine give you a great chance at minimizing your pain. I am not a Doctor, but it seems that if you only take your prescribed medicines on rare occasions when the pain is unbearable, he most likely is not talking directly to you. There are many other people, whose pain is also very real, that cannot live without their medications but are in worse shape than they would be if they were not on them. There is a lot of data that supports many of these individuals have formed dependencies and/or addictions to these medicines and not only has their pain become worse, they now are debilitated by these strong prescription medicines and their relationships with their loved ones are falling apart. By no means, however, do I believe Mel is trying to lump every reader or individual with chronic pain who takes opioid medicines into one group, and I am fairly certain the last thing he is saying is that your pain is not real.

JessieW, Thank you for your

Thank you for your kind comments. I do appreciate them. And I *do* understand what Dr. Mel is saying -- I simply disagree with him completely.

You see, I think that Dr. Mel is showing us a perfect example of the following principle: The diagnoses you receive is dependent upon which type of doctor you go to in the first place.

If one goes to a psychiatrist for a headache, it's due to unresolved tension in your childhood or stressers in your life now. However, go to a neurologist with the same headache, and it's due to migraines. Go to your regular MD, and this doc tells you to take two asprin and call in the morning. Go to a chiropractor, and it's due to your spine being out of place. See what I mean? Depending upon who you see, you get a different answer for the same question about the cause of the headache!

Dr. Mel believes 80% of chronic pain is due to "emotional" causes. "In my experience, chronic pain is about 20 percent sensory, and the rest, the other 80 percent, is emotional." These are *his* words. It is *his* experience. But, I wonder if he has bothered to ask the people experiencing the pain! Because -- at least in *my* case, (and I believe in *most* cases) -- he's wrong.

However, Dr. Mel is a social worker. Consequently, he is trained to look at the *emotional* causes of whatever the person is there for. So, that is what Dr. Mel sees -- emotional causes. He sees this *emotional cause* regardless of whatever the real cause is! And it is here, in my opinion, that Dr. Mel makes his error: "Emotions drive the experience of pain."

Dr. Mel, it is pain which drives the experience of emotion. You have it backwards. Unending, severe pain brings on the emotional experience. It is not the other way around. One's back begins to hurt, and one *may* begin to get anxious, (thinking about how work will go, or how you will pay the bills with another day's pay lost, for example). But, it's not the anxiety that causes the back pain!

I thought I also saw another of his own statements in the article shows this propensity. How ever, I cannot find it now. Did you, Dr. Mel, take out a sentence on how it would be impossible to conceive of the emotions not playing a part in the pain? I was certain I saw something to that effect when I read the article before. If not, I am sorry.... However, if it was there, then it clearly showed the inability of Dr. Mel to "conceive" of any other cause except the emotional cause -- which he has been trained by his profession to see. Again, if I am wrong, and I do hope to hear from Dr. Mel here, then I do apologize...

And these are the reasons I completely disagree with Dr. Mel. I do not think that the doctor can see the forest for the trees. He is caught up in the thinking of his own profession. And, I say this with due respect -- it happens to many professionals. A healthy and honest one will seriously look at this statement as a critique, not a criticism, and see it as a means to grow professionally.

On the other hand, I do agree that functionality is and must be the goal. So, if mindfulness, meditation, deep breathing, imagery, exercises, physical therapy and non-narcotic medications are *not* helping one function, I ask Dr. Mel, what then is the answer? Because in over 10 years, I've done everything *except* the narcotics, (due to my own healthy fear of them). And since I am struggling to continue to live my life, not to close it out as a dependent on disability, I ask if you have anything better to offer.

Shalom, Salam, Peace!

This reminds me...

This reminds me of something,

about a hundred years ago a lot of people - including many doctors - believed among other theories, that polio was " all in your head" maybe a kid had been punished too harshly and pretended he could not walk anymore? Maybe one could be reasoned to snap out of it?

And it turned out polio was very real and not " in the head" at all.

Then until fairly recently pretty much every health expert was assuring us that stomach ulcers were caused by stress, thus were " all in your head", maybe you were a workaholic, too ambitious or something like that and you needed a new attitude because it was " all in your head"?

but it turned out that ulcers are caused by a bacteria and are very real and NOT "in our head" at all.

Please do not get me wrong, I am not "bashing" psychology, it has done great things and will continue to do so, and I am fascinated by psychology - when it is right about something - but sometimes people in this field get "carried away" and believe everything in this world is psychological.

they are just as wrong as those who believed polio or stomach ulcers were " all in the head "

Thoughts and emotions do affect - to a certain extent - how tolerable or intolerable a body pain is, but the pain and its cause are very real.

Most people if promised an interesting reward will be able to tolerate more pain than they normally would, like how long they can hold their hand in ice cold water, but that does not make the pain of having a hammer slammed violently against your fingers 80% in your head.

One might say "but the hammer slamming your fingers is not chronic pain!"
ok then,
what if I slam it on your fingers every 6 hours for the next ten years? will you still argue the pain is 80% in your head?

It is very frustrating to be told it is all in my head, my gout is real, my migraines are real , my herniated disk is real and the pain from all of those is real.

think I am wrong? go to your nearest hardware store, get a nice shinny hammer and slam your fingers every six hours and call me in the morning...

shiny hammer

I loved your way of trying to explain pain to people who don't have it. Very funny! But true! Just wanted to stop for one last moment and reply to you. I had part of my spine REMOVED. I've had nerves cut and muscles cut away and moved....you have no idea! I was told I would have chronic pain for life. But the surgery was to SAVE my life. I had no choice. Not every tumor is cancer but they can kill you just the same! So I don't understand why cancer is the only tumor disease people want to recognize. I also have a tumor disease but it's not cancer. But trust me it spreads and requires wide resections, just like cancer. Yet some would have me to do without treatment because I don't have 'cancer'. Most doctors haven't heard of my condition. The amount of diagnosed cases is under 30 in the world. Yet if they do get by with this rule to not treat anyone who doesn't have cancer, I will suffer! The baby and the bathwater become one. Out will go it and out will go my relief. I'm still in pain but with devices I can function somewhat. At least I can get out of bed and walk around the house now. When I need my wheelchair I get pity. I don't want that so try to walk...but can be in a store and have to lay down! Talk about embarrassing!! :) And as far as counseling goes, I did go to one to see if there was anything I could do to help decrease my pain. He said what all doctors say to me. You have intractable severe pain. Meditation may help some people's pain but not yours. I've heard about people going through surgery with no medication at all...they do it via hypnosis. But who do you know who can do this? I don't have the money for hypnosis doctors or accupuncture. If these things worked so well why doesn't Medicare and insurance companies pay for them so people can benefit?
Ok...just wanted to stop for a minute and say I enjoyed your words. Thanks for the smile. :) But don't hold your breath waiting for people without pain to understand what you are saying. It won't happen...until THEY are stricken with chronic pain.


Ok, I knew I saw the comment, but, it was not in Dr. Mel's original post. It was in his follow-up post. Here it is:

"It is impossible to conceive that when you are in pain, there is no effect from emotions and thoughts, which are generated in areas of the brain close to the pain centers."

To state something is "...impossible to conceive..." shows a refusal to look. And that is, by necessity, unscientific. It is against the very scientific hypothesis that all good scientists are held to in their investigations. As a social scientist myself, I am held to such standards; Dr. Mel is held to them also.

Again, I point this out only to show that Dr. Mel is caught up in the thinking of his own profession. He is convinced that there is an emotional cause for everything, including our pain. And this is why I disagree with him. Maybe his drug dependent pain patients had these problems. Drug addicts have lower emotional ages, (if that's the right way to put it?), depending upon when their drug use began. Which is, in fact, another reason why I do not wish to be lumped in with drug dependent people just because I have chronic pain, (as your first post suggests).

However, I wish to respectfully suggest that he has it backwards. It is the pain which *may* create emotional responses. Then again, with the proper mindset, good people working with you to try and help alleviate the pain, and a good support system, emotions do not rule our lives -- or our pain levels. And many of us who live in chronic pain have just those conditions. So, we do not need to be told that "it's in our heads - but it's real to us."

It's REAL!
And it's time to listen to the patient, now.
Because what we say does matter.

I do not think Dr. Pohl has it backward

As Jesse pointed out, semantics can make this topic difficult and certainly "hot button". To review Dr. Pohl's statement again "It is impossible to conceive that when you are in pain, there is no effect from emotions and thoughts, which are generated in areas of the brain close to the pain centers." This statement is not about emotions first then pain, its about real pain effecting emotions and thought. He is saying it is impossible for pain to not effect emotions and thought. It goes like this...........my back is an 8 out of 10 today. How am I going to deal with the kids, be a loving spouse, sit at work all day and so on. The stress that comes along with real pain can and does increase pain. Loss of a favorite pass time as a result of real pain can create feelings of sorrow and grief.......those emotions can increase pain sensitivity. Emotions and thought are the bi product of pain, those bi-product emotions then effect pain. It is a terrible cycle.

I believe Debbie is correct in that depending on what type of doctor you see, your cause for a headache could be varied. But you have to remember is that each doctor is going to look at the problem from their very specialized training and experience. If a psychiatrist tries to adjust your back, you should probably run!!! By seeing different specialists, the hope is that you can narrow down the cause. Who knows, the solution could be a combination of all the specialists Debbie listed. Psychology is tough for a lot of people because there is less physical proof - no x-ray, MRI and so on. What I believe Dr. Pohl's work is doing is adding a new piece to the chronic pain epidemic. Pain Doc's do little to deal with psychological impact. The brain is one of the most complex structures we know of. Look up Pseudocyesis to see an example of psychology effecting the physical body in a dramatic way. If the mind can do this, why can it not play a significant role in the over all chronic pain experience.

so pain is emotional? YOU then need emotional help!

This is a bunch of BUNK. I have had chronic pain for 2 years due to surgery. Opiods help alot and I am not tolerant...after over a year. Your 2-3 month message is not true. Pain is physical. Nerve and muscle pain. Period. You need some education on pain mangement. Stick to psychology and let the pain management doctors deal with physical pain.

so pain is emotional? YOU then need emotional help!

This is a bunch of BUNK. I have had chronic pain for 2 years due to surgery. Opiods help alot and I am not tolerant...after over a year. Your 2-3 month message is not true. Pain is physical. Nerve and muscle pain. Period. You need some education on pain mangement. Stick to psychology and let the pain management doctors deal with physical pain.


" I have had chronic pain for 2 years due to surgery. Opiods help alot and I am not tolerant...after over a year."

You just proved the opposite point of the one you were trying to make. Like the stoner who says "I smoke pot ever day, and I'm not addicted!"

No, this person did NOT make

No, this person did NOT make the opposite point of the one they were trying to make. Anti-opioid forces are stuck on stupid! If you want to suffer with intractable pain, cool. Please do not impose your ignorant views on others. You are clueless!

Stuck on stupid

And you are stuck on defensive. I didn't say one should NEVER take opioids. Where did you get that? Don't be so quick to assume, it really makes you look stupid.

this is a bunch of bunk

I've been in chronic pain 2 years. One year on opiods. No tolerance or increases needed yet. And you don't HAVE to increase for tolerance. You can switch meds or take a holiday...off a couple of days (in bed) and then back on and that fixes it sometimes.
Stick to psychology and forget writing about pain. Obviously you don't know a thing about it.
I will give you this...stress CAN POSSIBLY tighten painful muscles and cause more pain but that is not chronic pain but acute pain. It goes away. Chronic pain doesn't go away.
How you got an article in a magazine with such silly so called facts is beyond me. Psychology Today..why don't you interview pain patients who really suffer with INTRACTABLE pain? I bet this social worker doesn't even know the meaning of that word.

Emotional Resopnses

I took some time to do research and looked up Dr. Pohl and Las Vegas Recovery Center. To those who are so offended by Dr. Pohl's article, believe it or not, his program seems to be evidence=based and not some random, unproven, untested philosophy. I am not sure about you, but I tend to rely on fact as opposed to how I feel about something. In essence, I am a "proof is in the pudding" individual, so to speak.

If you care to do your research, I found that you can access what they call their Pain Outcome Profiles which summarize their chronic pain clients' pain outcomes by going to the "Pain Treatment" section on that website, then scrolling down to "Pain Treatment Program" and then choosing "2011 Client Pain Outcome Profile Summary". You do have to sign up to receive them however.

After considering the documented evidence of LVRC, reading Dr. Pohl's article and then reading the dramatic, emotional arguments on this blog, I am forced to consider the logic of Dr. Pohl's stance. Furthermore, I am also forced to wonder if it is not a coincident that some of the more emotional responders on here are in so much pain. Have some of you considered if you addressed the obvious attitude displayed through your replies, your pain might actually decrease? (My comments are not toward the objective responders on here.) From where I stand, you are additional evidence.

I've read the comments here

I've read the comments here as well. Many are lengthly and very nice...hardly 'emotional'. Many took alot of time formatting their response. I didn't...NOT because I'm emotional but because I'm BUSY! I take care of many disabled dependents and don't have time to go into details as you do...and you don't know me so you can't judge my emotional make-up. I simply don't have time and besides I don't care do divuldge all of my personal medical details...it's no one's business but mine. I said simply and stand on my statement that this guy is out of his league. He doesn't understand pain. Like I said stress can tighten muscles and make more pain but that is temporary pain so called 'acute'. Chronic pain is pain that stays. It doesn't go away once you are no longer stressed.
I don't have time to go back and forth with you. You have your opinion and I have mine. You read what you want to into the article and other writings. I read and interpret what I feel I read. Have you ever been in a game where one person tells a story and passes it on...eventually it gets back to the first person. They tell the original story and then the one that got back to them. Totally different stories. You have your opinion and I have mine. But I HAVE chronic pain. I'm betting you don't. So I know what I know from experience.
I'm done with this as I have many people relying on me. Without pain treatment I wouldn't be able to function at all...so am thanking God I do have treatment so I can do His will and works.
Signing off the subject....but still encourage you to talk to pain patients who can tell you what it's really like to have intractable pain. Sorry I have no more time. Thanks to pain management I have a life to live.


My goodness, I am quite surprised at the vehemence and diversity of responses to this blog. I’m going to attempt to clarify, concisely, what I tried to communicate in the original article.

First—all pain is real! I’m not sure how many different ways I can say this. It seems to really offend some of you that pain lodged in the brain’s limbic system and somatosensory cortex (the site of emotional experience and perception of pain) is as real as the pain coming from the nerve receptors in the skin, joints or spine. The brain’s response to pain is negative. It’s an instinctive aversion response that enables us to protect ourselves from injury or further damage, once injured. That’s the purpose of acute pain.

With chronic pain, which I am referring to in this blog, the tables turn. Experts much smarter than me from Stanford and other centers of excellence around the world have defined the process of “Maladaptive Pain”—that is, pain that has outlived it’s usefulness but won’t go away. Chronic back pain from a bulging disc doesn’t serve the person who has it one bit, yet it continues. It is a source of annoyance, frustration, inconvenience, and anger, which often impairs function. This pain occurs in the brain!

Yes, a significant contribution of the pain experience is in your head, because that’s where the brain is, and the brain is the site of much of the individual’s response to chronic pain. Pain, which occurs in the brain and is experienced as emotion, is no less real than a slipped disc or swollen joint.

I am a physician, not a social scientist, and in my clinical experience with hundreds of patients, I have found that until you deal with your emotions, the likelihood of having a “good life” that is full of meaning and value is diminished. My work involves helping patients come off opioids and live a productive life without them, because the opioids are not making them better.

As for opioids—I can’t say clearly enough that if they are helping you to function better and your life is better on opioids, then I am sincerely happy for your success. Many, unfortunately, get transient relief of pain from these drugs, but the benefit diminishes over time and they end up physically dependent on them. Though addiction is horribly stigmatized, that is not the issue here—simply whether opioids make you better or worse. If they make you better, count yourself lucky and enjoy the benefit!

Reply To I've read the comments on here

Hello Anonymous, I encourage you to go sign up for the pain outcome profiles at Las Vegas Recovery Center's website and read through them. That is Dr. Pohl's program. They are proof that Dr. Pohl is well within his league and those POPs are all based on feedback of chronic pain patients. Enough said.

The author benefits financially from getting patients off opioids

The author of this article benefits financially from getting patients off of opioids, via the Las Vegas Recovery Center, so he is not completely objective and unbiased. While I agree that many (with or without pain) can benefit from modalities such as acupuncture, yoga, chi kung, meditation, massage, nutrition, etc..., opioids remain a crucial treatment option. There are too many pain conditions to try to come up with a one-size-fits-all solution. Let patients and their doctors decide.


Not as much as so-called "pain management" doctors profit from the pharmaceutical industry. Your argument has a touch of the absurd about it.

That doesn't make sense

It's the doctors overprescribing opioids who benefit financially from the pharmaceutical industry. Getting patients off drugs is hardly a recipe for financial gain. Once the patients are hooked, they are customers until they od, or die, or get unhooked. Repeat business for pain pill doctors. But a doctor who helps a patient get off opioids is killing the golden goose. I don't think your statement makes sense.

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Mel Pohl, M.D., is a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. more...

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