Argoff - Defeat Chronic Pain Now!

We dedicate this book to our patientseven those we have yet to meetfor its you who have taught us more than we ever learned in medical school, in our residency, or in our pain fellowships. We only hope we have given as much to you as you have given to us.

Text 2010 Bradley S. Galer, M.D., and Charles E. Argoff, M.D.

First published in the USA in 2010 by

Fair Winds Press, a member of

Quayside Publishing Group

100 Cummings Center

Suite 406-L

Beverly, MA 01915-6101

www.fairwindspress.com

All rights reserved. No part of this book may be reproduced or utilized, in any form or by any means, electronic or mechanical, without prior permission in writing from the publisher.

14 13 12 11 10 1 2 3 4 5

ISBN-13: 978-1-59233-407-0

ISBN-10: 1-59233-407-5

Digital edition: 978-1-61059-362-5
Softcover edition: 978-1-59233-407-0

Library of Congress Cataloging-in-Publication Data

Galer, Bradley S.

Defeat chronic pain now : groundbreaking strategies for eliminating the pain of arthritis, back and neck conditions, migraines, diabetic neuropathy, and chronic illness / Bradley S. Galer, Charles E. Argoff.

p. cm.

Includes index.

ISBN-13: 978-1-59233-407-0

ISBN-10: 1-59233-407-5

1. Chronic painPopular works. I. Argoff, Charles E. II. Title.

RB127.G35 2010

616.0472dc22

2010008983

Cover design: Emily Brackett

Book design: Kathie Alexander

Layout: Kathie Alexander

Printed and bound in China

The information in this book is for educational purposes only. It is not intended to replace the advice of a physician or medical practitioner. Please see your health-care provider before beginning any new health program.

GROUNDBREAKING STRATEGIES FOR ELIMINATING THE PAIN
OF ARTHRITIS, BACK AND NECK CONDITIONS, MIGRAINES,
DIABETIC NEUROPATHY, AND CHRONIC ILLNESS

BRADLEY S. GALER, M.D.

Co-founder of American Academy of Neurology Pain Medicine
Special Interest Group. Named one of the leading doctors in pain
management by the Best Doctors in America

CHARLES E. ARGOFF, M.D.

Co-founder of American Academy of Neurology Pain Medicine
Special Interest Group. Professor of Neurology, Albany Medical College;
Director, Comprehensive Pain Program, Albany Medical Center

Chronic pain is a silent pandemic, affecting people all over the world, regardless of age, ethnicity, or race. It is a condition that acknowledges no boundaries. Chronic pain is one of the most common medical problems, especially among those of us who are approaching middle age! We bet that if you ask anyone you knowwhether at work, in your church, or at your childs Little League gameyou will find that he or she either suffers from chronic pain or has a family member or good friend who does. Everyone knows someone who suffers from chronic pain.

It has been estimated that about one-third of all Americans suffer from chronic pain. That means about 105 million people in the United States are living with conditions including chronic back and neck pain and migraine headaches. A study published in 2003 found that approximately 150 million Americans took medicationsincluding both prescription and over-the-counter drugsduring the previous months to relieve their acute and/or chronic pain.

As our population ages, these numbers are going to increase. Indeed, chronic pain is a bigger health problem than most other medical conditions that get more airplay. Because you cannot see it, chronic pain is easy to ignore and discount; because it attracts less attention, it receives less government funding for research. Insurance companies compound this problem by frequently denying appropriate medical care for chronic pain sufferersand thats a shame.

Another unbelievable and scary fact is that most doctors are not properly educated in the management of chronic pain. Pain courses are rarely if ever taught in medical schools. During their years of internship training and residency, doctors are seldom instructed in how to properly diagnose and treat chronic pain. And who suffers as a result of this lack of education? You do.

Since the mid-1980s, during our last years in medical school, we have devoted our careers to helping people who are suffering from chronic pain (in fact, thats how we met and became friends and colleagues). We have been blessed to learn from pain experts worldwide and privileged to work alongside some of the best pain management providers of all time. Indeed, we were lucky enough to be trained by and work with the Hall of Famers of pain management.

However, we have also witnessed far too much bad pain management over the past twenty-plus years, and we feel it is our obligation to help anyone who will listen. Thats why we combined our knowledge and experience to write this book, a personal survival guide for chronic pain sufferers. Our aim is to present all the important factsthe good, the bad, and the ugly. We want to give you real answers to your tough questions.

Many of you may be given the wrong advice by undereducated or selfish doctors and other professionals, or be prescribed the wrong medication or treatment based on overzealous pharmaceutical, supplement, or device companies. Many of you face roadblocks to obtaining appropriate care from your insurance companies. This is unacceptableyou are already suffering enough!

You dont have to fall victim to the uninformed doctors, insurance companies, workers compensation systems, drug companies, and device makers who all want to make a buck either by selling you a cure or by making recommendations based on their narrow worldview about chronic pain. You need to empower yourself with knowledge about your disease so that you know more than these deciders, most of whom are not truly educated on the subject of chronic pain. If we can spare you more pain and suffering by teaching you all there is to know about your painand warn you about what and whom to look out forwe will have done our duty as pain management doctors.

To that end, weve written in laymans language as much as possible throughout the book, particularly in Part 1, which addresses the specific pain conditions in detail. Why? Because this book is our offering to youthe patient. You are the one living with chronic pain, and it is your right to have the information you needin a way that you can easily understandso you can be an active participant in resolving it. Start with Part 1, where youll find chapters covering specific types of pain. Well tell you what treatments have been shown to work and highlight the most cutting-edge developments. In Part 2, well cover treatments and therapies in much more detailand with a bit more medical-speak, but dont worry, this important information is also written to serve you, the patient, the ultimate decider of care. Finally, dont skip Part 3! We discuss what pain is, why we all have pain, how one experiences it, how factors like stress affect it, and how your nervous system works. While there may be a few sections that bring back unpleasant memories of high school biology, this section teaches you (in easy-to-understand words) the key basics behind how pain works in the body. Again, our aim is to help you by giving you in plain English the most important information about pain that we have learned over our multiple decades of being pain doctors.

This book is not intended to replace the services of a physician. Any application of the recommendations set forth is at the readers discretion. As every persons medical condition is unique, the reader should consult with his or her own physician or specialist concerning the recommendations in this book.