Dr. Dillards work offers a welcome focus on the whole person in describing the many diseases that produce chronic pain, the extraordinary range of treatment options, and the movement to integrate complementary therapies into mainstream pain management.
Russell K. Portenoy, M.D., Chairman, Department of Pain
Medicine and Palliative Care, Beth Israel Medical Center
A fine, useful, and highly readable guide to the important field of integrative pain treatment.
Probably the most comprehensive book of its type I have seen in the past decade, and should be part of your patient library.
Professor John D. Loeser, M.D., American Pain Society Bulletin
I highly recommend this wise and practical book to the millions who live with pain.
This book is designed to help you make informed choices; it is not meant to replace medical treatment by a physician or other licensed health care provider in the diagnosis or treatment of chronic pain. If you suffer from acute or chronic pain, please seek appropriate medical care and carry out the treatments discussed in this book only under the guidance of a qualified professional.
ACKNOWLEDGMENTS
I would like to thank my wonderful agent and friend, Jill Kneerim, who believed in me and in the importance of this work. Without her faith and support, this book would not have been possible. For her gifted writing and eternal patience, Leigh Ann Hirschman deserves a tremendous debt of gratitude. My thanks also go out to my extraordinary editor, Toni Burbank, for her invaluable contributions and her belief in this project. Many thanks to Irwyn Applebaum, Barb Burg, and the whole Bantam team for their enthusiasm and drive.
A number of people contributed by reviewing technical content, and by contributing thoughts and suggestions, including Sekhar Upad-hyayula, M.D., Maureen McSweeney, Ph.D., Todd Wilkowski, P.T., O.C.S., Adriane Fugh-Berman, M.D., Kenneth Gorfinkle, Ph.D., Joseph Loizzo, M.D., Ph.D., Tieraona Low Dog, M.D., Barbara Bezdicek, M.D., Steven J. Scrivani, M.D., D.D.S., Fredi Kronenberg, Ph.D., Harriet Bienfield, L. Ac., Kathleen Madigan, L.P.N., and Josephine Musto, M.S., R.N. Though their help has been tremendous, final responsibility for any inaccuracies in the work will rest with me.
I would like to acknowledge the inspiration and teaching of Dr. Michael Lerner, Dr. Rachel N. Remen, and Dr. Andrew Weil for leading the way. They have had a profound influence on my thinking and approach to this topic. I also have learned much from my mentors through the years, including Ted Kaptchuk, O.M.D, L. John Faye, D. C., Scott Haldeman, M.D., Ph.D., D.C., William Prensky, O.M.D., Assibi Abudu, M.D, Michael L. Weinberger, M.D., Stanley J. Myers, M.D., James S. Lieberman, M.D, Russell K. Portenoy, M.D., and Alexander Mauskop, M.D.
My wonderful lawyer and friend, Russell Smith, has been a constant source of support and wise council during the project. My many water dog friends have been wonderful and helpful. They put up with me working every day on this book during a windsurfing trip, without throwing my laptop into the sea. And Caroline Gillespie has been endlessly helpful with proofreading, various reality checks, and helping to keep my life on the rails. I send out much thanks to all.
INTRODUCTION: THE CHRONIC PAIN SOLUTION
Diana, a makeup artist in her late twenties, came into my office toting a shopping bag. She heaved the bag up onto my desk and then slowly eased herself into a chair. She explained to me that she suffered from severe endometriosis, a painful disorder in which uterine tissue implants itself in other areas of the body, and that she had seen several doctors in her search for relief. When I opened the shopping bag, I saw that it was filled with prescription bottles. Every time I see a doctor, I bring in my bag and he adds another to my collection, she said, obviously expecting that Id do the same. I looked at the labels; she had been regularly downing a dangerous combination of pills. Still, Diana was in terrible pain. She could drag herself through work, but at night all she could do was lie on the couch with a heating pad on her abdomen. It sounds trivial, she said, but the worst part is that Im lonely. Ive been so depressed and exhausted from the pain that no one wants to talk to me. She sighed and ran her hand down the side of her face. I guess I cant blame them. Im not the person I used to be. Since the pain started, Im just not myself anymore.
A few years ago, Victor, a fifty-four-year-old lawyer, developed arthritis in his left hand. His doctor told him to take Tylenol, and when that didnt help, Victor decided hed just have to live with the pain. At first he hurt mainly before a change in the weather, but now his hand had begun to ache every day. He could still force himself to type documents at his computer, but he wondered if hed need to fire his longtime secretary and hire a new one who could take shorthand. Sometimes the pain woke him up at night, especially in winter. It was even getting hard to pull on his socks. Tell me if this is something Im just supposed to put up with, and I will, he said. But theres got to be more I can do.
I could tell at first sight that Jacobs life was governed by pain. He shuffled through the door with his arms held close to his sides. I offered him a seat, but he winced and remained standing. In a barely audible monotone, he told me his story. Three years ago, Jacob had injured his back at work; despite two surgeries and long periods of total bed rest, he had not recovered. In fact, he was in agonizing pain every hour of the day. He couldnt work, couldnt relaxhe couldnt even sit downand the doctors who signed off on his workers compensation payments wouldnt renew his prescription for the only painkillers that had given him any relief. His wife had stuck by him so far, he told me reluctantly, but the marriage was precarious. He summed up his life with pain: I spend all my time trying to protect my back. I cant even go downstairs to pick up the mail or help with the dishes. Im afraid to. Theres no way Ill risk making the pain worse.