July 02, 2015
(+++) THE HUNT FOR HEALING
The Pain Antidote: The Proven Program to Help You Stop Suffering from Chronic Pain, Avoid Addiction to Painkillers—and Reclaim Your Life. By Mel Pohl, M.D., and Katherine Ketcham. Da Capo. $16.99.
This book dangles a promise that it cannot possibly deliver on for most people, and in that respect it is immeasurably cruel. Whether it is crueler than the promise of relief from chronic pain through long-term use of medication, especially opioids, is a matter of opinion and an ongoing source of debate in the medical community. Dr. Mel Pohl’s book (and it is really his: all first-person references are to him, with Katherine Ketcham apparently having the primary role of style polisher) approaches chronic pain – a condition affecting one-third of Americans – from the perspective of a family practitioner who believes much of modern medicine is misguided. Pohl runs the Las Vegas Recovery Center, a pain-and-addiction treatment facility where he personally and apparently enthusiastically supervises a program to wean people with chronic pain from medicines and provide them with healthful-living alternatives through better diet, more exercise, and other improved lifestyle choices.
Nothing in The Pain Antidote is really new. The debate about potent opioids and similar medicines for use in long-term pain management (as opposed to the handling of acute trauma) has been ongoing for years, and has been the subject of many books and countless shorter articles (both scholarly and nonprofessional), meetings, seminars and research projects. There is general agreement that drugs developed for treatment of intense, acute pain are inappropriate for long-term use, and that there are ways to remove patients from them and substitute alternative approaches in some cases, if not all, through intense, long-lasting counseling, careful ongoing management, substantial social support, and a medical team committed to spending a great deal of time with each patient.
This is exactly the medical model that is unavailable to most people in the United States these days – and has become even less available since the advent of the Affordable Care Act, which has resulted in overworked physicians generally needing to spend even fewer minutes with patients than in the past (when those minutes were very few already). Programs like Dr. Pohl’s at the Las Vegas Recovery Center are few and far between, and they are generally extremely time-consuming, extremely costly, and available only in very limited geographical areas. Whatever successes Dr. Pohl has attained must be seen, therefore, as ones that are not readily replicable in the everyday lives of the vast majority of people with chronic pain.
Thus, The Pain Antidote will be most useful for helping people with chronic pain understand why their bodies are going through such ongoing misery; and it may point people toward possible dietary or lifestyle changes that they can attempt to incorporate into their everyday living in part, even if not in full – even if Dr. Pohl would insist on an all-or-nothing, my-way-or-the-highway approach to changing pain management.
The book starts with five unexceptionable observations: all pain is real; emotions affect how pain is experienced; opioids may make pain worse over time; functional improvement rather than pain elimination is an appropriate goal for chronic-pain sufferers; and “expectations influence outcome.” This last point is crucial to Dr. Pohl’s approach: you must believe that his proposals will work for them to do so. (This is reasonable on one level, as is known from studies of the placebo effect, which the book discusses at one point. However, it is all too readily subject to abusive interpretation: if you do not improve when using Dr. Pohl’s plan, the fault lies in your lack of belief rather than in the plan itself.)
Dr. Pohl is fond of providing information in grouped form. There are “Six Basic Points” about pain and the brain; seven possible “secondary gains” that people with chronic pain may receive, thereby reinforcing their pain; “12 Behaviors That Might Signify an Addiction Problem”; “12 Ways of Thinking That Get Us into Trouble”; and so forth. He likes to present ideas in simplistic chart form, even when the ideas themselves are far from simple to implement – for example, there is a “Thought Pattern Chart” in which an initial thought about being in too much pain to get out of bed, or even move, is supposed to lead to the “reasonable response” of, “The pain isn’t going to kill me and I know movement is good for me – so I’d better get moving!” Eventually, Dr. Pohl gets to the heart of his belief, in a chapter called “Reviving the Spirit: Finding Meaning and Purpose in Your Life.” Here he presents “The Basic Spiritual Principles Underlying the Twelve Steps” used in many anti-addiction programs. He urges chronic-pain sufferers to find ways to feel and express gratitude, to move toward acceptance, to practice forgiveness, and more. And if this sounds more like a spiritual manifesto than a medical one, that is because it is – one of Dr. Pohl’s bigger understatements, two-thirds of the way through The Pain Antidote, is, “You probably have gleaned by now that I am not a fan of opioids for the long-term treatment of chronic pain.”
Where The Pain Antidote eventually takes readers is to recommendations for specific changes in one’s diet and lifestyle – changes that have been put forward many times in many other contexts: eat less red meat and more fish; work out 15 to 30 minutes a day; try massage and/or yoga; etc. There are also some recommendations that will be less familiar: locate specific acupuncture/acupressure points and massage or press them yourself to “influence the energy flowing through your body, thereby reducing inflammation and pain” (which is in fact the Chinese theory underlying acupuncture, but not a belief system supported by scientific research); and learn and use specific breathing techniques such as prana breath and breathing Om. To reinforce his message about the importance of proper nutrition for pain management, Dr. Pohl provides an appendix of “Delicious and Nutritious Pain-Reducing Recipes” such as “slow cooker ginger tea,” “curried butternut squash soup,” and “gluten-free peanut butter cookies.”
There is absolutely nothing wrong with trying the approach recommended in The Pain Antidote, and it may be quite effective when used in a highly supportive institutional setting providing patients with long-term, extended interactions with medical professionals. This is just what the Las Vegas Recovery Center appears to offer. The underlying difficulty with this book for the majority of pain sufferers, though, lies in the sad reality that what works when carefully monitored and strongly supported by a professional staff is much, much less likely to work in people’s individual, highly stressed, time-pressed, frequently isolated, pain-filled lives. This fundamental disconnect between what Dr. Pohl urges readers to do and the circumstances under which his patients actually do these things risks making chronic-pain sufferers, already burdened by unceasing hurt, feel even worse because they simply cannot do all the things that The Pain Antidote suggests, rather too glibly, that they ought to be doing.