Curing Chronic Pain

Robert T. Cochran

Description

In 2004, Dr. Robert T. Cochran published Understanding Chronic Pain, a ground-breaking work exploring the links between pain, depression, childhood trauma, substance abuse, and bipolar disease. A companion to that work, Curing Chronic Pain demonstrates the advancements Cochran has made in successfully treating patients suffering from pain. He has found that chronic pain, a single core illness, can be alleviated with the careful application of certain drugs, even those in the controversial opiate class. In many cases, Cochran says, miraculous cures have been achieved. Presented in a conversational, anecdotal format, this book examines the specific experiences of chronic pain patients under Cochran's supervision. As a reader you will be struck by Cochran's warmth, compassion, intellect, and willingness to confront the complicated issues surrounding treatment. There is hope in Curing Chronic Pain.

Sujets

• Essays
• Medical
• Médecine

Informations

• Publié par: Turner Publishing Company
• Date de parution: 01 janvier 2009
• Nombre de lectures: 0
• EAN13: 9781618588593
• Langue: English

Extrait

I invite you to come with me on a voyage of discovery. It will take you a few hours, yet it took me four years. The journey began with the publication of my first book, Understanding Chronic Pain , and ends, or at least pauses—for there is much yet to learn—with this work.
Curing Chronic Pain is a bold, even audacious title, but I think it is appropriate. Admittedly, neither I nor anyone else can cure everyone with chronic pain, but that goal is nearly within reach, and I believe my optimism is warranted.
In my first book, I explored the relationship of pain to depression, childhood trauma, and substance abuse. I explored also, however tentatively, its relationship to bipolar disease. This work moves many steps forward, for in it I examine the relationship of pain to delusions, hallucinations, phobias, obsessive-compulsiveness, dementia, narcolepsy, cravings, and anger. All of these offer incredible clues for successful treatment, and I will describe many cases in which miraculous cures have been achieved. Many of these have occurred with the usage of opiates, a group of drugs I disdained in my first book because of their potential for addiction. My thinking on this matter has turned 180 degrees, for I have learned to weigh the potential for addiction against the probability of cure. The balance tips strongly to the latter, and I now employ opiates regularly and with great success, for I know that their therapeutic spectrum extends far beyond the mere relief of pain.
Those of you who have read Understanding Chronic Pain will find that this work follows almost seamlessly. Although Curing Chronic Pain will stand on its own, I encourage those unfamiliar with my first book to take a look at it. I believe you will marvel, as constantly I do now, at just how much a doctor can learn in four years.
“Dr. Cochran is a very competent, compassionate physician recognized for his ability to treat patients with complicated pain problems. This book should be a valuable resource for any person seeking help with complicated pain.”
Everette Howell, MD, Neurosurgery
 
“The real magic of Dr. Cochran’s approach to understanding and curing chronic pain rests in his willingness to be present and listen to those who suffer and then walk with them on their journey to wholeness.”
Keith Hagan, MD, Urology
 
“Dr. Cochran’s book is a useful, colorful, and practical guide for physicians who encounter patients with chronic pain syndromes.”
Karl VanDevender, MD, Internal Medicine
 
“Dr. Cochran has the ability to actively listen and make connections that allow him to find the root of the issue. By finding the link between the mental and physical, Dr. Cochran was able to give answers to my questions and heal me from the inside out.”
Angel, who suffers migraine and bipolar disorder

Copyright 2009 by Robert T. Cochran Jr., MD
 
All rights reserved. Written permission must be secured from the publisher to use or reproduce any part of this book, except for brief quotations in critical reviews or articles.
 
Printed in the United States of America
 
13 12 11 10 09 1 2 3 4 5
 
Library of Congress Control Number:
9781618588593
 
Cover and page design by LeAnna Massingille
To Donna, Elma, and Bob
It is much more important to know what sort of patient has a disease than what sort of a disease a patient has.
—Sir William Osler
Table of Contents
Title Page Copyright Page Dedication Preface and Acknowledgments CHAPTER ONE - How Did You Know What to Do? CHAPTER TWO - Pharmacy for Pain CHAPTER THREE - Pain in the Jaw CHAPTER FOUR - Depression and Pain CHAPTER FIVE - Demons and Ghosts CHAPTER SIX - Remembered Pain CHAPTER SEVEN - The Damaged Brain CHAPTER EIGHT - Pain Behavior CHAPTER NINE - Drugs of Abuse CHAPTER TEN - Why I Fail CHAPTER ELEVEN - Analgesic Rebound CHAPTER TWELVE - Childhood Abuse CHAPTER THIRTEEN - The Bipolar Spectrum CHAPTER FOURTEEN - The Opiate Cure CHAPTER FIFTEEN - Anger and Pain CHAPTER SIXTEEN - Dreams and Pain Epilogue Index About the Author
Preface and Acknowledgments
I want to tell you a little about myself, and in doing so, explain how this book came to be. I was cradle gifted with a B+ intelligence and an A+ imagination (I am glad it was not the reverse). This is to say ideas, not always necessarily good ones, come easily to me. I was also gifted with an even disposition, and that, I assure you, is an important attribute in one who spends his life listening to others talk about how much they hurt.
After I completed my formal academic studies, I entered internship and residency in the field of internal medicine—certainly a happy career choice. Also a happy choice was my decision to spend a year as a resident in neurology. During their subspecialty year, most of my classmates entered the sexy and rapidly developing fields of infectious disease, rheumatology, and above all, cardiology, where great things were being done. The field of neurology was much less seductive because little was being done, but I did feel the brain, although little understood, was not an unimportant part of the body.
I entered practice and did what internists do: treat heart attacks, strokes, bladder infections, and all the rest. I did see my share, however, maybe more than my share, of painful people—those with migraine and a disorder then known as fibrositis, but now described more eloquently as fibromyalgia (which means quite literally, pain in the muscles and the connective tissue that attaches to them). I began prescribing psychiatric drugs, chiefly antidepressants, for the treatment of those disorders, with some success. Intrigued by this, I elected to attend a psychopharmacology (drugs for the mind) conference—an enterprise about as far removed from my daily professional life as one could imagine. I enjoyed it enormously, and from that point on some thirty years ago, most of my obligatory continuing medical education credits have been in the field of psychiatry and psychopharmacy.
Perhaps it was my simultaneous interest in several different medical fields that led me to be invited to join a new pain clinic that was opening at Centennial Hospital in Nashville, Tennessee. There I met and had daily conversation with anesthesiologists, psychiatrists, neurologists, physical therapists, and psychologists. Our clinic was multi-disciplinary, that is, many different minds were working to solve very difficult problems. And problems they were—the sickest people I have ever seen in my life, suffering badly, sleepless, frustrated, and depressed.
Although I respected my colleagues greatly, I found the multi-disciplinary approach fragmented and without direction. I resolved that if I was ever going to make any sense out of the pain thing, I would have to do it with my own brain, not somebody else’s. I left the clinic to pursue my study with my own agenda. Gradually it started coming to me. I realized that there was great commonality in people who suffered pain. Whether it was due to migraine, neuritis, lumbar spine disease, irritable bowels, or whatever, I kept hearing the same story. Disordered sleep. Disordered mood. Disordered memory. Disordered appetite. I began to realize that chronic pain was not many diseases, it was a single, core illness with many different expressions. As my experience grew, and as the new psychopharmaceuticals came on the scene in great variety, I found that my patients’ recovery rates were improving substantially, up to as much as 50 percent.
Some ten years into my study of chronic pain, my ideas had crystallized enough for me to at least begin writing a book. It was an exercise that was to take nearly five years. I discovered that by putting ideas to paper, I was better able to organize them and make them coherent. I was beginning to see a pattern.
Understanding Chronic Pain: A Doctor Talks to His Patients was published in January 2004. Although published by a smaller, regional press and having little marketing effort other than my willingness to go anywhere for a book signing, it achieved national distribution and has been a top-rated book on the subject on Internet sources from early on. It is now in its second edition.
Understanding Chronic Pain has had a favorable impact on many lives. I know this from conversations with readers and from letters and e-mails received from near and far. I have been deeply touched by these communications, and I have included a number of them in this text. They are eloquent, describing in the first person the plight of the painful, and I am sure that they will resonate with many readers who suffer and who sometimes feel they are alone. They are not.
Following the publication of my book, I continued my work and the learning curve gradually ascended with my outcomes ever improving. Pleased with my success, I decided to write another book, but for some reason it went slowly. Then, about a year before this writing, I began to see things more clearly. I found my imagination sometimes running away with me. There were good ideas, lots of them, and also good luck. There were remarkable observations and experiences and cures so dramatic that they seemed almost providentially directed. That which had begun at a glacial pace had become meteoric in velocity. To put that in some perspective for you, a third of the content of this book consists of material that I did not even know existed when I began writing it one year ago. Indeed, I have found it difficult to conclude this book because it seems weekly, and sometimes daily, a patient offers me a new insight.
Curing Chronic Pain , like its predecessor and companion, consists of the stories of people who suffer pain and who have entered my life seeking help. Some of the stories evolve in such a melodramatic manner that they may appear contrived. I assure you they are not. They are true stories of real people. The changes I have made are to disguise identities and sometimes to simplify the story so my reader does not hav