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Clarifying the top mystery pain · Cultural Wars | America Out Loud News

• 0:47
  Hello everyone, this is Dr.
• 0:49
  Steve Latolip.
• 0:50
  Welcome to Unity Without Compromise on America Out Loud Talk Radio.
• 0:55
  Today I am going to carry on with a series on central pain syndromes that I have been sharing with you for the past several weeks.
• 1:06
  Today I'm going to describe one more central pain syndrome, and I feel like I really had to do this because it is a real tough case to crack.
• 1:20
  It is the most misunderstood form of all central pain types.
• 1:26
  And that is complex regional pain syndrome.
• 1:31
  If I were speaking to doctors about it, they would be rolling their eyes, they would be eager to hear what I had to say if I said I could treat it and heal the syndrome, and I say that I can with confidence.
• 1:56
  But understand this, you cannot solve the CRPS mystery without considering the emotional impact of the initial injury that results from the devastating psychological, physiological, morphological changes that were actually caused by the injury.
• 2:20
  Now that is the same for pretty much all the central pain syndromes.
• 2:24
  They are initiated by a strong emotional reaction in a negative way against something that happens to a person.
• 2:37
  And with complex regional pain syndrome, understanding the emotional impact actually the emotional impact of the injury opens the door to effective treatment and ultimate healing of complex regional pain syndrome, which is abbreviated CRPS.
• 3:02
  So let's begin by just simply defining CRPS.
• 3:08
  Now, if you ask doctors to define it, or if you go get on the web and start searching for a definition, you're going to discover right away that they have a real tough time defining it.
• 3:22
  It's hard to define something you can't understand, right?
• 3:27
  How can you possibly define anything that you don't understand?
• 3:32
  Well, the truth is you cannot define it.
• 3:35
  The best that you can do is describe it.
• 3:39
  And that description is likely to be very vague, as you will see.
• 3:45
  Go to the National Institute of Neurological Disorders and Stroke website, and you'll see that they define complex regional pain syndrome as quote, a broad term that covers long-lasting pain and inflammation that can happen after injury or a medical event, such as surgery, trauma, a stroke, a heart attack, or whatever it may be.
• 4:21
  What does a broad term that covers mean?
• 4:26
  That's how they define it.
• 4:28
  Oh, yeah, CRPS is just a broad term that covers something.
• 4:33
  Huh?
• 4:34
  What do you mean by that?
• 4:35
  See, it doesn't really tell you anything.
• 4:37
  This is about as vague a description as you can get, and the description really says nothing other than okay, you've got some kind of unexplainable mysterious pain that seemed to get really bad after you had some kind of a mishap, a bad thing happened to you physically.
• 5:03
  So this vague definition that really does say nothing reflects the poor understanding of the syndrome.
• 5:11
  So I want to really help to clarify what this syndrome really is.
• 5:16
  And I do feel that I have a strong handle on it.
• 5:19
  Now, if you can't even define a disease or an ailment or condition, then you cannot possibly explain it.
• 5:28
  And that's what the CRPS research to date shows us.
• 5:36
  The best that they've done is described three subtypes of CRPS.
• 5:42
  So there are three subtypes recognized, really um called uh something really catchy, type one, type two, and type three, and these designations refer only to the causative event that actually led to the tissue damage.
• 6:01
  And I'm not even going to waste your time getting into a description of these subtypes because they're absolutely meaningless.
• 6:10
  They don't affect the prognosis of the condition, they don't affect the treatment in any way, and they absolutely do nothing to aid the clinician to treat the syndrome appropriately.
• 6:28
  So that tells me that the subtypes are absolutely meaningless and useless.
• 6:35
  So if you want to learn them, go ahead and look them up through the three subtypes.
• 6:39
  But um, you know, in my estimation, maybe they were just an attempt to better grasp what they don't understand.
• 6:47
  They say, well, you know, this it seems to happen.
• 6:50
  The injuries happen in three categories, and one of those subtypes is just an undefined category, by the way.
• 6:57
  But the subtypes have absolutely, and I mean absolutely nothing to do with the treatment and the resolution of CRPS.
• 7:09
  And of course, like all other central pains, if you look on all the big websites, the research hospitals, or anywhere you go, they're going to tell you that CRPS is incurable.
• 7:22
  Of course, you know that I believe that is pure nonsense, and I only say that because I have healed plenty of CRPS patients, as I have all other types of central pain.
• 7:35
  So I'm not going to waste your time or mine expounding on the three subtypes further, but I what I really want you to understand is why CRPS is such a mystery to both clinicians and victims of this condition to patients and to the general public.
• 7:56
  They have no idea what this is or how to treat it.
• 8:01
  And therefore, the patients that, of course, arrived in my clinic, having been attempted treatment by all kinds of different specialists who just threw up their arms, said, I don't know what's going on here.
• 8:15
  Well, guess what they did?
• 8:16
  They made the patients worse and sometimes much worse to the point of being suicidal.
• 8:23
  And I'll share one of those cases with you today.
• 8:26
  But what is significant about CRPS is this?
• 8:31
  It does involve a preceding form of actual real physical trauma resulting from either an injury or from surgery.
• 8:43
  Now, if you are an astute observer and listener, you rightfully might be challenging me right now because CRPS does entail real tissue damage.
• 8:57
  Okay, at least at some point in the progression of the development of CRPS, it actually, in other words, you can look at a patient and say, ah, yes, I see postoperative changes or post-traumatic changes, something is different.
• 9:14
  I see the tissue damage, perhaps.
• 9:18
  And if you remember that a defining characteristic of any central pain syndrome is that a past traumatic emotional event triggers the central pain.
• 9:57
  Because if a central pain syndrome.
• 10:00
  Is based on a past traumatic emotional event that actually triggers the chronic long-term learned pain that I've been talking about for several weeks now, and that no physical evidence of a pathologic process is present, is present or discoverable or useful to make a diagnosis of a central pain syndrome, then you know what is going on.
• 10:28
  Because CRPS seems to contradict this rule.
• 10:34
  Well, okay, I'll grant you that.
• 10:36
  But how then can I call it central pain?
• 10:39
  And that's what you should be asking me right now.
• 10:42
  When actual evidence of physical harm exists, you got to say, hey, what's going on?
• 10:48
  This is precisely what throws doctors into a therapeutic tailspin.
• 10:54
  They have no idea what's going on here.
• 10:56
  And it is why they call CRPS incurable.
• 11:00
  But they are wrong.
• 11:03
  It is not incurable.
• 11:05
  Anybody can be healed from CRPS.
• 11:08
  And I'm going to just lay it out right now.
• 11:10
  Here is the key to understanding complex regional pain syndrome.
• 11:16
  The traumatic or surgical injury and the hardship stemming from it constitutes actually makes up the emotional trauma that causes things to go awry.
• 11:32
  In other words, the physical trauma experienced from an injury or from a post operative outcome that went bad, a surgery gone bad, that actually leads to significant physical impairment or maybe a disturbing visible deformity that psychologically traumatizes the patient.
• 11:54
  So there it is.
• 11:56
  The emotional pain from experiencing the severe bad outcome following an injury like a crash injury or a surgery that resulted in postoperative changes that were highly undesirable and perhaps unexpected.
• 12:16
  So this results in limbic inflammation.
• 12:20
  And quote, learned, unquote, regional pain.
• 12:24
  And when I call it regional, I mean it is not dermatomal, which means it is not physiologic.
• 12:31
  It's not what you would expect when considering where the nerves innovate the specific tissues that they innervate, the muscle tissue specifically.
• 12:43
  So the physical damage caused by the trauma or the postoperative tissue changes readily accounts for the undesired appearance or function, which may include visible signs, such as limb swelling, alterations and skin color and temperature, sweating anomalies, compromised joint range of motion, perhaps, or chronic joint pain, or a desthesia or sensory impairment, such as localized burning pain, hypersensitive skin, limb pain, gross deformity or scarring, and other such adverse changes following the injury, whatever it was.
• 13:35
  So all of these factors can cause significant emotional distress.
• 13:40
  Other the CRPS was defined by many different names previously, and the older descriptive names for complex regional pain syndrome give you an idea of what was happening, such as reflex, sympathetic dystrophy, causalgia, which is nerve pain without visible damage, or posttraumatic dystrophy.
• 14:07
  They called it shoulder hand syndrome, reflex, neurovascular dystrophy, pseudex atrophy, all these describe post-traumatic physical changes that you can actually see.
• 14:20
  And sometimes, rarely, not often, but these changes can sometimes be permanent due to irreparable nerve damage, such as crush injuries, uh maybe fractures, uh, surgical damage or complications, such as from infection and uh leading to other changes.
• 14:44
  And these deformities can persist indefinitely sometimes.
• 14:49
  However, the pain should resolve with tissue healing.
• 14:54
  That's what we normally expect in the normal process of the healing of damaged tissue.
• 15:03
  And so you gotta understand that even elective surgical procedures, something you say, yeah, I was going in for a knee replacement, or you know, some other surgery.
• 15:13
  Well, any elective surgery can lead to complications, which are unexpected, such as varicose veins might proliferate following a knee surgery.
• 15:23
  I've seen that happen with some of my patients.
• 15:26
  You can get asymmetrical limb swelling, and that can result from damage to blood vessels and the lymphatic system, or perhaps from blood clots.
• 15:36
  We have things like a postphlebitic syndrome and veno stasis changes that are chronic changes that lead to swelling of a limb.
• 15:44
  And uh these kind of changes like limb swelling uh is common, for example, after having a radical mastectomy and lymph node dissection, where they, you know, you've got breast cancer, they take off a breast, they dissect and take out the lymph nodes to make sure they get all the cancer, and these changes are usually permanent, but they ought not be physically painful per uh, you know, chronically.
• 16:12
  So the physical symptoms of most CRPS cases generally do resolve and you know, at least they resolve gradually and at the very uh least they diminish a great deal over time.
• 16:30
  If the pain persists beyond tissue healing, then it has become centralized.
• 16:38
  And what matters in understanding CRPS is what impact the nerve or tissue injury and resultant deformity or dysfunction has on the individual's psyche.
• 16:57
  How much are they troubled by this emotionally?
• 17:01
  How much emotional pain have they suffered from these changes?
• 17:06
  In other words, if you can measure or you know, estimate the amount of emotional pain or stress caused by the tissue damage, then you're gonna nail it.
• 17:19
  Because that is the cause of CRPS.
• 17:23
  And it's right in the name.
• 17:25
  It's complex, it's regional, which means not uh anatomical and physiological, it is emotional pain gone bad, and that, like every other central pain is the key to diagnosis.
• 17:41
  Now, generally, the more prolonged the pain, and the more emotionally traumatic the injury, then the worse the chronic pain becomes.
• 17:52
  It's just a general trend that we see with CRPS.
• 17:59
  And this is the focus of the central pain clinician.
• 18:05
  As it determines the success of recovery, you have to understand what you are treating to heal it.
• 18:13
  It's as simple as that.
• 18:16
  Now, oftentimes with CRPS, early on, there is some nerve pain.
• 18:21
  Remember, the pain is perceived by nerve receptors, pain receptors called nosoceptors, and those nosoceptors transmit the pain to nerves.
• 18:32
  So early on with CRPS, we are generally treating nerve pain in the acute phase of injury.
• 18:40
  And that, at least in my experience, is usually not difficult to treat if you treat it with the right medications.
• 18:48
  And you can use medications and other modalities.
• 18:52
  But I find that treating nerve pain in the acute phase is really not that difficult.
• 18:57
  And even following a significant injury, including an up to an amputation.
• 19:03
  Controlling that pain of regenerating nerves is really not that hard to do.
• 19:10
  If you've ever had shingles, you understand what nerve pain is all about.
• 19:15
  If that is properly treated, it's not as bad as you might think.
• 19:19
  But if the pain does not follow a dermatomal pattern, then it originates from the emotional trauma caused by the injury.
• 19:28
  So that's the point to understand.
• 19:30
  So preventing CRPS, then, and if you're an orthopedic surgeon, you should be tuning in really closely right here.
• 19:39
  Preventing CRPS, therefore, requires treating the pain and discomfort, including the emotional pain associated with the physical trauma during the acute and subacute phases of recovery of injury repair.
• 19:58
  If a deformity
• 20:00
  Or malfunction from an injury causes severe emotional distress, then it needs to be addressed early on and immediately recognize it, acknowledge it, and treat it.
• 20:16
  You're treating a human being.
• 20:20
  Because if you don't, well, otherwise, emotional pain processing through the process of reactive astrocytosis will centralize the pain.
• 20:33
  And now you have a chronic pain patient, and it can get really severe with CRPS.
• 20:38
  So physicians must never minimize or ignore the emotional component of an injury.
• 20:47
  That is so important.
• 20:50
  Now the same process that generates CRPS also occurs in phantom limb pain.
• 20:59
  So I want to touch on that a little bit today.
• 21:02
  In fact, the only difference between CRPS and phantom limb pain is that in one case, the limb is gone, and in the other, it remains.
• 21:14
  But the pain is exactly the same.
• 21:18
  And therefore, the treatment is the same.
• 21:23
  So the focus must be supratentorial, that is, in the brain.
• 21:30
  You are treating a pain that originated in the limbic system of the brain and through reverse processing experienced limb pain, even in a limb that may be absent.
• 21:47
  So how do you treat them?
• 21:48
  Well, after, you know, I described my three-step process, after stopping the wrong medications, which oftentimes were, you know, benzodiazepines, uh, opioids and things like that, that only made the pain worse, I'd stop those medications, and then I would start the right medications to control the physical and emotional symptoms.
• 22:12
  Remember the primary symptom triad of any and every central pain is the pain itself, anxiety associated with it, and insomnia.
• 22:24
  That is the triad.
• 22:25
  So I would focus on that, and then as I am treating those symptoms, then I focus on the most crucial part of treating central pain, and that is to train the brain to actually retrain the brain, which involves changing perception and reversing the faulty brain wiring, the neuroplasticity that taught you to feel your chronic pain.
• 22:55
  Now, I think this is a good time to reinforce a point because I'm not only talking to patients, I am talking to uh patients and physicians as well, and anybody that wants to understand central pain.
• 23:09
  How in the world can pain be felt in a limb that isn't there?
• 23:15
  And how do you control it if they're feeling it?
• 23:19
  Well, an American uh Indian or Indian American neurologist and psychologist named V.S.
• 23:26
  Ramachandron did a whole lot of work with amputees.
• 23:32
  And um, I I thought his work was incredible when I was reading it initially.
• 23:37
  He confirmed a correlation between the amount of plastic change that neuroplastic modulation that rewires the brain, changing its structure and function in the brain, and then the and the degree of phantom limb pain that people experience.
• 23:54
  So Ramachandron actually recognized that the more emotional pain people felt, the more pain they had in the limb.
• 24:06
  And without actually calling it central pain, another researcher and a psychiatrist named Norman Deutsch described central pain with amazing clarity, even though he didn't call it central pain.
• 24:22
  He said, in some horrific cases, the original agony of losing a limb is locked in.
• 24:31
  So there it is.
• 24:32
  And this, and when he recognized that, he said somehow they learn how to experience pain.
• 24:38
  And this happens by storing the painful event in the brain's memory, and that is centralization of pain or learning it.
• 24:50
  He also recognized that pain could become either chronic or intermittent and even dormant for years before it recurs and flares up due to some kind of a trigger that recalls or redefines the painful event.
• 25:07
  You know, if some a person learned that, wow, that accident should never have happened in the first place.
• 25:12
  It could have been easily prevented.
• 25:14
  Wow, that's emotionally traumatic.
• 25:16
  I just lost a limb because of somebody's stupid mistake.
• 25:19
  You can see where this can become emotionally painful even years after an event.
• 25:26
  But understanding the amputee's pain as a bizarre illusion, Ramos Chandron experimented with these mirror boxes to combat one illusion with another to retrain the brain.
• 25:40
  This was a way of retraining the brain to undo the damage that was done by the limbic system.
• 25:50
  And Ramachandron's success has had an actual profound influence on understanding of our central pain, except they didn't apply it to all forms of central pain.
• 26:03
  But it applies if only we will allow for it, that is allow for pain, emotional pain to be a causative agent of peripheral pain, pain elsewhere outside of the brain, or even in the brain, as with migraine headaches.
• 26:24
  So you see, once the amputee makes the connection between the imprinted emotional pain and the pain in the missing limb, then he tends to gradually heal.
• 26:38
  Isn't it wonderful?
• 26:39
  It's amazing.
• 26:40
  The pain resolves over time as the amputee addresses and reprocesses his psychological issues related to the loss of limb.
• 26:53
  So full healing is the norm for central pain, at least it was in my clinic.
• 27:00
  And I found that it was repeatedly quite easily treatable.
• 27:07
  The only time that it does not happen is when a victim seeks to gain something from the condition.
• 27:14
  If you have an amputated leg, it's pretty easy for everyone to see.
• 27:18
  And if an amputee dramatically plays on the sympathy and sorrow that some people might respond to him with when they see that he's got a missing leg, especially if he's wearing, you know, a military garb, a military jacket or something like that, you know, maybe his suspension sustained pain can be beneficial to him because it tacitly solicits favor or recognition, okay?
• 27:46
  And a patient seeking this kind of favor may inadvertently foster or reinforces pain.
• 27:54
  And this is called secondary gain, by the way.
• 27:57
  So if somebody can benefit from having pain, you know, it's gonna maybe not want to go away, and you gotta explore those issues.
• 28:07
  And of course, this can happen with any type of central pain, but I found it didn't happen often with other types.
• 28:14
  And um it's not just phantom limb pain, though, that it can occur with, but an absent limb is readily visible, and thus it lends itself to that kind of behavior.
• 28:26
  So you got to think about that.
• 28:29
  But both complex regional pain syndrome and phantom limb uh pain.
• 28:37
  Now, there is a phantom limb syndrome, by the way, which is not painful, it's just a sensation of that the limb is still there because of the memory that your brain has of having a limb all its life before it was lost.
• 28:48
  So when I talk about phantom limb pain, I'm talking about a painful situation, a centralized pain.
• 28:55
  Phantom limb syndrome is just the sensations that the limb is still there and present and functional.
• 29:03
  But both CRPS and phantom limb pain do not respond to non-steroidal anti-inflammatory drugs, NSADS like aspirin, iperprofen, uh neproxin, and so forth.
• 29:15
  They do not respond to muscle relaxers or opioids and God forbid benzodiazepines or anti-eleptic medications beyond the period of nerve and soft tissue healing after an amputation.
• 29:29
  So if you've got nerve regeneration going on, some antiepileptic drugs work really well for that kind of nerve pain, but beyond the period of normal healing, then they become useless.
• 29:42
  But psychological trauma associated with limb loss, such as depression, severe anxiety, that should be addressed and treated appropriately and not necessarily with medications.
• 29:56
  And I want to make that point clear.
• 29:58
  You don't have to treat
• 30:00
  Anxiety and depression always with medication.
• 30:03
  There are risks to all of these medications, although I think that some of these risks have been hyped up in recent years.
• 30:12
  Um, but that's a whole different topic.
• 30:15
  But nonetheless, treat the emotional pain in your CRPS patients are going to improve.
• 30:23
  Well, I'm going to present to you a real interesting case study that will drive this point home.
• 30:30
  And I'm going to do that after a take a short pause.
• 30:34
  I shall return momentarily.
• 30:36
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• 36:34
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• 36:37
  So today I am discussing one last central pain syndrome that which is extremely confusing to medical doctors and to patients.
• 36:48
  I'm trying to clarify the mystery, the top mystery pain, which is complex regional pain syndrome.
• 36:56
  And along with that goes phantom limb pain.
• 36:59
  Although phantom limb pain uh involves a limb that is absent.
• 37:04
  But it's also a mystery because how in the world can you have pain in a limb that is no longer there?
• 37:10
  It tells us point blank that pain originates from somewhere else.
• 37:16
  It has to, it does, and that emotional pain resulting from an injury is what causes complex regional pain syndrome.
• 37:27
  It is not the physical changes of the tissues resulting from some type of a severe traumatic injury or postoperative changes.
• 37:38
  It is from the emotional trauma, the emotional pain resulting from the injury.
• 37:46
  So if you can understand that, then you can understand complex regional pain syndrome.
• 37:53
  So today I want to kind of drive the point home, okay?
• 37:58
  Because uh if you're treating emotional pain, you got to recognize what you're treating.
• 38:03
  And unfortunately, in Western medicine, doctors who are not psychiatrists or primary care physicians don't really care a whole lot about treating other conditions uh that are outside of their box.
• 38:18
  If you're a podiatrist, you treat foot pain.
• 38:21
  If you're an orthopedist, you treat bones.
• 38:24
  If you're a rheumatologist, you treat joint pain.
• 38:27
  But to treat central pain, you have to treat the entire human being to make a man whole or a woman whole.
• 38:38
  And so there's a way to do it, a right way and a wrong way.
• 38:42
  I've talked about my three-step plan of stopping the wrong medications, and usually they are horribly wrong medications that have worsened patient central pain because doctors don't understand what they are treating.
• 38:55
  And then I start the right medications to control the three primary symptoms of all central pain.
• 39:02
  Those are pain, insomnia, and anxiety.
• 39:06
  And they are very common.
• 39:07
  If you can get those under control, then you're off on the road to healing.
• 39:13
  And it's incredible.
• 39:14
  And then finally, the third branch of treatment is crucial to healing central pain, and that is training the brain to relearn how to not feel the pain that it learned through the emotional trauma.
• 39:32
  And if you can get that accomplished, you're going to heal any patient of their central pain.
• 39:39
  Now, I think that's exciting.
• 39:42
  Okay.
• 39:43
  So I want to describe a case today of complex regional pain.
• 39:47
  This occurred years ago when some uh a patient came to me.
• 39:54
  He was referred to me.
• 39:55
  He had been to an orthopedic surgeon.
• 39:58
  He had been to several pain specials.
• 40:00
  Specialist, he had been to a psychiatrist and a primary care physician.
• 40:04
  And this guy came to me madder than a hornet.
• 40:08
  He was angry because nobody, and I mean nobody could tell him why his knee hurt so badly.
• 40:17
  Well, here's what unfolded.
• 40:19
  And this is really interesting.
• 40:21
  Now, let when I say this guy was mad, it is an understatement.
• 40:25
  You got to understand that.
• 40:26
  Six months prior to this gentleman establishing his care at my office for severe and intractable knee pain.
• 40:37
  This 47-year-old framing carpenter had a left knee arthroscopic surgery for arthritis and a meniscus or cartilage tear in his left knee.
• 40:51
  Now listen closely and you will understand CRPS.
• 40:55
  So here's what unfolded.
• 40:57
  Well, I'll call this guy Don.
• 40:59
  Okay, that's not his real name.
• 41:01
  But Don loved his job and he didn't want to have surgery in the first place.
• 41:07
  But you know, he was afraid of surgery.
• 41:10
  He was afraid of having downtime, but then his pain uh got so severe, it was becoming so unbearable on the job that he could no longer function well at work.
• 41:21
  And this guy loved his carpentry work.
• 41:23
  So he feared the downtime if he did agree to having the surgery, and he admitted that he absolutely dreaded the thought of having a complication from the surgery.
• 41:36
  Now, for most people, arthroscopic surgery goes very well for the great majority of people.
• 41:42
  But sometimes things do go wrong.
• 41:44
  There are always risk to every surgery.
• 41:48
  So Don's worst nightmare became a reality.
• 41:54
  After his surgery, his knee became warm and red and swollen and increasingly painful.
• 42:03
  A few days after his surgery, he was in an exquisite severe pain.
• 42:08
  He calls his orthopedist, who then tells him, look, this is just normal.
• 42:12
  This is par for the course.
• 42:14
  Hang in there, it's going to get better.
• 42:15
  You're going to just, you know, give a few more days and you'll be fine.
• 42:19
  Well, Don took his advice, but he was upset.
• 42:23
  He just felt that something was wrong.
• 42:27
  And he told us to his orthopedists.
• 42:29
  He said, look, something was not normal.
• 42:32
  Something felt wrong.
• 42:35
  And despite his signs and symptoms worsening, his surgeon still brushed him off.
• 42:40
  Well, finally, Don was in such excruciating pain that he walked into his orthopedist's office yelling, screaming, and saying he he was not going to leave until he was evaluated.
• 42:54
  Well, guess what?
• 42:56
  Right on that on the spot, he was admitted directly to the hospital for IV antibiotics.
• 43:02
  He had a severe postoperative infection.
• 43:05
  Huh.
• 43:06
  Orthopedic surgeon screwed up, didn't listen to him, didn't listen to the patient.
• 43:12
  You think that he might have had some emotional trauma from that, added on to all of the fear that he had previously of even having the surgery?
• 43:21
  Oh, yeah.
• 43:22
  Well, he had a pick line placed, a peripherally introduced central catheter, and he was sent home to continue six weeks of IV antibiotic therapy.
• 43:31
  And guess what?
• 43:33
  After the course, he was told that his infection was fully resolved and everything looked great.
• 43:39
  And he was cleared to return to work.
• 43:42
  Only one little problem.
• 43:44
  I mean, that should have been good news, right?
• 43:46
  But Don's pain was now 10 out of 10, far worse than it ever was before his surgery.
• 43:54
  But the repeat x-rays that they took in his blood work confirmed everything looked normal.
• 44:00
  There was no infection.
• 44:02
  The knee looks good following the surgery.
• 44:04
  Go back to work.
• 44:05
  What's your problem?
• 44:06
  So then he was referred to a pain specialist who escalated this guy on methadone up to a dose of 360 milligrams per day.
• 44:18
  Now that's a dose that would kill an elephant.
• 44:20
  Okay.
• 44:22
  I used methadone.
• 44:24
  It's a great drug for somatic pain.
• 44:27
  But my ceiling dose, the highest I ever went for any patient on methadone was 40 milligrams a day.
• 44:34
  This guy was on 360 milligrams, so high it was making his pain so much worse, not better.
• 44:42
  And uh he has several other things going on for him.
• 44:44
  But Don also had severe generalized anxiety, bouts of severe depression.
• 44:50
  And his past history, um, he admitted his anxiety and depression, by the way, were never controlled, but he did meet the DSM-5 criteria for bipolar disorder, and that was undiagnosed, even by a psychiatrist.
• 45:04
  And that happens more often than you would think.
• 45:08
  But he was tormented by chronic insomnia, and he admitted uh a history of heavy methamphetamine abuse for about 14 years, but he was now clean and sober for 10 years.
• 45:21
  So that was in his past.
• 45:27
  He had obstructive sleep apnea for which he was prescribed CPAP, continuous positive airway pressure, but he didn't tolerate the sleep apparatus.
• 45:36
  And so his insomnia worsened his anxiety and his depression.
• 45:41
  And he now worried that his wife might leave him because he was, as he said, uh living with an ogre isn't easy.
• 45:48
  He said, and my wife, he was afraid she's gonna boot him out of the house.
• 45:52
  And that's when he came to me, totally devastated after his psychiatrist, his orthopedist, pain specialist, primary care doc didn't know what to do with him.
• 46:04
  So his intractable pain just worsened on the methadone so bad that he said it's not making me better, it's making it worse.
• 46:11
  So he started self-tapering.
• 46:12
  Um, was all this pain in his head?
• 46:15
  Well, he was referred to the psychiatrist who put him on diloxetine and high dose clonazepam for anxiety and zolpidam ambient for sleep problems, and then omeprazol for heartburn, which he said he didn't have.
• 46:30
  So this was an absolute recipe for disaster.
• 46:34
  And Don's pain, his anxiety, his depression, and insomnia continued to further worsen because he was placed on the high dose benzodiazepines and high dose opioids.
• 46:47
  That is asking for central pain.
• 46:50
  His bipolar disorder was still undiagnosed when he came to me.
• 46:55
  And then most devastating to him, he was forced to apply for disability through the carpenter's union, and he felt at this point that his life was over, had ended, and he actually had thoughts of suicide.
• 47:10
  He says, you know what?
• 47:11
  I'm ready to pull the trigger.
• 47:12
  I just don't think I can go on any further.
• 47:15
  I mean, this guy was just, he was just mad, angry beyond anything I'd ever seen in any of my patients in my clinic.
• 47:26
  And he was asking me, why do I have all this pain?
• 47:29
  Why can nobody tell me why I am in such severe pain?
• 47:34
  Well, that's when he was first referred to my clinic.
• 47:37
  So let's talk about Don's recovery.
• 47:40
  Well, Don began the healing process at his very first visit.
• 47:44
  When I told him that not only could I explain his pain, but I could make it go away.
• 47:52
  You should have seen the look on his face.
• 47:54
  All of a sudden, Don got quiet.
• 47:57
  What?
• 47:58
  Yeah, suddenly he found hope.
• 48:02
  Well, I started the C three-step process.
• 48:05
  So I stopped or tapered the methadone, the clonazepam, the deloxetine, they all had to be tapered and then stopped.
• 48:14
  I don't like deloxetine, by the way, even though it has an indication for treating central pain like fibromyalgia.
• 48:21
  I don't like the drug.
• 48:22
  It's hard to get off of and it doesn't do the job.
• 48:25
  Secondly, I prescribed Suboxone for his opioid dependence.
• 48:30
  I was licensed to do that.
• 48:32
  I was certified to do that.
• 48:33
  And so I started him on Suboxone, and that works very well for pain, by the way.
• 48:38
  And I started him on eripipazole to get control of his bipolar depression.
• 48:46
  And guess what?
• 48:48
  He started to improve drastically.
• 48:52
  His bipolar disorder was controlled.
• 48:54
  I gradually tapered him all the way off of Suboxone, and I thoroughly explained his CRPS diagnosis to him and started training his brain to reverse the adverse neuroplastic changes that caused his centralized pain, which resulted from his severe emotional trauma resulting from a surgery going bad.
• 49:18
  So this metaphorical eeure of my medical practice actually began showing up to my clinic with a smile on his face.
• 49:28
  Nobody could believe it in my clinic when I saw him.
• 49:31
  Hey, Don, how are you doing?
• 49:34
  He was doing great.
• 49:35
  He would tell a joke, he'd smile.
• 49:37
  And guess what?
• 49:38
  He resumed work.
• 49:39
  He opted for uh eventually having a total knee replacement because he had severe arthritic uh uh joint, a severe arthritic joint in the knee, and this time he had no complications at all.
• 49:52
  He resumed work as a maintenance man in a housing complex, and he was functioning very well.
• 49:59
  He lost.
• 50:00
  Weight, his marriage stabilized, and he went on to enjoy a good quality of life.
• 50:07
  His CRPS was healed, and he got off all of his pain medications.
• 50:13
  All of them.
• 50:14
  His bipolar disorder continued to be well controlled.
• 50:19
  Don was whole again.
• 50:21
  He was living proof that anyone can recover from central pain.
• 50:27
  Now, let me just discuss with you two cases of phantom limb syndrome that contrast with each other.
• 50:35
  Let's call it a tale of two amputees.
• 50:38
  All right, so phantom limb syndrome is painless.
• 50:42
  Remember, it just results from memory of the absent limb.
• 50:46
  But when it's painful, then it is always central pain.
• 50:50
  And we call it phantom limb pain.
• 50:53
  I had a 28-year-old desert storm male veteran who lost a leg in a rack from an improvised uh explosive device, an IED.
• 51:04
  He lost his leg above his knee, and this combat hero compensated for his 12-inch left thigh stump with a prosthesis, and he learned to walk again.
• 51:16
  And he resumed a fairly normal life again.
• 51:21
  He had received counseling to deal with his wartime trauma.
• 51:26
  And guess what?
• 51:27
  It made a huge difference.
• 51:28
  And he demonstrated great emotional recovery because it was dealt with right away.
• 51:34
  He was happily married.
• 51:36
  He exercised regularly, he ate healthy, and he was pursuing a prosthetic bioengineering degree.
• 51:45
  And this guy was planning to actually do research and mechanical limbs.
• 51:49
  Isn't that awesome?
• 51:51
  He had no phantom limb pain whatsoever.
• 51:56
  In contrast, a 63-year-old woman in my practice, who was a diabetic, severe brittle diabetic, whose left lower leg below the knee was amputated because of her diabetic microvascular disease.
• 52:12
  She, in contrast, experienced intense emotion emotional trauma from losing her leg.
• 52:19
  This really bothered her.
• 52:21
  She lamented her reliance on a poorly fitting prosthesis that she said was very heavy, and she had to don it in the middle of the night just to use the bathroom, and this just aggravated her to no end.
• 52:34
  She was angry because she felt she had to quit her job that she loved because of this amputation.
• 52:41
  And she was embittered by her loss of mobility, and she resented her complete dependency on her husband for transportation.
• 52:52
  She felt constantly miserable, and her daily life became drudgery.
• 52:57
  Well, this all contributed to her centralizing of their phenomlimb pain.
• 53:02
  So this limb pain developed from bad emotions.
• 53:08
  And it demonstrates how much impact perception has on processing emotionally charged painful life events or circumstances.
• 53:21
  Despite being treated for her chronic depression, she maintained the most unfavorable outlook on her stressful life.
• 53:31
  It could have been a lot easier.
• 53:34
  Well, they were both treated, but how ironic that a young male amputee lost his leg in the military at a very young age, you think he's the one that would be disgruntled.
• 53:48
  When in fact he was coping very well, adapted very well, and never developed phantom limb pain.
• 53:55
  As opposed to a 68 or 63-year-old who had all kinds of pain because she was so bitter and angry and couldn't pick up her life and move on.
• 54:07
  So that shows you how complex regional pain syndrome develops, how phantom limb uh pain develops.
• 54:18
  And I hope after this discussion today that you have a better understanding of CRPS and phantom limb pain and other types of central pain as well, because treating them is pretty similar in a lot of ways.
• 54:34
  Now, I haven't covered all of the syndromes.
• 54:40
  But I did discuss them at length in my book, Pain Free and Living Again, How to Heal Fibromyalgia, IBS, Migraines, and Other Mystery Pain Syndromes.
• 54:51
  So I would encourage you to read that book if you want to dig in further.
• 54:54
  And I go pretty deep in there, but it is uh I don't use a lot of medical jargon.
• 54:59
  I make it understandable so that you and your physician can have a great discussion on central pain, and you can both speak the same language if your doctor also reads this book.
• 55:12
  Most doctors don't understand central pain.
• 55:16
  So next week I plan to conclude this series on central pain as I discuss the most important step in healing all central pain, and that is how to train the brain to reverse central pain.
• 55:34
  It isn't hard to understand.
• 55:37
  It is not hard to initiate, and it does not take long to get lasting, life-changing results that restore normal, pain-free living again.
• 55:51
  So I encourage you to tune in next week and listen to that.
• 55:54
  It is where I part ways with mainstream Western medicine because it is grossly lacking and backwards in its thinking about how the brain and body interconnect.
• 56:15
  Thanks for listening today.
• 56:16
  You're listening to Unity Without Compromise.