Hippocrates once stated, “The natural healing force within each of us is the greatest force in getting well.” I love this message, not only for its wisdom, but for the message of self-empowerment. I believe the message we tell ourselves is the most powerful one of all. I am aware every moment that there is much to despair about and much that causes suffering. This is a time of great uncertainty and fear. Will we ever trust each other again? Will things ever “go back to normal?” At the same time, I also tend to be someone who wants to hold on to hope and positivity. I want to try to share some of the silver linings if I can, see more glasses half full.
With my 12+ years of experience in the practice of pain medicine, I never forget all of the many suffering patients out there, and the terrible, painful diseases seemingly being ignored, or postponed, during COVID-19: the unfair circumstances, grief and isolation, unemployment and disability. There is depression, anxiety, and addiction. I cannot forget the 2.3 million people with opioid use disorder, and the mental breakdowns that may occur with more and more loss. Due to the strange new world of social distancing, every social dynamic and every structure supporting modern society is undergoing a massive online transformation. It is a seismic shift that will take time to fathom. We are all now sensing the same human despair felt by the survivors of hurricane Katrina, the 2019 Mississippi River floods, or the horrific fires of California and Australia. Those disasters did not affect everyone personally the way this disaster is, in such a contagious, insidious, and ubiquitous way. COVID-19 is the greatest equalizer of all. It is the strongest message from our planet that we have ever had to face in our lifetime. We are learning, in so many ways, how deeply connected we are as a human race.
As a spine interventionalist, I am confident that eventually, procedures and elective surgeries for pain will come back. In fact, they too are only evolving and changing. We will all get through the slow and complicated transformation of much of our hands-on medicine into telemedicine, and perhaps even return to many of our old ways of delivering care in the end. But COVID-19 gives us the chance to change pain care delivery, the industry of health care, and our collective conscience about “what is essential medicine,” forever. We have to rethink the way we deliver and consume health care, and how our nation will support it in a safe, ethical, and compassionate way. Physicians need to think carefully about how to educate and counsel suffering patients moving forward, and how to keep people well.
The most important part of chronic pain management is learning from and teaching suffering patients how to engage better in self-care, both mentally and physically. There are endless ways humans suffer physically – no end, it seems at times, to the suffering from trauma, severe pathology, aging, anxiety, addiction, isolation, and depression, which this pandemic does not make any easier. The process to living better and feeling less pain is not easy or clear for anyone, and pain care must be individualized to the patient. What I do believe is that we all have the innate ability to heal, and there is a way to practice thoughts and behaviors to feel better.
Buddha understood, thousands of years ago, that the root of suffering is Attachment. Attachments to physical comforts, behaviors, and our very thoughts constantly telling us how we feel and who we are – are going to be very difficult to let go. I must not lose the nerve to dig more into the psychological and behavioral root causes of suffering, while there is this unique time to at least try. No more excuses of the previous daily grind, the endless commutes, the pressures of consumer health care and the business model of medicine. Medical evidence about the pathophysiology of pain, pain psychology, and gold standard paradigms for pain care has already proven time and time again that chronic pain cannot be explained simply by the degenerative disc disease, arthritis, or soft tissue pathologies reported by radiologists after a patient’s umpteenth MRI and long history of failed symptomatic treatments. Pictures don’t ever explain or predict someone’s degree of suffering, or his or her response to standard pain care options. Nor do long-term opioid refills truly heal the suffering that underlies chronic pain and medication dependency. I believe there are ways to get through chronic pain without pills, procedures, and surgery, because I have seen many people do it, but it will take some time to really believe or understand this on a wider level.
There is a new opportunity to change the course of what it means to suffer from pain and how to treat it. To do this, providers and patients first need to learn how to navigate the Internet, get Access to Telehealth (virtual visits), and give their time and attention to the providers they trust. What used to be one of the greatest sources of “burn-out” – screen time — is now a great asset and means of delivering ambulatory, specialized medicine: The giant Telemedicine machine that is part of the rapidly transforming virtual world. If I can just help my patients get Telehealth access, and figure out the right virtual model for truly interdisciplinary, functional, integrative, restorative pain care, the possibilities are endless. I now become the screen that used to interfere with face-to-face time with my patients, so essential during doctor’s visits. I can reach potentially anyone, anywhere, at a designated time, in the comfort and security of a patient’s own home. No more depending on drivers, worrying about parking, or figuring out how to physically get to a specialist so far from home. Just a click or two, and I am with you. I am here to listen, as always, but also, I hope, to counsel and teach things that may really help with chronic pain. The old Latin root definition of “doctor,” or “docere,” after all, is “to teach.”
What I am working on now is how to implement a program to those who need it the most, as soon as possible. If you are a chronic pain patient suffering during COVID-19, and you would like to be part of my integrative pain care group list (used only to share information about upcoming educational events, workshops, and virtual pain care programs)), or learn more about a pilot virtual integrative pain care program involving several integrative pain care disciplines/ expert providers, please email integrativecarefoxboro@gmail.com. All Mass General Brigham patients may schedule a virtual visit with me by calling: 508-718-4375/ 617-643-7963, Monday-Thursday.
Please see the Calendar of Integrative Pain Care Events, which will be updated monthly.