Mama always said, life is like a box of Percocets and Ambiens

It’s no fun to be in chronic pain. It’s no fun to take cocktails of medications that alternate between drugging you up entirely or leaving you awake at three in the morning alone with your pain. Many pain sufferers live in constant fear of becoming addicted to their pain medications. Many doctors are totally inadequately trained in managing pain and thus tend to under treat.

recent online article speaks of a terrible situation where the number of Americans experiencing pain in their last year of life has increased. Present-day medicine is a double-edged sword. It is making it possible for people to live much longer than ever, even in comparison to a generation ago. Modern medicine is able to cure diseases that were thought incurable until recently. But modern medicine is failing to deal with the ravages of age. For every spry 80-year-old who is still playing tennis every day, there are many others who live literally a daily hell. Even after taking all of the medications for their various diseases, they are still left with chronic pain that no medication really seems to help. So, modern medicine simply is not helping enough.

I have mentioned in the past that I am a chronic pain suffer. I spent a year and a half with constant searing pain which destroyed my day-to-day life. My luck in the midst of all this was that I work primarily from home. If not, I would have probably become registered as “incapable of working” many years ago. And despite the fact that I am a physician and can work under a whole variety of situations, during the worst period of my pain, every day was a horrible struggle. I still have chronic pain which has moved around my body. It was initially in my neck which thankfully responded to epidural injections of cortisone and then it moved down into my lower back which has stayed with me now for a long time.

In some ways, I am thankful for this experience. One of the constant challenges that doctors face is that they have no personal experience with the difficulties of living with a particular disease. I think there is no question that a doctor who suffers from diabetes can connect with a diabetic patient on a whole different level.

Ever since I became a pain sufferer, my sensitivity towards the pain of my patients and others in general became far more acute. I became much more aggressive in treating pain quickly and with more intense medications. Everything I did was safe. Everything I did was scientifically sound. That’s what’s so infuriating. I didn’t have to break through any glass ceilings. I didn’t have to lay new ground. All I had to do was apply existing principles to treating people’s pain. I cringe at the under-management of pain that goes on throughout the world and even in top medical facilities.

This lack of proper pain control is a crisis. This is something that demands a fundamental change in the way doctors are trained. This is something that should have special software written and then incorporated into EMRs, to make sure the doctors never forget to manage a patient’s pain.

Pills are not the only way to manage pain. There is a whole world of “alternative” medicine that deals with pain issues as well. I personally really do not like the term “alternative”. If something works, and can be proven to do so according to the standard scientific approach, then it is not alternative – it is part of classical medicine. Whatever we decide to call treatments like acupuncture and reflexology and yoga, the only real question is whether they help.

Interestingly, during a discussion I had just this morning, I suddenly realized something that I never really formulated before. Doctors are taught how to treat the diseases that we know how to treat. When treatment fails, doctors are also taught, but less so, how to treat the symptoms of those diseases. Therefore, when a patient presents with back pain, that patient will undergo an evaluation intended to find some type of anatomical problem to explain the back pain. In most cases, a reason is not found. At that point the doctor treats the symptoms using pain medications of various sorts. In some cases, when these medications and other treatments no longer work, the doctor will lift his/her hands in admitted defeat and say “why don’t you try alternative medicine, since you have nothing to lose”.

What I realized this morning was that it shouldn’t be a choice. In fact, back pain is now recognized by classical medicine as being far more complicated than just an anatomical problem. “Back centers” house various specialists who deal with diagnosing a medical source of back pain, and then providing a whole variety of treatments, from physiotherapy to acupuncture, looking for an overall plan that will get the pain under control..

The point is that doctors and the public tend to see classical medicine and alternative medicine as a dichotomy. You are either in one group or the other. If an orthopedist is taking care of you now, why would you bother going to see a reflexologist. The clear best approach is for difficult problems to be treated is in unison.

There is a very interesting group online that is investigating causes of sleep disorders. I have personally become fascinated with this group and I consider myself lucky to now be part of their work. Their premise is straightforward: they wish to learn as much as they can about sleep disorders in order to turn this information around and use it to help people with sleep problems.

When a patient goes to a doctor complaining of difficulty sleeping, almost invariably the patient will be given one of a range of medications that affect our state of wakefulness. Some medications are very nonspecific and cause general drowsiness and other side effects. Some other medications are more specific and really can help a tremendous number of people get a good night’s sleep. The point is that dealing with sleep disorders should not be that much different than dealing with pain.

Most doctors have no formal training in dealing with sleep disorders. The doctors who are more familiar with the issue tend to think that sleep disorders are primarily related to sleep apnea [problems with breathing during the night]. But sleep, like pain, is apparently a very complicated physiological entity. When a person can’t sleep, there can be many reasons for it. And unfortunately, most patients never get to a doctor who can really identify the cause of the sleep disorder.

So what do doctors do? Well, just as with pain, they will try to identify a problem causing the sleep disturbance, although a clear cause is rarely found. Then the doctor will treat the symptom, for which there are a plethora of medications. But there are other options. I have come to learn of a large group of specialists who help people deal with their sleep problems in a whole variety of ways. and it is now clear to me that people with sleep disorders should explore both options simultaneously.

So let’s say that a physician prescribes one of the classic medications for insomnia. The patient takes the medication and manages to sleep and functions better on a day to day basis. But the solution is not perfect. Many sleep aids have side effects which can be very problematic under certain circumstances [such as people who need to drive to work early in the morning].

Now let’s say that the patient takes the prescription for the medication but also seeks out the care of a specialist who deals with understanding the source of the sleep problems. This specialist often uses a whole variety of techniques to help a person relax and achieve better sleep. It might be that after a couple of months, the patient finds that he or she can sleep fairly well without the help of the medications. But the medications still do help. So the patient continues taking them for another few months, by which time the patient discovers that he or she can now achieve a proper night’s sleep without any medical assistance. Pardon the pun, but a success story like this would be a dream.

Doctors, healthcare workers and patients all have to realize that we are still far away from having all the answers, even for problems that chronically plague people and make their lives almost unlivable. We all have to keep our egos in check and make sure that we are working to find the best individual or combination of treatments that help patients. I don’t think anyone could expect more. And over time, as we get better and better at treating patients for the problems that bother them, we will reach the day when people no longer needlessly suffer.

Thanks for listening

My website is at

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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