Pain Relief for the Potential Out-of-State or International Patient

Please Rescue Me From My Pain!

_{Be sure to stick around for the second half of today’s post because I take you through a contact form that I received just yesterday (I turned it into a CASE HISTORY)}.

Everyone (that would be everyone as in “everyone“) who CONTACTS ME wants to know the same thing. They ask the very question that I would be asking if I were in their shoes. Doc; can you help me with my pain? You see, no one contemplates traveling a distance to see me unless they are struggling with real, tangible, life-wrecking pain. The kind of pain that is making them dysfunctional and altering — or even destroying — every aspect of their life (the same is often true of our LOCAL PATIENTS as well).

While every case person is different and exceptions abound; who am I most likely to be able to help — particularly when it comes to those of you who have been dealing with your problem for a very long time, years or even decades? Let me give you some simple rules of thumb.

First, please don’t be upset at me if I tell you that I am doubtful as to being able to help your particular problem. I have had a fair number of potential long-distance patients take it out on me because I do not think I can help (HERE is one such example). I have also had people decide to come despite me telling them that being able to help them was “iffy” at best. In a significant number of those cases my treatment actually helped them tremendously.

Also, I do not need a book. I have received emailed histories that are several pages long, some of them single-spaced and without paragraphs. I need concise, to-the-point detail. What kind of detail? Follow along. As a side note: I have had a number of people who keep a running history and simply email it to me as an attachment. That works as well.

Can I Help You With Your Pain?

The truth is simple. Who really knows whether I can help you with your pain or not? In 100% of all cases I treat, local or long-distance, I never really know until I examine, lay hands on, and actually treat a patient as to whether or not what I do will help. What I promise is that I will always treat you fairly. I will never take advantage of you even though it is easy to do with people who are in pain (see previous link) and will do everything in my power to change your life for the better.

The Weirder the Symptoms, the Less Likely What I do Will Help With Your Pain

The weirder and whackier your symptoms, the less likely I will be able to help you with your pain. I am not going to rehash this here because I actually wrote AN ARTICLE ON THIS VERY TOPIC. But realize that I turn away the majority of the potential long-distance patients who contact me (over 50%) because they fall into this category.

It’s not that I don’t feel for those of you living this nightmare, it’s that if I don’t really believe in my gut that I can help, I won’t lead you on. Again; it’s the top reason I turn away well over half the people who contact me. Maybe as many as four out of five — I have never kept track. If I have any ideas for you, like visiting a FUNCTIONAL NEUROLOGIST, I will make those when I tell you.

Realize that because I get so many people contacting me with questions about ??????, I cannot possibly answer them all (if I do I will likely turn it into a POST TO SHARE WITH EVERYONE) such as you will see momentarily. Also, if I get something like this in my inbox, “neck pain,” I will not be responding to you. You would be shocked at how often this happens; no exaggeration. And then people are ticked at me because I didn’t answer them.

What Makes Your Pain Worse?

Thirdly, what makes your pain worse? Can you reproduce it or is it totally random? I help a lot of patients with MUPS and symptoms that they cannot reproduce and that no one has good explanations for (you know, the kind of problem that every doctor / specialist you visit tells you something different, and it’s all BS — LIKE THIS). Just realize that in most cases, if your problem is, say, exacerbated by turning your head to the left, it’s probably a straight-forward and simple case. Again, I say “probably” because I never really know.

What Makes Your Pain Better? What Have You Done for Pain Relief on Your Own and Has Any of it Worked?

Fourthly, what makes your pain better? In the same way that it is important for me to know if you can reproduce your pain, I also need to know if you can tone it down or shut it off completely by doing something or by stopping something specific. What have you done for yourself? In other words, are there steps that you have tried, whether successfully or unsuccessfully? “I can relieve it by stretching” or “I can relieve it by laying motionless in bed” or by getting an adjustment or whatever it is. If there is nothing you can do to relieve your pain except take meds, I need to know that as well. If you can get relief from something (stretching for instance) but feel like it only lasts for a couple minutes before you have to stretch again, I want to know that as well.

Provide a History of Your Pain

Fifth, I want the history of your problem / pain. Was your pain caused by an injury or did it have a gradual onset with no known cause? How long have you been dealing with the pain? How much worse is it now than when it started? Or is it better? It goes along with the previous section, but who have you seen for your pain (orthopedists, neurologists, chiros, PT, massage, acupuncture, etc, etc)? I’m always interested in what they have told you, but I do not need to see thick reports or treatment records. Have you had any imaging done and if so, what were you told?

How Do I Decide Whether I Think I Can Help You or Not?

How do I make my decision? I’ve been a chiropractor for three decades. I’ve been doing specialized fascia work for the last two of those. If you follow my site you know that I stay current (or at least as current as a person can with the ocean of information out there) on the latest peer-review in the fields of body work, fascia, chronic pain, and a whole host of other topics in the realm of functional medicine.

My decision to treat you or not treat you is not made frivolously or taken lightly. It’s based on lots of experience with similar patients and similar situations. That’s right. Unfortunately there are way too many is the same boat you are.

My “Pain Relief” Pledge to You in Three Parts

Thirty years in practice has made it possible for me to make you a pledge — a pledge that I stand by fully. If you come to see me for one of our 6:30 am Tuesday or Thursday morning appointments…..

• Secondly, I am not here to “sell” you something. No gimmicks. No sales pitches. And no trying to up-sell you on ????? once you are here. This is not to say that I won’t send you out of here with some LIGAPLEX and a DAKOTA TRACTION DEVICE. But as far as “selling” you on anything, including return visits, I won’t do it. As to the question of whether or not you should return in the future for more treatment, only you can really answer than question (see next bullet point). Some do, some don’t.

• The third part of my pledge is equally simple. Long-distance patients will know after one treatment whether or not my approach will be helpful, or if I am full of hot air (or something else). Nope; I am not suggesting that I can completely solve your pain in a single visit (ALTHOUGH THAT HAPPENS WITH LOTS OF OUR PATIENTS). What I am saying is that you will know if it is helpful. A week or ten days after treatment; if you have to ask yourself if it was helpful, it probably wasn’t. And if it was not helpful the first time, more of the same is not likely to be helpful either.

What About Long-distance Patients Whose Pain I Don’t Help?

Yep; it happens. Despite everything some people don’t see any results. Many of those people have fascial adhesions by the bushel but don’t get much if any relief of their pain from my approach. What does this mean? It could mean, in certain instances, that THEIR PROBLEM HAS CENTRALIZED (I rarely take on patients that I believe this to be the case, ALTHOUGH IN SOME CASES IT MAY BE WORTH A TRY).

It could also mean that yes, their pain is likely being caused by fascial adhesions, but said adhesions are TOO DEEP FOR ME TO GET AT. It may mean that there are other things going on that I do not completely understand or even see.

That aside, I know of no one else telling prospective long-distance patients that they will know after a treatment whether or not my approach will successfully address their problem (I am talking about truly chronic, NON-DISC-RELATED problems here that I think I can help).

Turning a Contact Form Into a Case History

Again, please realize that even though I enjoy going through histories such as the one I got from Misty just yesterday, and showing you what goes through my mind by “thinking out loud,” I can not answer them all specifically or in detail.

Pay attention to how my thoughts of being able to help Misty go from ‘no way‘ to ‘maybe‘ after getting her actual contact form in my inbox. Here is Misty’s first email to me….

Please contact me regarding starting process for out-of-state patient evaluation. I have suffered for years with migraines, trigeminal and occipital neuralgia, fibromyalgia, chronic pain. The spiral downwards began after a severe car accident 20+ yrs ago. Thanks!

My first impression was to say to myself, “heck no; there us no way I can help Misty — all her problems are all neurological“. Yes, we help a lot of people with MIGRAINE HEADACHES. Yes, we help plenty of people with various NERVE ENTRAPMENT SYNDROMES & NEUROPATHIES. And yes, I have helped plenty of people who have both FIBROMYALGIA (a form of small-fiber neuropathy) and CHRONIC PAIN.

The questions running through my mind are legion, but by far the biggest is whether she has CENTRAL SENSITIZATION or not. Tic Delroux (aka Trigeminal Neuralgia, aka “suicide disease” is never a good sign). More on the neuro stuff momentarily. Now we will start to tackle the second email she sent me — the detailed history.

I was in a bad motor vehicle accident 22yrs ago, which started my spiral downward.

Experience would lead me to argue that MVA are the single biggest traumatic destroyer of health and cause of pain in America. I could not even begin to tell you how many people I have seen who have been totally messed up by WAD (Whiplash Associated Disorders). Now mix this crazy fact into the mix. A team of renowned whiplash researchers (both British orthopedic surgeons) concluded approximately two decades ago (HERE) that whiplash injuries frequently result in an array of “bizarre and seemingly unrelated symptoms.” This is our starting point.

I required shoulder surgery to repair a broken collarbone and rotator cuff repair. I had damage to my face, neck, left side of my body. I did extensive chiropractic care. It never completely relieved my neck pain (have had neck pain every day since). At some point it stopped helping as much and the pain continued to get worse, so I stopped going. Range of motion and overall health continued to decline.

A lot to unpack here. First, there are FASCIAL ADHESIONS and restriction all over the place! Damaged ROTATOR CUFF. NECK INJURY. And different than plain old HEADACHES, she may have both FACE PAIN (or HERE) and SKULL PAIN.

And while I don’t have any real idea at this point whether or not TISSUE REMODELING would have helped (best guess is yes), what I know for sure is that CHIROPRACTIC ADJUSTMENTS without dealing with underlying SCAR TISSUE will lead you to THIS SCENARIO (someone who had been adjusted 3x/week over a thousand times before finding us — all due to an MVA if I remember correctly).

Fast forward some years and I started developing migraines, dizziness. The meds started and the weight started piling on. Another few years pass and I developed nerve pain. A series of doctors/specialists and I was diagnosed with trigeminal and occipital neuralgia, fibromyalgia and insomnia.

Have not talked about VERTIGO yet but realize that virtually all of these problems have roots in a hyperactive brain (SYMPATHETIC DOMINANCE). In the same way that various things can lead to an overactive immune system — a system that decides it’s going to attack “self” (AUTOIMMUNITY) — an OVERACTIVE NERVOUS SYSTEM leads to a myriad of problems as well, usually exacerbated by certain stimuli (light, heat, cold, stress, wind, noise, smells, etc, etc, etc).

I went to Mayo. They disagreed and said my issues were from past unresolved trauma, depression, and because I was overweight. I went back to my local doctor (neurologist) and have continued to be treated by him, as it felt like he was the only one that believed me.

This is the sort of cop-out that frankly chaps me. All three of these diagnoses are nothing more than convenient scapegoats. A way to blame the patient, while providing nothing helpful other than some CRAPPY DRUGS. If anything, Mayo has it just backwards.

Both DEPRESSION and OBESITY / OVERWEIGHT are considered “inflammatory” or CAUSED BY INFLAMMATION (something that far too few doctors truly understand, let alone the general population). Deal with the underlying inflammation and you have a fighting chance. Especially once you realize that inflammation always results in FIBROSIS (the medical word for scar tissue).

As a quick side note here, realize that few commonly-prescribed classes of drugs have a higher side effect profile than anti-inflammation meds (HERE).

I came home from Mayo and decided to put it all into losing weight to rid that Dr of the excuse that I was just overweight. I lost 40lbs. It helped some, but I was still in pain and eventually ended up not being able to work due to pain and side effects from meds used to treat pain.

One of the things I already love about Misty is her determination! As you will see, she does not want to be on meds (for injuries like her’s, YOU CAN EXPECT TO BE PRESCRIBED THE “BIG FIVE”). Living has become a struggle and even though she’s a fighter, she knows that control of her life is slipping away and it’s a crushing realization.

I’ve tried many medications, massage, chiropractic, acupuncture, injections, PT. Some of the medications have been helpful – but I truly try to take as little as possible because of side effects. What I have found more helpful has been a more holistic approach. I’ve been able to come off a lot of meds simply by adjusting my diet. The healthier I eat – the better I feel.

A lot of truth in this paragraph. I already picked on the chiros, but physical therapy is no different. Fail to first address scar tissue and not only will treatment not work well, in some cases it makes people worse (HERE). PHASE I must come before PHASE II, which all has to do with the DIFFERENCE BETWEEN SECTIONAL MOTION AND SEGMENTAL MOTION IN THE SPINE.

As to drug SIDE-EFFECTS (click to learn the truth about antidepressants), history will one day look back on our generation as Gen Pharm. Most people really don’t want to live this way and Misty is no different. Pay attention to her truth bomb — the holistic approach worked better. I tell people every single day that if they are not willing to step outside of the box, true recovery is a distant mirage that they can see, but will never reach. More on this shortly.

The problem with this is that it takes a lot of effort to eat whole non-processed foods. I love to cook, but this becomes very difficult when I am in a pain cycle. I’ve been in a downward pain cycle for about a year – so I fell off of eating gluten free and more processed/prepared foods have crept in. The weight has been adding back on. An article in your website reminded me of how much eating gluten free helped in the past and I will be working on getting GF again! Also, cutting down sugar and making sure I am properly hydrated helps the nerve pain considerably!

Difficult to do; yes. But there are few things in life that are both good and easy. You are spot on as far as GRAINS (be sure to read Dr. Perlmutter’s ‘Grain Brain‘). If you have GLUTEN SENSITIVITY, it will foul your neurological systems (HERE).

Processed and fast foods are two I barely need to mention, BUT DO ANYWAY. And as for SUGAR, it’s the most inflammatory thing people are putting in their mouths all day, every day — arguably the #1 way people are sabotaging their health and causing, or at least heightening, their pain. Realize Misty that I am not picking on you here (you said nothing about fast foods) but I am providing info to lots of people in your boat. Also realize that I am not sure I have ever met a female fibromyalgia sufferer to is not ADDICTED TO SUGAR.

My strength, as I’ve become more immobile, has decreased. About two years ago I strained my lower back. It never fully recovered and I suffer from quite a bit of back pain now. With the addition of the back injury two years ago – cooking became even more difficult as standing for too long is painful. I rely on heat a lot. It helps loosen things up.

None of this is surprising and is probably related to the THORACOLUMBAR FASCIA (almost 90% of all back pain is actually labeled by the powers-that-be — not by those actually making the diagnosis — as “non-specific”).

I really like epsom salt baths. Drinking BCAAs helps. Yoga and stretching helps initially, but it feels so easy to overdo and I get a lot of rebound pain the next day. The initial relief is also short-lived and I never feel like I’m getting anywhere, except worse. My favorite yoga is Yin Yoga where the positions/stretches are held for longer. This provides the most relief.

Most people tend to be magnesium deficient as it is (Epsom salts are Magnesium Sulfate). Throw in the chronic pain and over-hyped nervous system and bam; your body is literally hemorrhaging this all important mineral.

I’ve always been a fan of yoga stretches and other CORE STRENGTHENING EXERCISES. Be aware that the issue of your stretching making you worse (HERE or HERE) is analogous to other physical/mechanical therapies making you worse or at least aggravating your pain — if significant scar tissue is present. Hard to get better while trying to stretch, exercise, or get adjusted through a mountain of scar tissue.

But yoga/stretches are hard to do – it feels like there are so many restrictions inside my body. And when I’m doing the moves – I work on one part and it strains another. My obliques are super tight. The rare occasion I can get them to release – it seems to help lower back.  Some of the stretches for low back hurt my shoulders. Some for shoulders hurt my lower back. Foam rolling requires using arms/shoulders to support yourself. The muscles are so tight and weak at this point it’s very hard to do. I feel like every way I twist – something is pulling and tight. I struggle to loosen up my muscles, I often get very painful spasms if I go too deep. But not going deep really does nothing.

Fascia is what connects every part of you to every other part of you (HERE). Compensation is occurring all over the place. The problem is spreading. BTW, I am a fan of FOAM ROLLERS and promote them but do not sell them (I also promote ROLLERS THAT ARE IN NO WAYS “FOAMY”).

I tried physical therapy twice a week for about 4mos last year. I got frustrated. He was frustrated with me. I never really felt like he understood my pain. We made very little progress. I’ve tried a lot of massage over the years. It feels good at the moment, even with the pain that is caused from deep tissue massage. But the effects just don’t last.

I dealt with this at length previously.

My migraines are most often triggered when my next pain has increased. Heat often helps neck muscles relax. I spend some part of almost every day on a heating pad for lower or mid back. Or my neck heating pad.

Using LIGHT TO YOUR ADVANTAGE — maybe with infra-red, SUNSHINE (definitely w/ sunshine), or even LASER could be beneficial as well, as could a hot tub.

Rest is a double-edged sword. Some rest is good, but too much leaves me feeling super tight and in more pain. Another source of pain for me is my abdomen.

Rest is a double-edged sword. I could not have said it better myself! The reality is that CHRONIC FATIGUE is almost always associated with an amped up sympathetic nervous system. The result is that people are always exhausted but never able to sleep — or at least sleep restfully (HERE).

I had a hysterectomy approximately 15yrs ago due to endometriosis. I have a large scar across lower abdomen. I have since had 3 surgeries to go in and clean up adhesions since hysterectomy. The last surgery required my right ovary and appendix be removed due to adhesions. My intestine had become attached to abdominal wall. They cleaned up as much as they could. The pain was better for awhile. The pain has been increasing again and I know the adhesions are back. I also have adhesions on the left side that they did not want to attempt to fix because they are surrounding my colon.

I waited until here to address issues with your OBLIQUES AND ABDOMINALS. Remember, however, that there is a big difference between adhesions of the abdominal wall and those of the abdominal cavity (HERE). The former are usually not so difficult to address successfully — I dealt with two or three of these yesterday (SJ). The latter I cannot say that about. Internal adhesions and all of the mess that goes with it (HERE — endometriosis, fibrotic adhesions, etc) are very difficult to address successfully (where they don’t come back).

My low back pain also includes issues with very very tight hips. It always feels like something is “out of place” in my low back. Chiropractors can rarely get movement. I can occasionally after heat and using a ball for trigger point therapy – get something to pop. It helps temporarily, but doesn’t last long at all!

Again, thoracolumbar fascia. But just being a woman makes you much more prone to “hip” pain (BUTTOCK PAIN) around the SACROILIAC JOINTS and hip region. All the more true if you have had children.

As far as trigeminal pain – I definitely experience pain in the trigeminal nerves. But I often wonder if it’s truly “trigeminal neuralgia”. TN is not supposed to affect both sides of the face – it’s generally one side or the other. While it’s predominantly on my left side and in the upper two branches, I do also experience pain on right side. I get the trigger pains from stimulus, but I also experience constant pain on the left side. I also did see a TN specialist at the U of M. He said he had no doubt something was compressed – but in his words “you can’t do exploratory surgery in the brain”. I also have quite a bit of tightness in my jaw and when I open my jaw you can feel knots in the muscles in the jaw joint. 

The only thing I know to do here is calm the sympathetic nervous system and use a laser (sometimes functional neurology helps as well). As far as TMJ is concerned, when you add everything else into the equation, you are almost assured of either being called “crazy,” or being told that it’s all in your head, simply because RESEARCH HAS SHOWN that a significant amount of jaw pain comes from the brain itself and is not always purely “mechanical” in nature.

So sorry for the disorganization of this. At this point my whole body feels involved and it’s hard to sort it out if that makes sense. Thank you for your time reviewing this!! I look forward to hearing your thoughts. Sincerely

Yes; your whole body (BRAIN included) is involved, which is what makes it all so difficult. Best guess is that I can help you with some of this, particularly the CHRONIC NECK PAIN (and probably the back pain — maybe the tight abs/obliques). If you lived close I would unequivocally say yes, get in here and let’s give it a shot. Because I have no idea where you live (I would guess you’re a Vol — not too terribly far from me), it makes things a bit more difficult.

In a situation like this, I totally leave it in your hands Misty. If you want to give it a whirl, just call Cheryl and see when she has availability. However, realize that my treatment may stir some of your problems up temporarily. It’s so hard to know. So hard to guess. Wish I could do better.

If you decide not to come see me, I get it and that’s completely OK. In the meantime be sure and READ THIS POST because it may help you address some things you have never thought of.

Sincerely, Dr. Russ