Chronic Pain

The Best For Chronic Pain

Chronic pain is the ultimate epidemic in America.  You may be surprised to know this.  If you took all the people in the U.S. with some type of illness or dysfunction and added them all together you would not match the number of people with chronic pain.  This post will reveal what therapy works the best for chronic pain.

Chronic pain seems to not get the respect it deserves. What’s up with that?  Let me postulate a number of reasons for this:

chronic pain

  • Chronic pain is not taught as being a separate illness. We usually think of it as a symptom associated with another illness such as cancer, arthritis, and Diabetes Mellitus. However, chronic pain changes the physiology of a patient so that given equivalent illnesses, the patient with chronic pain dies sooner.  That makes chronic pain an illness as well as a symptom.
  • Actually, chronic pain management is hardly taught in medical schools in the U.S.. In her book, “A Nation in Pain” Judy Foreman (a chronic pain patient herself) surveyed U.S. medical schools and found the average number of hours that pain management is taught is five. That is 5 hours in an entire medical school curriculum!  Some medical schools don’t even teach it.
  • There is no formal teaching of chronic pain management in most residency programs after medical school.  Doctor’s are expected to “just know” how to treat chronic pain from their experience treating acute pain during their training.  Acute and chronic pain are approached quite differently and often have different mechanisms.
  • Formally trained pain management physicians (PMPs) usually are anesthesiologists or physiatrists (specialists in physical therapy).   Medical students, Interns, and Residents are not required to do clinical rotations in these sub-specialties.  Because of this they may get no exposure to chronic pain management despite having completed many years of post-graduate training.

When the medical profession devotes so little attention to teaching the principles of chronic pain management, it sends a message to young Doctors that pain management is not a priority.  Few young Doctors will gravitate to areas of medicine that have been given so little priority in their training.

What this results in is a form of “cortical blindness” on the part of Doctors towards chronic pain management.  They can not see what they do not know when they have not been exposed to it.  The same is true of dentists, nurses, physician’s assistants, pharmacists, and any other health related profession.


Because there is so little teaching on chronic pain management, knowing what therapies work the best is also poorly evaluated.  I have created a way to quantify the value of pain therapies based on several metrics.  In the next section I will teach you how my rating system works so that you can rate pain therapies on your own.

Do You Know My Metrics For Evaluating Chronic Pain Therapies?

The following metrics are used by me to evaluate a chronic pain therapy (click here to link to my article evaluating the 7 best therapies):

chronic pain

  • Effectiveness:  treatments that are reliably effective will get the best rating. Reliability is a statistical concept that means the therapy is predictably and consistently effective at relieving pain.
  • Cost:  the best treatments will be low cost while still being effective.  A high cost treatment that is effective will have limited impact.
  • Risk:  the best treatments will have minimal immediate risk to the person using them.
  • Availability:  this metric takes into account the practical application of a therapy to as many people as possible.  Highly effective therapies that can only be administered to a few will score poorly.
  • Recovery Time:  this metric is particularly directed at surgical procedures.  It also has application to other therapies in just how long it takes to relieve chronic pain (or whether there is a long delay in the therapeutic effect of a treatment).
  • Side Effects:  the inducement of severe side effects from a treatment can greatly diminish its value to a person in chronic pain.
  • Durability:  a good chronic pain treatment will have a lasting effect on reducing pain.  This metric includes the concept of tolerance which is seen in most therapies for chronic pain.

Do You Know The Best Treatment For Chronic Pain?

You may be under the false impression that to obtain the best relief of pain as possible you will have to be treated at an academic facility (such as a medical school).  Or perhaps you have become a little cynical and you just believe that unless you are rich you will not have access to the best treatments.  You may even think that your religious group, ethnic group,  racial group, or country of origin decides whether you will be able to obtain relief for your pain.

None of those presumptions is true.  The therapy that I am going to share with you as the best therapy for chronic pain is available to all people.  This therapy scores well on all metrics.


The metrics for it are as follows:

Effectiveness:  exercise for chronic pain causes physiologic changes that reduce inflammation (as if you were taking Motrin) and releases endorphines (substances in your brain that reduce pain acting like a dose of morphine).  Exercise actually works like a “medicine” without all the side effects that are possible taking a medicine.  It gets a 10 out of 10 rating in this category.

therapeutic exercise

Cost:  most of the exercise that is needed for chronic pain can be done at home without expensive equipment.  I rate exercise a 10 in this category.

Risk:  with a little common sense, there is virtually no risk with exercise in chronic pain.  Since common sense is uncommon I rate exercise a 9 for this category (otherwise it would get a 10).

Availability:  exercise is virtually available to all people…my rating is a 10.

Recovery Time:  the benefits of exercise begin with the very first session.  The rating here is a 10.

Side Effects:  except for over-training, there are no negative side effects to therapeutic exercise.  I give a 10 rating here too.

Durability:  the benefits of exercise are experienced at all stages of life. The beneficial effects are enduring even after the exercise regimen has been discontinued.   I give this a 10 out of 10.

Exercise has the highest score of all therapeutic modalities for chronic pain at a 69 out of a possible perfect score of 70.  Exercise is not optional therapy when you have chronic pain.  Every person with chronic pain should be on a daily exercise regimen.

Here are 2 links for  highly rated books on therapeutic exercise:

The American Physical Therapy Association Book of Body Maintenance and Repair

Therapeutic Exercise: Foundations and Techniques, 6th Edition

There Is Hope

Not long along I published a post called, Best Exercises For Lower Back Pain” which outlined a regimen of exercises.  This type of regimen (also discussed in the book links I have provided) will gradually reduce chronic pain.

Every pain patient needs to be in an active exercise program.  Perhaps pain management practitioners should make it a requirement for every chronic pain patient.

Given all the advantages of therapeutic exercise, why not get started today?  Link to the books I have suggested and purchase them, discuss a regimen with your pain practitioner, start at home or join a gym.

You are in charge of your pain relief…get busy!

Wishing you joy and healing,

Dr. Jeffrey Bado, D.O.


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