Pain Management and Medication Addiction, Bay Recovery's Jerry Rand, MD (From Blog July 2009)

I was priviledged to be invited to present at the same kickoff konference with Kesta related to a chronic pain educational documentary film series, and it was a highly read blog which I wanted to be sure people who were reading in this Forum area would see... so here it is!  And please remember that the little buttons at the bottom of this screen that say "print" and 'e-mail' are wonderful tools for YOU to be a liaison for Lumigrate and fibromyalgia education! ~~ Mardy

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"Doctors train patients to take pills for all their needs.  Doctors are trained to do this.  But in the end, the meds are more problem than the pain."  Dr. Jerry Rand, Medical Director of Bay Recovery Centers and Medical Clinic was a pleasure to hear speak and to get to know more informally later.  He is obviously an expert on chronic pain and it's treatment, and the addictions that unfortunately occur too frequently.  Stating it is 'disgraceful and cruel' what happens between doctors and patients in the escallating struggle that can happen with doctors and patients who originally were trying to treat pain, he impressed upon me his compassion toward people and his passion for his work.  He was a wealth of information, and I'm going to share what I can and also give the link to his clinic's website at the end.

There is a difference between dependence on a drug for pain and dependence for the chemical which is addictive.  Drugs can be safe, or 'create a mess'.  As he presented in the beautiful 4th Street Studio in Berkeley, he craftily wove an analogy about artwork: Pain and Medication are like separate paintings which get overlaid when you treat pain with medication -- you end up with both together.  His clinic utilizes an integrative model, which is also Lumigrate's model ("luminous" and "integrate" is how the name was devised).  An integrative model addresses pain management by focusing on "Functioning and Quality of Life" versus "Reduce Pain Level".  (Anyone wanting a thorough understanding of the reductionistic basis of the allopathic model can download our free video 'Health Management' by Chris Young, PhD -- it's an excellent study in theory of medical models which offers progressive solutions for health care for systems and individuals). 

The brain has what is called 'neuroplasticity' -- it changes.  Alterations to the body's systems occur with drugs due to changes in chemical responses, affecting the brain.  Blood flow, adrenal glands, and the hypothalamus to name a few.   This changes over time and when you stop a drug, the brain may never be the same as it was before the drug. 

It was clear there was a key point to learn from Dr. Rand about 'addiction' and 'pseudoaddiction'.  Pseudoaddiction is when the person needs increasing medication to control what the medication is prescribed for, but is not seeking more due to 'addiction', which is when the body is craving more of the chemical.  Many times people use a prescription pain medication to cope with emotions or take it for sleep.  Opiates directly affect the hypothalamus, so you get non restorative sleep when taking them.  This is a critical point for people with fibromyalgia and other chronic pain conditions: our Dr. Young's seminar on chronic pain (in development) teaches that opiods are appropriate for acute pain for a short time (after an injury or surgery, dental work, etc.) but are not appropriate for long term use because of the effect on the hypothalamus. 

There is a quiz on Bay Recovery's website which will help you determine where you are at with your medication use, and I recommend everyone take a look whether you're on pain medications or not, as it is very educational.  Treating pain and treating addiction are done very separately and it's very complex. 

Acquired prescription drug behaviors: Most addictions start at age 12-25, which is a time when the brain is growing, so it's a really bad time for the brain to be receiving drugs.  The statistics he quoted about 12-18 year olds' use of oxycontin was staggering, and many are getting them from their home's 'pharmacy' -- prescriptions in the parents' medicine cabinets.  Which brings us to 'abherent drug behaviors'.  Unsanctioned dose (taking more trying to reduce pain), asking for more, hoarding.  He was kind about this: "People are not exact.  If a person is to take a medication once a day, they are 99% with it.  If it's 3x/day, it drops to 74%".  So people end up with extras, which they hang onto and then that can cause troubles later.  The patient and the doctor lose trust with each other in the time abherent drug behaviors surface.  This can also include patients requesting a certain drug, accessing multiple doctors (which is illegal in some states now), forgery and stealing.  And this is where Dr. Rand came back to talking about our youth who have access to these medications and then become addicted.  

There has been a lot of conversation on facebook among the pain population about new legislation about pain medication and people were quite up in arms about it.  It was my opinion that in the long run it was going to be beneficial, but I understood each person's concern that they would have more trouble accessing pain medications.  I encourage everyone to become more educated about this topic and then help your doctors be more educated as well -- remember, nobody has as much understanding of your needs as YOU.  If you're asked to have a 'pain contract' by your doctor, really understand why these exist.  Keep learning about medications and the options available, both pharmaceutical and non.  Yesterday I wrote and referenced Dr. Teitelbaum's talk and website, which includes which medications and supplements he recommends, and generally he and Dr. Rand's information was in agreement (although Dr. Rand does not prefer to use Ambien for sleep and said he will prescribe Lunesta sometimes). 

The take home message is clear for those of us with chronic pain: find other ways than opiates and if you are currently on them, start finding information and providers who can help you get switched over to other things.  (Mindfulness meditation was something another speaker presented about -- which is a 'coping strategy'; I learned it before I had chronic pain and it's been invaluable and perhaps has thankfully kept me from going the route Dr. Rand speaks of occurring too frequently).  Pain is not fun and it can limit your life, but addiction ends up limiting it more.  Lumigrate has plans to have a pain management home study program in the future, which you can purchase and work with your local providers with, so we do have this on our radar screen to bring to YOU.  Keep learning and keep teaching your providers! 

The link to Dr. Rand's site: www.bayrecovery.com  He also suggests: pain.com

 Note from January 2012: I have been contacted by more than one former patient of Dr Rand's at Bay Recovery who have asked me to remove all information about him due to their concerns for others based upon their experiences. I appreciate that they are taking the time to research where he might be doing outreach to get his name heard, so thank YOU.  That is true 'generosity of time and energy' which might be translated into 'spirit'.  

I had encountered a change with Dr Rand's behaviors when interacting with me which were very different than how I had experienced him when we spent a day at a chronic pain conference together, so had stopped working to get information from him into Lumigrate at that time.  I have removed all the solo pieces he and his team had posted in the past in Forums but I have opted to keep this and one other piece but adding this disclaimer/caution, because it is "baby with bathwater" as this is an excellent resource for people.  If he was providing good information in the past which is included here and people can learn from it, that's one thing; using him as a physician would be another which I would want people to make their own decisions about.  

To help in your researching this provider (and I suggest you do this for all your providers) here's a link to the portion of the California Medical Board related to Dr Rand's current and past  http://www2.mbc.ca.gov/LicenseLookupSystem/PhysicianSurgeon/Lookup.aspx?licenseType=G&licenseNumber=25749. My apologies for not having done that step after we had met when Lumigrate was only two months 'live' -- I continue to learn with this enterprise and change my procedures just as I have as a medical consumer. Just because a big TV show uses him doesn't mean there's a good history.  Not something I had to know as a woman with fibromyalgia or an OT practicing in Colorado!