How to help diagnosis and treatment of pain2022-05-21

The greatest evil is physical pain.

—Saint Augustine

Most people will suffer from pain in their lives. It is a basic signal that something is damaged, we need to do something about it, and avoid future damage. Clinical issues often arise. Pain might persist, seem disproportionate to the injury, not be taken seriously, and/or be treated ineffectually or with addictive medications like opioids.

Like everything in medicine, it has to start with phenotype. For pain, there is often no external visible component, and sometimes even no internal component visible by imaging studies. Measuring intensity of pain, and interference with daily life, is important. The first, intensity, is what really matters for the internal well-being of the person. Some people perceive pain more intensely, due to their biological built, and some less intensely. The second, interference, is what matters for the external ability to function of a person, in the context of their personal and professional life. Some people have lives and careers where the particular interference is prohibitive, and some are more sedentary with less interference.

Keeping track at home in a quantitative fashion of the intensity of your pain, the interference with your daily activities, and the effect on your mental health, addictions, life success, and life satisfaction, can all be done by journaling or entering things in an app. We have created a place to do that in a precise, user-friendly and confidential fashion, using our Life x Mind app. After the initial 2-week monitoring, that data is used to generate a report that can be shared with your clinician/therapist. Afterwards, just use it as desired, for life improvement purposes. Patients are encouraged to get it and use it, clinicians are encouraged to recommend it and integrate it in their personalized assessment.

The next step is to get blood testing, to get an objective read-out of current acute pain, future risk of chronicity, and most importantly to match people with non-addictive, non-opioid, nutraceuticals and medications in a personalized way, based on their biology. We have created a blood test for pain. It needs to be ordered by a prescriber, and the report is provided to the clinician/prescriber, to integrate as needed in their personalized treatment approach. Afterwards, repeat the testing once a year if so desired, for preventive purposes. Longitudinal data is very powerful at predicting things.

Lastly, pain sometimes hits people very hard. They may have accumulated other risks for suicidality, and the pain puts them over the top. Doing a risk factor profile once a year should be part of preventive medicine approaches for all. Thus, risk factors can be identified early on and mitigated, before they cumulatively become a problem and lead to a crisis. We have developed a suicidality risk profiling tool that can be taken online, confidentially, and does not ask about current suicidal ideation. It needs to be ordered by a clinician, and the results are provided to the clinician/therapist, to counsel and work on with the patient in a personalized and targeted fashion.

As we often say, the medicine of the future is prevention. These tests can improve and even save lives for patients, make the practice of clinicians easier and more successful, and save money for payors and employers (hospitalizations, repeated failed treatments, and absenteeism are much more expensive).

Live. Happier. Longer.