This letter is dedicated to my former patient, Byron Boots, aka t.b. Carpenter, his writer’s pen name. Although Byron passed away 23 years ago at the tender age of 69, his memory burns vivid.
Byron was referred to me in 1989, and he became the first graduate of my multidisciplinary Functional Restoration Program, now considered the gold standard of evidenced-based treatment for chronic spine pain. The only problem was that the concept was brand new back then. Mine was the only program of its kind north of Sacramento in California at the time.
Naturally, all the local insurance carriers denounced it as a “mill” designed to make money. Hmmm, seems that kind of criticism is now leveled at my posts and books, because many people would rather believe in the ugly side of human nature.
My argument was that it was the same model I had been taught in my residency training at U.C. Irvine. I had watched numerous intractable pain patients get off drugs and find a quality life with the FRP, an intensive eight-hour-per-day program that immersed a maximum of four patients with Physical Therapy, Occupational Therapy, and Psychology for five days per week for three weeks. The program changed their lives and marked a turning point for many off of opioid dependence, and toward a life of function and empowerment.
I used all the tools I learned in my specialty of PM&R. I administered trigger point injections instead of adding pain meds. Patients received epidural blocks instead of surgery, 95% of the time. Patients with pain flares sat in the spa instead of going home and lying in bed. They worked through their intense anger with the psychologist, and they found ways around their “stinking thinking”. They learned breathing techniques, Feldenkrais movement patterns, daily stretching routines, and many other self-help tools. Even as a practicing physician, some days I would put away my script pad, take off my white coat, roll up my sleeves, and take the group to the gym for my special brand of P.T.
And at the end of the intense three-week program termed Phase I, we held a graduation ceremony. All those who finished received a certificate and a designer-spine keychain. Cake and punch were served every time. I still see many of my graduates who say that program marked the turning point in their mastery over their pain. Many say simply that it saved their lives. A majority went off opioids. Some returned to work. All experienced vast quality-of-life improvement. We offered Phase II and Phase III follow-up care which incorporated one year of monthly and structured psychology-led support-group visits to prevent relapse.
I still see at least a dozen of those graduates. Many of them still require opioids. Because the truth of the matter is that opioids are a necessary and vital part of long-term pain control, at least in the hands of a board-certified Physical Medicine and Rehabilitation Specialist like me. Those who say otherwise have not experienced a patient of theirs commit suicide. I have. And more than I would care to mention. No amount of sanctimony or arrogance by “Addiction Specialists” will convince me to allow another pain patient to do that.
Today’s young whipper-snapper anti-opioid-doctor zealots should be shipped off to some island off the coast of South America where they cannot do our country any more harm. Ignorance and greed are a nasty combination.
Yes, the FRP was worth its weight in gold to those patients, Byron included. But the insurance companies required us to break down the charges into 15 and 30 minute increments. This allowed them to pay less than 25% of the bill. We were forced to close our program in the year 2000 as we could not make ends meet. And that has been the experience of most other similar FRP programs.
Part of me died with my program, Performance Plus, and its closure. Following the wind up, I was forced to help pain patients with the only tools I had left, the only ones the government would cover. I still did trigger point injections, and I still sent patients for epidural blocks. I still warned patients about the dangers of spine surgery and opioids. I refused to prescribe OxyContin and most long-acting opioids. I rationed them because of my training while my colleagues welcomed them.
Byron convinced me to write a book. He came up with the title, “How to End Your Back Pain Nightmare”. I was not much of a writer in those days; instead I dictated the chapters. And they were all unreadable. Painfully unreadable.
Byron rewrote the entire manuscript on his old newspaper-reporter typewriter. I recall when he would pull up to my house in 1991 in his Uncle-Buck-like beater. Alarmed by the backfiring, the neighbors would come out to see who had been shot. The perfect manuscript stunk of stale cigarette smoke. But the words were fresh.
Byron retold the story from the standpoint of a patient, a sufferer. I published the book under two pen names. Byron’s was t.b. Carpenter. Mine was Justus R. Hope, because of the great injustices being done to injured workers in California’s worker’s compensation system at the time. Now the injustices are being dealt to the entire nation’s chronic pain patients. I was just a naive 35-year-old doctor back then. I thought the system was unfair. Now I am a 62-year-old dreamer. I still think the country can do the right thing, especially if everyone has the correct information, the facts.
I wrote the two Physician Primers, not to make a buck, but to change the world, to end the opioid epidemic. I wrote the Pain Patient Handbook for Byron. So, yes Byron, now I feel like a writer. I no longer dictate most passages; I type. It feels good, and as Byron once told me, “Don’t worry about offending anyone when you write. If you have something to say, then say it. Don’t pull your punches for fear of criticism.”
I wrote the 25th anniversary edition of “How to End Your Back Pain Nightmare” aka “The Pain Patient Handbook” and dedicated it to Byron. Rest in peace my friend.