The Chronic Pain Story Unvarnished in a Powerful New Book

The Chronic Pain Story Unvarnished in a Powerful New Book

By Ed Coghlan

Cover imageDr. David Nagel is a New Hampshire pain physician whose important new book on pain:  Needless Suffering: How Society Fails Those with Chronic Pain is being released this week. The National Pain Report, which had a chance to read an advance copy of the book (and liked it), interviewed Dr. Nagel on what the pain community (and others) should get out of the book. Here is an excerpt from the interview:

National Pain Report: What should patients get out of this book?

Dr. Nagel: “I should first say what this book is not about.  It is not about the medical treatment of pain.  I don’t outline miraculous new therapies or breakthroughs.  There are plenty of books that do that.  My goal is to address the problem of chronic pain from a social perspective, and I hope the reader will come to understand how common the problem of chronic pain is.  I hope the reader will change their perception of the pain sufferer from someone with a perceived character flaw to an often heroic individual in need or our help.  I also stress that we as providers must be honest about what we can really offer those who suffer, and I hope the reader will learn as much about our limitations as what we can offer.

With that as a background, what do I wish the patient to get out of this book?  I first want the patient to know they are not alone.  I want to find ways to empower them.  They do not need to be silent.  I always include the patient’s family as part of the patient.  We know in rehabilitation medicine that the ability of the patient to adapt is dependent on the quality of the support structure around them, and the family is the most important aspect of this. So, my book is addressed on behalf of the family as well.

At the same time, I want the patient to be realistic.  While it may be reasonable to hope for a better future, one needs also to best maximize function bio-psycho-socially within their current limitations.  We do not have a “magic bullet” for chronic pain.  That does not mean one should not search for a solution for her pain.  I have learned from many patients that when their search for a cure becomes all encompassing, to the effect they neglect the rest of their lives, then they and all around them suffer needlessly.  I have had many patients tell me they only found meaning in their lives when they found a way to put their pain to the side and focus on their residual abilities.  That is not to suggest there is anything easy about doing that.  I hope my book will give them courage to look to an altered future, rather than fixated on an unrealistic past.

Are you available to come and speak to groups?

Most definitely.  I admit I am technologically challenged.  I prefer face to face contact.  I learn from those I speak to, and that is what I desire.  I also wish to travel out of my comfort zone, because that is where I learn the most.  Whether you think you agree with me or not, I would love to come talk with you or your group.  At the very beginning of the book I state that I would be disappointed if the reader agrees with everything I say, so, let’s talk.  I can be reached at

You can order the book here .

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Authored by: Ed Coghlan

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Christine Taylor

Stephen Rodrigues MD

I agree that some of what you have said can effectively treat pain such as Physiotherapy, massage, diet, Chiropractic care, cold/heat, but I do not agree with other things. I have success in alleviating neck and back pain using several of the methods you described but other pain such as nerve pain and sinus for me can only be brought to control with pharmaceutical intervention. I can get a temporary relieve using a cold pack but can only use it lying down which makes it impractical to wear for how ever long an attack is happening. I also do not believe that just these methods alone can treat ALL pain completely. I have tried acupuncture many times and have found it to be useless. Any benefit is likely a placebo effect. Muscle pain is an issue but so is bone and nerve pain. .If inflammation is present I would think that needling would only add to trauma and scarring in the muscle which would lead to even more pain not to mention the increased risk of infection. Of course the most conservative proven methods should always be tried before all else.

Tim Mason

Doc Rod,
My pain responds very well to morphine and its derivatives. My pain onset was caused by a 1964 Buick which I ran out in front of at the age of 14. After three months on my back and With a lifetime still ahead of me, I took various labor jobs like most young men do. At one time in my life I too was naïve and thought I could survive anything. I did not see things with my mind, only my eyes. I overlooked the millions of elderly people that moved before me at churches, stores and picnics. It takes lots of different skills and labor to build and maintain this civilization. These jobs take their toll on our skeletal and muscle systems. Ergonomic designed things are still fairly new concepts. The ether and scalpel were and still are necessary advancements in medicine. I do not discount the value of a massage given by a talented A&P professional but I would not discount the levels of pain that you have not yet experienced on a personal level.
“The embalmer does not know what it feels like to be dead just because he works in a funeral home”

Stephen Rodrigues, MD

It is psychological abuse to allow a human being to live in pain without full disclosure of ALL of their valid options.

The scalpel and medications have established and historically vetted indications to be used in tumors, infections, cancer, and defects.

Knifes and painkiller are NOT the corrective treatment options when it comes to the most common location of pain – The Muscular System.

This is criminal behavior.

Allopathic academics, marketing, editors, citizens, advocates, associations, boards of medicine, government officials, and educators who perpetrate and support these lies are accomplices!!

Wake up.

Stephen Rodrigues, MD

All pain problems have solutions. (most all)
In 1960s, we perfected the ALL of the solutions to the most common location of pain.
Most all pain problem which have plagued mankind have vetted, valid treatment options.
The most common location of pain is in the muscular system.
Muscle pain is the result of microscopic scars inside the involved muscles.
Muscle derive pain is best eradicated with the application of the full spectrum of options all under the heading; hands-on physical theory.

For the patient:
Daily self-care includes, vitamin, mineral and trace elements.
Heat, soaking, massage, stretching 4-6 x per day, range-of-motion movements, yoga, inversion, traction and spinal adjustments.

For the professional:
Profession a massage 2-3 x per week.
Spinal adjustment 1-2 x per week.

For the medical specialist:
If pain reoccurs which interferes with well-being; Add in dry needling 1-2 x per week.
If the pain is long term and stubborn; Add in more holistic Acupuncture, myofascial types.
If the pain is still resistance and stubborn or If the thin needles can not predictably and consistently resolve the pain; Add in wet hypodermic needling + stacking all of the prior options.
If the pain is old, stale, neglected; Jump to wet needling + stacking.
If the muscle tissues are too dense for a standard 25-27g needle; The provider is obligated to use 20-23g needles.

For a mainstream provider to do based on AMA CPT codes:
Hands-on options @ 2-3 x per week:
Massage CPT: 97124.
Joint Manipulations CPT: 98925 and 98926.
Thin intramuscular needling options @ 2-3 x per week:
Dry needling CPT: physical therapy codes
Acupuncture CPT 97810.
Hypodermic (cutting tip needle) intramuscular needling options @ 1-2 x per week:
Trigger Point Injections CPT: 20552 and 20553.
Tendon and Ligament Injections CPT 20550 and 20551.

Muscle derive pain will not respond to interventional pain management options. The results are unpredictable, may not at all, or very poorly. This is because they are all misguided and aimed at the secondary pathology of pain. The primary pathology is embedded intramuscular not outside the muscles system.
These in my book are worth-less than oldschool PT. I would have them banned from use because they defy the laws of human biology.
Celiac Plexus Block
Chronic Pain Relief with Botox
Electro Diagnostic Test
Facet Joint Injections
Intrathecal Pump
Kyphoplasty and Vertebroplasty
Lumbar Epidural Steroid Injection
Lumbar Sympathetic Block
Radio Frequency Ablation
Regenerative Medicine
Spinal Cord Stimulator
Stellate Ganglion Block

Dr Rod


There will be no more pain relief. Pain is no longer a diagnosis. End of story.

Tim Mason

It appears that “Chronic Pain Patient” by their definition is one that has pain but no apparent reason or diagnostics do not indicate an organic cause. (see below)
NIH on Chronic Pain
“•Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair”
“•Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. So, health professionals rely on the patient’s own description of the type, timing, and location of pain. Defining pain as sharp or dull, constant or on-and-off, or burning or aching may give the best clues to the cause of the pain. These descriptions are part of what is called the pain history, taken during the start of the evaluation of a patient with pain.”
“•Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved.
•Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members, who each have different training backgrounds and understand chronic pain. The person with pain and his or her loved ones also must be actively involved in the treatment.”
I do have chronic pain. However, my pain was determined to be caused by Severe Osteoarthritis and diagnosed by MRI, X-rays etc, My medications were reduced some after surgeries to correct worn out joints i.e. lumbar fusion, hip replacement. My medications were increased due to scar tissue formation and the cascade effect that can develop after spinal fusions. I find myself getting the occasional intra-articular injections to alleviate some of the inflammation. I play by the rules and have done the post op PT and even PT in-between surgeries. I have never had my narcotics taken away neither has their been a hint of taking them away. Pain-Wise is a good book and I am looking forward to this new book coming in the mail. My Question is this: Am I really a Chronic Pain Patient by the NIH definition? Perhaps I am just an old man with a disease that is old as mankind. What percentage of people have debilitating pain but have no detectable cause? I would like to see an accurate number. ( +/- 5 %)
I think analytically and never make a decision until I have all the facts. “Theory guides and experiment decides”
Isn’t the entire opioid debate about those with no defining cause? Is it that simple?


Its not empowering to those individuals in pain to discourage them from having a goal to become pain free. It is as unethical as it is biased fortune telling for any professional to tell or suggest to a person in pain they will never be pain free and that they will die in chronic pain. Pain specialists have failed to study those people in pain who have become pain free and have failed to even give careful consideration to patient authored texts of those who claim to have become pain free. And so I take exception to the authors erroneous position on the issue.
If our government can fund a cures inititative and a moonshot for cancer- both supporting cures- and cures for some painful conditions- then why is it so difficult for pain spcialists o overcome their bias toward such.
We have accounts for rheumatoid arthritis, migraine, lupus, ms, fibromyalgia,osteoarthritis becomeing pain free. One person who had chronic back pain wrote how meditation cured him of such, another person wrote how Dr Sarnos method cured him of widespread pain, others have written of how special diets or stem cell therapy have cured them of arthritic conditions When I first had fibro Linda Rector Page had a book with a diet to cure fibro. In some cases GONB has cured migraines. Anti tnf alpha therapies have lead to treatment free remission of rheumatoid arthritis. There are innumerable accounts of faith healing. In fact the other day I saw a video by the author of pigs in the parlor who claimed an exorcism cured a man of chronic headaches.
Yours truly was cured of fibro- and as of next month it will be 16 years fibro and pain free!
I went to several doctors- endocrinologists, pathologist, chiropractors, nutrititionists, rheumatologists, etc- not a single doctors or practitioner even hinted that i could not become disease free- they all helped me toward my goal. And so no legitimate purpose is served by mocking or criticizing people seeking to be disease and pain free. It is the individuals pain and life- and not the doctors. If a doctor doesnt wish to help a patient who seeks to be disease free then they should respectfully say they cannot be of assistance. But again no good purpose is served by trying to discourage people from seeking the best outcome possible for their pain.