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Pain Management

Dr. Rotchford's concepts regarding chronic non-cancerous pain and addiction are "cutting edge"
Alex Cahana, MD, Professor & Chief
Div. of Pain Medicine
University of Washington Medical Center

Pain Management
   . Medical Pain Management Services
   . Physician Acupuncture Services
Dr. Rotchford is a seasoned pain management specialist and long-standing member of the American Academy of Pain Management. His pain management strategies focus on improving brain and spinal cord function. This is accomplished through education, behavioral changes, proper pharmaceutical care, supplements as indicated, and standard medical procedures as well as acupuncture and other "alternative" modalities. He is accustomed to seeing patients for which his colleagues have no further suggestions regarding their pain management. He is particularly skilled and experienced in helping patients who have been prescribed opiates chronically.

A Partial list of chronic painful conditions treated:
Neuropathic Pain
Chronic neck or back pain
Failed back surgery
Regional Pain Syndromes (Formerly Reflex Sympathetic Dystrophy)
Pelvic Pain
Bladder pain

The above can only be a partial list so if there is a condition or service in which you are interested which you do not find listed, please inquire.

Chronic Non-Cancerous Pain is a disease in and of itself. Dr. Rotchford specializes in this disease. For more information please review the handouts related to pain management on the tab related to Handouts - Some helpful documents and links are available including a talk on chronic pain as a disease.

Access to specialized services in Pain Management is sorely lacking.


Pain Management Related

A Ted Talk by Dr. Krane titled  " Mystery of Chronic Pain reviews the evidence for considering chronic non-cancerous pain a disease unto itself.
  • "The OPAS Experience" - an article in the  Pain Practitioner  - 2007 Dr. Rotchford
  • Syllabus Regarding the basics of Chronic Pain and its management  Dr. Rotchford
  • Neuropathies -  A Brief Overview  by Dr. Rotchford
  • Methadone and Pain Centers in Western Washington  - A partial list
  • There are a number of  online references.   Here are just a few that Dr. Rotchford recommends to look over:
    • Change your Brain, Change your Pain by Mark Grant, M.A.  2011  - This book is consistent with Dr. Rotchford's approach to chronic pain problems.  While emphasizing behavioral approaches the author clearly recognizes the importance of a "both/and" approach rather than simple either/or approaches.  Dr. Rotchford recommends EMDR for any patient who has chronic pain and particularly those with known history of trauma or positvie response to medical cannabis.  The hitch is to find qualified practitioners and secondly to get payment for same through third parties.   There is a helpful CD included that promotes some of the brain changes discussed within the book.  It's available online for around $40.
    • Patient Self-Help Resources  by Forrest Tennant, M.D.
    • Neuroplastic Brain and Body
    • Managing Pain before it Manages You  by M. Caudill, M.D -  Available online for purchase.- I consider this the "standard" workbook for behavioral management of pain.
    • The Pain Toolkit  - online Free
    • The Divided Mind   by John Sarno, M.D., who has written a number of books on the interplay between pain and emotional states, particularly anger and unexpressed rage. Practical suggestions are eventually provided and it is an eye opener for many who continue to believe that pain is simply a matter of what the x-ray or other biomarkers reveal. Please see the  Anger Appreciation handout below.
      • Dr. Rotchford has different opinions from those of Dr. Sarno.  While it is understandable to be critical of the lack of the formal appreciation of emotional stressors as potential explanations for many patient symptoms, Dr. Rotchford does not agree that contrasting psychological vs. physical vs. spiritual vs. energetic vs. cultural explanations is the best way to proceed. Dr. Rotchford finds these models are constructs. He believes the "truth" often lies outside of our man-made constructs, however appealing and effective our constructs may be.  The history of medicine is that our best "constructs" often change over time.  Nonetheless, Dr. Rotchford values Dr. Sarno's approach, because it is relatively safe and can be quite effective. There is also a definite value in appreciating how the unconscious "mind," however it is understood or defined (The "mind" is a "construct" too),  along with the measurable functions and physiology of the central nervous system, has a predominate role in the understanding and management of painful conditions.   Lastly, it is Dr. Rotchford's opinion that "either/or" ways of thinking and responding, while they are sometimes effective, are not often as effective as "both/and ways" of thinking and responding.  This is particularly true when managing complex diseases,  particularly those that affect the central nervous system.
  • Pain Management -  A recent CME update for physicians  - While this link was intended for physicians, I think it might be helpful for some to read in order to view the current "party line" as it relates to pain managment.           
  • Managing Acute Pain in Patients on Buprenorphine  by Dr. Rotchford
  • Managing Acute Pain in Patients Prescribed Methadone  by Dr. Rotchford
    • These 2 link are intended primarily for clinicians; however, patients may find them informative as well. Patients who use buprenorphine and methadone for opiate use disorders or for chronic pain are advised to only use opioids for pain as directed by a physician. Every attempt to diagnose the source of the pain is indicated and without a clear source of tissue injury or damage, opiates or other controlled substances are best avoided.  In cases where a clear cause of pain is not present every attempt to avoid pain pills is best.  Exceptions might be when one is dealing with a potentially life threatening problem such as a heart attack.  In brief, patients on buprenorphine should be provided options for pain management that do not involve opiates or other controlled substances whenever it is possible or reasonable.  The following is a link to a slide presentation intended for clinicians about the use of buprenorphine in pain management:  The Role of Buprenorphine in Pain Management  by Gregory Rudolf, M.D.
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