On the other hand, I get a lot of what we call “train wrecks,” people who’ve been through a lot. They’re depressed either moderately or severely and they live with a fair amount of anxiety. These people are often on multiple medications, sometimes the strong opioids, and very often they’ve had multiple trials of combinations of the different poisons that we put people on. So part of the challenge is trying to unravel that nasty ball of yarn that’s tied up in a huge knot. These patients can get so desperate and sad and confused, which makes it even more of a challenge. Most of these patients are also horribly unorganized. In many cases, they don’t even know what medications they’ve taken or what other treatments they’ve had.

One of the things that I argue for in The Chronic Pain Solution is that a pain patient has to get organized. You’ve got to write down your story. What happened, what did you try, what were the responses? How much did you try? If you were put on amitriptyline, what was the dosage? If they started you on 25 milligrams a night and then you slept for two straight days, that’s important for me to know. Unless I have information like that, there’s no way for me to know whether or not it was an adequate trial. In the book and also on the PBS television show that I did, I emphasized the notion of the adequate trial. Very often people get into terrible situations because they haven’t had an adequate trial.

What’s an adequate trial of chiropractic? Let’s say the patient went to a Network practitioner for a couple of visits and they say, “Well, it didn’t do anything for me.” Or they had one session of DNFT [a very low-force chiropractic method] and then they say, “It didn’t do anything for me, so forget about chiropractic.” Now, with the backgrounds that you and I have, we would say, “That’s not an adequate trial of chiropractic treatment!” So the question becomes, what is an adequate trial? It’s the same with medications. Very often people come in and they’re on a lot of different medications that aren’t working very well. I’ll ask them, “You’re on 300 milligrams of Lyrica a day. Is that making you feel any better?” And they say, “I don’t know.”

If they don’t know, how can you know?

I can’t. These are very complex knots created in the strain of the person’s life and teasing it apart is very complicated. Many patients do have severe enough pain that they will need to be on one or more medications. The question is, how do you select those? And that means you have to know these meds really well and know what effects they may have. Number two, you have to be willing to do the work of teasing this all apart. What did they try? What’s been an adequate trial? What are the adverse reactions? What are the side effects?

Let’s say a doctor started them on a high dose of Levo-Dromoran and they vomited their guts out. Well, it doesn’t necessarily mean that that medication is not going to be helpful. It means that it was a horrible trial. So my number one premise (which I described in detail in my book and on the PBS show) is that by sensibly weaving in non-pharmacological, complementary and alternative therapies, and finding the ones that actually make a difference for the person, you can significantly reduce the dependency on pharmaceuticals or the need to use them at all. I do this every day in my office. I do a little of this and a little of that, I get them doing breathwork and relaxation work, and by a month or two down the road, their medication list is completely different and it’s one half or one third as long. That’s what the book and the TV show were all about. Stories of my patients being able to do that successfully.

Because of your unique training, you can personally provide chiropractic adjustments, acupuncture needling, and/or prescribe medication to your patients. You’re able to provide a kind of one-stop shop, but that’s quite rare. What do you see happening, both currently and in terms of future trends and possibilities, regarding collaborative relationships among chiropractors, acupuncturists, massage therapists and medical pain specialists? How can they best serve their common patients?