About John F. Petraglia, M.D.

Dr John F. Petraglia is a board-certified anesthesiologist and pain management specialist practicing in Southern and the Central Valley of California. He shares his greater than 25 year experience of treating chronic and acute pain conditions through the eyes of a busy pain management provider. He provides information relating to proper diagnosis and includes sketches and workbook type questionnaires in an effort to help the reader better understand and work with their physician to diagnose their condition. Dr. Petraglia shares these stories of chronic pain affliction through the vignettes of characters that may suffer similar conditions in order to provide learning and direction to the reader. Dr. Petraglia attended medical school at the State University of New York at Downstate Medical Center and performed his residency at the New York Hospital Cornell-Columbia Medical Center. He currently has an active practice in all aspects of pain management, is published in other medical journals and is involved in weekly support group education to help those who suffer in pain better understand the proper usage of medications.

From Pain Control to Out of Control

In the past, choices of drugs for recreational purposes consisted of mind altering substances as well as substances that caused the body to be depressed or stimulated. Anesthetics used for their numbing effects such as lidocaine, cocaine, & tetracaine have been utilized for years. Dentists and oral surgeons know this all too well.

In modern times, drugs of choice used for recreation are Vicodin, Roxicodone, Norco, Demerol. Why has this changed?

Medication used for pain (which can be abused) has changed significantly in the last 10 years. This is in part due to an impatient society where it is important to find a universal and effective analgesic (and treat a problem yesterday).

Unfortunately, many of the medications utilized which do work effectively have potential for dependence and addiction. It is also unfortunate that many of the medications used effectively for treating pain are extremely dangerous and potentially lethal when used for recreational use.

The safety margin of these medications has been reduced due to the higher potency of the currently available medications. In addition, some have suggested that there is a profit motive for the pharmacy manufacturing companies when it comes to physicians utilizing prescription opioid medication. Drugs used for recreation in the past were for the most part illegal. Now it only takes a sprained ankle to get a prescription for a potent opioid narcotic.

Everybody faces the risk of addiction. Remember those middle-school film strips about saying no, and it only takes one time to get addicted? Those aren’t just a C-list movie director’s efforts at moving up the Hollywood totem pole.

If you’re looking for an example without wondering the dark streets of downtown Chicago, LA, or New York, look at Hollywood. Elvis Presley and Marilyn Monroe both died from prescription drug overdose, and Rush Limbaugh and Carrie Fisher have struggled with prescription drug abuse.

Because of the crackdown on prescribed medications that were freely available as recently as three years ago, it is commonplace to see dependent individuals using medications in abnormal way such as smoking or liquefying their pills. In that way, they can concentrate the effect of the drugs. It is also likely that these individuals will resort to using heroine and other drugs that can be purchased a mystery that are far more lethal than a prescription medication that they were originally provided.

Want more Hollywood examples? River Phoenix (brother of Joaquin Phoenix) died of a heroin overdose, as did John Belushi. One of Hollywood’s young starlets, Lindsey Lohan, has sullied her name through drug abuse.

For more information and stories that provide shock and awe – see The Great Pain Jack. Follow me at twitter @johnfpetraglia

Pain May Hurt, But It’s Necessary

Congenital insensitivity to pain: (also known as congenital analgesia) one or more rare conditions where a person cannot feel (and has never felt) physical pain.

Most may think that not feeling pain would be great; After all, who likes pain?

Pain can be important. It tells our body something is wrong, it teaches us. Burning a finger teaches us not to touch the hot stove. Pain in our belly tells us there is something there that shouldn’t be.

This condition, while not extremely common, is extremely dangerous. Kids have blinded themselves, broken their bones, and gotten incredibly ill, all because they can’t feel pain.

Sadly, in these cases, there is nothing that can be done but keeping an eye on the person with the disease. It’s another example of the balance of life- balancing pain, balancing pain management, and balancing life in general.

The Evolution of Dependency Dance

When it comes to the fine line between proper pain medicine use and abuse, I often demonstrate a little dance at my life survival classes at my office.

I draw a line and say this is “dependence” and this is “abuse/addiction”. This dance from dependence to addiction is evolutionary- it slowly grows and changes, eventually changing a person completely.

Once you make that crossover and have behavioral changes associated with the compulsive need, despite demonstrated harm to obtain pain medications or drugs in a illegal or illicit way, you’ve crossed over into the “addiction camp.”

Sometimes people are not even aware that this is happening to them. This may happen before the very eyes of loved ones. Sometimes, this conversion from dependency to addiction takes on an ugly twist.

Let’s say things are very stable, and the condition for which the person needed pain medication in the first place has resolved. If an effort is then made to wean or reduce the amount of medications taken by that individual, the brain may actually start to demand more medication and may start employing devious behaviors in an effort to secure the medication to satisfy the brain’s need for medication.

Except a lot less amusing

The brain can be very sneaky and attack a very honest and intelligent individual. Once the brain of the afflicted individual perceives that he cannot get medication filled any longer, panic and anxiety starts to set in and every effort is made to either make excuses, horde medication, or even purchase or steal medication from the street. There is even the possibility of conversion to street drugs. It has  been shown over and over again  that when medication that is prescribed is removed from that individuals possession, all of a sudden illicit substances start showing up in that persons urine.

Occasionally we will see a patient completely drop-off  the program and start using heroine or other illicit substances.

Another form of is when people take prescription medication in ways other than prescribed. For example, people will often crush, dissolve, liquefy, smoke, or eat their medication. Why people would do this is beyond any sense of rational thought. The worst-case scenario that comes to mind is when an afflicted 50-year-old male became addicted to  fentanyl patches. He broke into a pharmacy and  held up the store with a wrench. He then proceeded to eat  a month’s supply, or about 5-6  fentanyl patches (which are supposed to be applied to the skin).

He ended up crashing his car, was chased and arrested by police and charged with multiple charges. A few months later he was dead. Indeed, a very sad  ending to a horrible situation.

The “Great Pain Jack ,“ my recently released book discusses many  of the other problems associated with riding the fine line between appropriate pain medicine use and drug abuse.

Made For TV, Not For Life

It seems that these days, you can’t flip through the TV guide without seeing a medical

And we can't forget Scrubs. Although maybe less likely to trust their diagnosis.

drama. In the late 80s, Doogie Howser took over. In the 90s, ER was the drama du jour. An uncouth doctor House solved medical mysteries in the mid 2000s, and the love-worn doctors of Seattle Grace Mercy West Hospital in Grey’s Anatomy currently rule the roost. Then there are the “reality TV” series on TLC; I Didn’t Know I Was Pregnant, Trauma: Life in the ER, and Mystery ER.

With so many medical dramas, it’s not hard to figure out why so many patients visit their doctors only to verify their own self-diagnosis of necrotizing fasciitis, lupus, or an arachnoid cyst.

Medical TV shows like “House” and “Grey’s Anatomy” affect patient’s confidence in self diagnosis. Many of the diagnoses on these types of TV shows are very dramatic and over-the-top. Most often, people do not have such “exotic” diagnoses.

Unfortunately, when you hear hooves you may think of zebras, when it’s really horses.

That's why his hair is so big- it's full of answers.

Patients may convince themselves that all of the signs and symptoms will lead them to the same conclusion as the TV show that was just watched. After all, who wouldn’t love to say they were saved by McDreamy, George Clooney, or House? (This is just one way that people can get into trouble with too much TV viewing and self-diagnosis.)

If one were to attempt to treat their problems without an accurate medical assessment, it is likely they will only aggravate the problem, causing more problems and pain.

There is no substitute for proper medical evaluation with objective diagnosis and appropriate treatment plan. In an age of split second decisions with social media outlets such as Twitter and Facebook, one can be lulled into foolishness by believing that one can obtain a diagnosis by watching a television show.

From a medical practitioner standpoint,   the TV shows are very interesting and often times technically correct (so thanks, Shonda Rhymes, for at least doing your research.) But who or what exactly is that television show trying to make a point of?  These dramas aren’t mean to solve medical mysteries; They serve to entertain with love, tears, and happiness.

If you read “the Great Pain Jack,” you’ll learn about many episodes of misdiagnosis under diagnosis in the world of chronic pain. There are many real-life episodes that are just as dramatic as House or Grey’s Anatomy discussed (not TV fiction or fantasy) whereby real-life patients pain situations are discussed, work through, and treated.

Seeking a Treatment

Lately, you can’t turn on the television or go on the Internet without seeing an advertisement for a pill that will treat depression, help your pain, empower your  “masculinity”, or do something else for you. The pharmaceutical industry spends billions on marketing and advertising every year. At one time, they were limited from marketing to the public directly. Now with ready access to advertising touting the benefits of such “wonder drugs”, it is no wonder that it is such a natural reaction to want to take medicine or a pill to cure pain.

What most people don’t realize is that this is a farce.

You see people dancing after taking an anti-arthritis drug, people swimming competitively after applying a rub and happy couples finding a solution to all the problems in that little blue pill.

Treating acute pain may well respond to anti-inflammatory, an anti-spasm medication or even a narcotic. Such example would be a massively sprained ankle, a back spasm that won’t quit, or a toothache that causes one to think about suicide. However the first line of reasoning should be to obtain a proper diagnosis for the condition in the first place.

Sometimes the condition is clear. For example you step off the curb and twist your ankle and the ankle becomes massively swollen, it is likely that you have a sprained ankle.

Sometimes, making a self -diagnosis after an acute injury or exacerbation of an existing injury can be quite difficult. For example, let’s say you’ve got a bad back and your hip has been hurting. You go snowboarding for the weekend and on Monday morning, you can’t get out of bed. You check to see if your friend or family member might  have a Vicodin or something laying around to help you get work or school. You take the medication and this eases the pain, but the condition persists. Weeks go by now you are bumming Vicodin off the street or resorting to other things.  You still don’t have a diagnosis and you’re back and your hip still hurts. You somehow manage on the medication because it’s easy. You try to find a doctor that will see you but you have no health insurance and it becomes increasingly difficult. To summarize, it is a lot easier to be complacent and just stay on the medication for pain and hope that things get better.

Unfortunately, sometimes things don’t get better and fractures, arthritis or other secondary conditions can precipitate or have already gone unnoticed. It is very easy to stay complacent and keep taking the medications. It is quite possible that one multiple medications are used and no proper diagnosis has been made, a person can become a “lifer” – one that takes pain medications the rest of their lives. Please avoid the tendency to do this.

Read about others that have fallen victim to “the great pain jack”. If you buy “The Great Pain Jack” for a loved one, you will see the kind act pay dividends over and over. Remember you can always give them the e-book version where they may derive just as much benefit.

When Treated Pain is the Problem

Improperly treated pain can become a problem in a number of ways. In my recently released book, the “Great Pain Jack “, I delineate a number of such examples from real life patients treated in my clinic.

If acute or sub acute pain is improperly treated or not addressed in the correct manner, it can progress to chronic pain, intensify and/or incorporate additional pain diagnoses into the original problem. For this reason it is recommended that acute pain be addressed and diagnosed accurately in the appropriate manner by seeing an appropriate healthcare professional. Typically, this will be your doctor. If a doctor is not available, do not substitute the Internet or friends or family advice on how to treat your pain condition. Opinions can be obtained for free this way but it is not safe when understanding that many people have been fooled by this “poor man’s way to deal with the pain problem”.

When pain isn't treated correctly, it can become significantly worse.

Oftentimes, a pain problem will progress to either a chronic condition which may then lead to over use of medications and a substance abuse problem or possibly an untreated condition which may lead to infection and catastrophically to gangrene and loss of limb or life. It is important to utilize the services of pain management physicians when pain becomes chronic or when the health-care system provider does not appear to have a solution for what appears to be a simple pain problem. Simply taking medications month after month may lead to a dependence, addiction or substance abuse problem which will then complicate matters further. Furthermore, occasionally a condition will be misdiagnosed by a general medical practitioner or a nurse that does not specialize in such a condition.

For example, let’s say someone breaks their arm and fractures a bone. They go to the emergency room to get the bone casted and they are told that everything will be okay. The bone heals improperly over weeks to months and then the diagnosis gets clouded. A condition known as reflex sympathetic dystrophy or complex regional pain syndrome develops which is not diagnosed early by the family doctor or orthopedist. This can lead to complete loss of function of the affected limb. If the condition was treated appropriately, it is likely that the development of the complex regional pain syndrome would not occur.

Far too often, people “borrow” medications or purchase medications on the street which are way too powerful to control symptoms of the original condition such as say for example, an ankle sprain. Once the body and brain gets used to taking powerful medications such as hydrocodone or oxycodone for treating the sprain, it is not going to go back and be happy with  ice and physical therapy. This is the basis of the “the great Pain Jack”. The brain is there for the taking and often times, it easy to be hijacked or ‘Jacked by pain.

Another example of how improperly treated pain can become a problem is when the condition may be over treated by the medical professional. If for example an acute back sprain is treated with life changing back surgery, you may treat the original condition but develop another pain syndrome associated with the back surgery. That is not to say that the surgeon was not well-intentioned to treat your pain problem in the first place. It is just that when given the tools for solving the problem involving the back when it comes to a orthopedic surgeon, the tool of choice is a scalpel and a surgery. I’m not stating that back surgeries are done for inappropriate medical reasons. I am quite simply stating that with today’s diagnostic tools and the emergence of a new specialty known as pain management, one who has a “back pain problem” should see a variety of different health-care providers that specialize in back pain before a decision is made to undergo life-changing back surgery These are just some examples of how improperly treated pain can become a problem in the future. Please read the fascinating accounts of many more of these types of stories in my book “The Great Pain Jack” , authored by Dr. John F. Petraglia,  board certified pain management specialist

 

Pain Case Studies

I have seen many types of pain and the ways in which pain can take over a person’s life in my field of work. Sometimes a small pain can be consistent enough to drive a person mad. Other’s have such terrible pain that it leads to prescription addiction.

Here are a few stories of some “pain jacks.” 

Case Study: Bob, a young painter and plaster handyman, fell off a scaffold and broke a small bone in his wrist. The bone, however, did not heal properly. Since the pain would not go away, Bob went to see his doctor. The doctor examined his hand carefully and found it necessary to perform a surgical procedure known as an open reduction and internal fixation.

Yet, after the surgery, Bob continued to experience pain in his hand. In fact, the condition worsened, and, over a brief period of time, he lost all functionality in it. A complex regional pain syndrome developed in his appendage, and Bob was forced to go through several other surgeries as a result.  While the fracture finally healed, the failure did not heal in a timely and normal fashion. This activated the nerves of the sympathetic nervous system and caused more damage. Bob developed severe limb and spinal problems that necessitated painful, extremely complex surgical procedures to treat.

Case Study: Dylan, a stocky and heavy twenty-year-old, came to see me regarding pain in his lower back. When in high school, he played football and got a herniated disk in his back. At age eighteen, Dylan underwent a diskectomy and fusion surgery, convinced by his doctor that this would make his pain go away.

The surgery went well, and Dylan was pain free. However, for whatever reason, within six months of surgery he developed a recurrent back pain. He began taking medication, which gradually increased in intensity and dosage, for the pain. He was now taking large, around-the-clock doses of methadone, morphine, and OxyContin to control symptoms. Dylan’s burning need for drugs steadily escalated, and at the ripe age of twenty Dylan began shooting heroin into his veins.

Soon, his drug addiction led to altercations with gang members and drug dealers, ultimately resulting in assault charges alleged against him. The first day I met him, I asked when he last took and prescribed or recreational drugs. He shot me a blank stare and said he injected heroin the day before. I studied this clean-cut, former high school football star from a well-to-do, high-income neighborhood and digested this information. I hoped Dylan was reaching out for help.

I thanked Dylan for his honesty, praising his decision to seek professional help. I prescribed his small doses of Xanax to ease his withdrawal symptoms. Fr physical pain, he was only allowed to take ibuprofen or non steroidal anti-inflammatory medication. With the help of N.A. Dylan would be subjected to strict urine testing and peer group counseling. This was supplemented by in-office urine tests and a written pledge to sobriety.

Pain can take over lives, and sometimes we are unable to stop ourselves. Recognizing how strong pain can be, though, both physically and mentally, can begin the process of helping us gain control of our lives.

The Great Pain Jack

Dr. John F. Petraglia has written , The  great pain Jack , a self-help mapping tool to allow the reader to help diagnose and treat  their chronic or acute pain condition. The reader will come to understand medical conditions as he or she is presented with real-life individual stories of the lives of chronic sufferers of pain. Each chapter is buttressed with a self-help pain mapping tool and questionnaire which will help serve the individual and their physician in an effort to diagnose and treat their pain condition. The author offers up hope , humility and treatment options but warns that is very easy to fall victim to ” the great pain Jack!”, A condition whereby the pain takes over the thinking part of the brain and the Jack occurs.