By Kristen Ogden, Guest Columnist
Rarely have I spent five days engaged in doing work that left me feeling as fulfilled as my recent stint helping as a volunteer in Dr. Forest Tennant’s pain clinic in West Covina, California.
For the past 3 years, I have been privileged to volunteer whenever I have traveled with my husband, Louis, for his appointments with Dr. Tennant. However, this was the first time I have given much thought to exactly what makes a visit to Dr. Tennant’s clinic such a special experience for his patients and their families.
Dr. Tennant and his wife and office manager, Miriam Tennant, sometimes refer to the clinic as a “mom and pop” operation. If “mom and pop” makes you think of behind-the-times or unsophisticated, think again.
Hidden in plain view, among the simple furnishings and interesting artifacts of a long career, is a true frontier in medicine, where discoveries are made, causes of rare diseases are pursued with vigor and, most importantly, a place where people suffering from constant pain are helped like nowhere else.
One thing that stands out about Dr. Tennant’s clinic is the focus on family participation. He requires prospective patients to be accompanied by a family member on their initial visits and encourages family members to attend. The active engagement and participation of family is critical to a successful partnership with Dr. Tennant. Patients and family members are required to sign documents to show their understanding of the off-label use of medications, willingness to participate in research, and acceptance of potential risks involved.
The role of the family in supporting the patient is critical. And why wouldn’t it be? Intractable pain exacts its toll on the entire family. A person suffering from undertreated severe pain becomes unable to function normally or participate fully in life. Many face loss of income, depletion of savings, routine tasks that don’t get done, loss of quality time with family, loss of contact with friends, and the loss of the ability to enjoy life. Families with excellent relationships and coping skills are greatly affected. The impact on families less tightly bound can be enormous.
I know many of Dr. Tennant’s patients and their family members. They are just regular folks, nice people from all kinds of backgrounds, with one thing in common. Somewhere along the way, their lives were hijacked by a rare illness or disease that bombarded them with unimaginable pain.
Dr. Tennant’s embrace of patients extends beyond the walls of the clinic and the usual office hours. During clinic week, you can expect to find him with Miriam enjoying dinner at a favorite restaurant with patients and family members, including many who traveled across the country and are staying in local hotels. It’s common to hear Dr. Tennant say, “We’ll be at Marie’s tonight around 7. Come join us for dinner.”
Who has ever gone to see a doctor and gotten invited to dinner? But that’s what he and Miriam do. It’s another way they engage with families, and demonstrate their interest and care for patients. They like to get to know their patients as people, not just names on a medical chart.
The informal group dinners bring other benefits. For some, it is the first time they will meet others who share the agony of intractable pain or share the same illness. You may go to dinner wondering if you will enjoy an evening with strangers, and leave feeling like you have found a new extended family.
Dr. Tennant always has some new diagnostic test or research study up his sleeve. Recently, he asked patients to participate in a new DNA study of genetic indicators not previously studied in rare diseases that involve chronic pain. Every new test and diagnostic tool reveals important information – hormone panels, nerve conduction studies, blood tests for inflammatory biomarkers, and MRI images that may reveal the presence of adhesive arachnoiditis.
All of these diagnostic research efforts produce new insights. For example, in a study of over 100 intractable pain patients who require relatively high opioid doses, Dr. Tennant found that 91% of them had genetic defects that impacted their ability to metabolize medications, suggesting why they need higher doses for effective pain relief.
Another example is the growing understanding of the impact of pain on hormone levels. Severe chronic pain initially elevates hormones, but if uncontrolled for too long, hormone levels become depleted. Hormone levels that are too high or too low are biomarkers of uncontrolled pain, and indicate that higher doses of pain medications or hormone replacement may be necessary. Ongoing clinical research is a key element of Dr. Tennant’s approach to pain care.
In my visits with Louis to numerous pain doctors prior to finding Dr. Tennant, almost all of them said, “The goal is to get you off those pain medications.”
I was shocked when I first heard Dr. Tennant say, “The goal is to relieve your pain.”
Dr. Tennant has the expertise to “see” a patient’s pain and to ask the right questions. His discerning eye can distinguish between intractable pain patients and the few who come to the clinic seeking drugs for the wrong reasons.
Dr. Tennant understands that most patients have already tried and failed at many different pain treatments. When that is the case, he tries to determine what will work. The goal is to relieve pain so that the patient has a chance at meaningful improvement of function and quality of life. There is no demeaning treatment, there are no words said that convey doubt or suspicion, there are no looks that say, “You must be a drug seeker.” Dr. Tennant’s clinic is one of very few medical facilities I have visited where there was no evidence of stigma toward pain patients.
An important piece of Dr. Tennant’s philosophy is that if you effectively treat the pain, improvements in function and quality of life will follow. Dr. Tennant prescribes medication as needed to enable patients to effectively manage their pain, which in turn helps to stabilize their overall condition, while the underlying causes are identified and treatments are attempted. If a patient’s pain remains undertreated, the likelihood of successfully treating the underlying causes is greatly reduced.
Transforming Pain Care
The Institute of Medicine’s 2011 report, Relieving Pain in America, called for “a cultural transformation in the way pain is understood, assessed, and treated.” The characteristics I would seek in such a transformation of pain care are visible every day in Dr. Tennant’s clinic. I wish that other doctors who treat chronic pain could get outside the bounds of their particular specialties and professional societies to view their patients differently.
As Dr. Tennant’s research has moved forward, he has found that the majority of chronic pain patients who go to his clinic have 4 or 5 rare disease conditions: adhesive arachnoiditis, post-viral autoimmune disease, Reflex Sympathetic Dystrophy (also called Complex Regional Pain Syndrome), and connective tissue disorders such as Ehlers-Danlos Syndrome. All of these conditions are often accompanied by very severe, constant pain.
In the last few years, Dr. Tennant has made great advances in identifying and treating the underlying causes of intractable pain. He credits two recent scientific advances for enabling him to treat the causes rather than just the symptoms of pain. First, we now know that microglial cells within the central nervous system, once activated by a painful injury, disease or trauma, cause inflammation inside the brain and spinal cord. This neuro-inflammation causes chronic pain to centralize in the spinal cord and brain, resulting in severe pain that is constant.
Second, we now know that nerve cells may regrow, a process called neurogenesis. Certain neuro-hormones in the brain and spinal cord can promote neurogenesis when neuro-inflammation is reduced. Dr. Tennant’s approach is to reduce neuro-inflammation while simultaneously promoting neurogenesis. His protocols for treatment of neuro-inflammation are in their early stage, but they are already providing disease regression, enhanced pain relief, less suffering, and, for some patients, reduction in the use of opioids.
It is a true privilege to work as a volunteer in Dr. Tennant’s clinic. When I asked him in 2014 if I could be a volunteer, I had two specific reasons: to learn more so I could fight back against our insurance provider (who had suddenly decided to reduce the reimbursement for my husband’s pain medications), and to educate myself so that I could become an effective advocate for chronic pain patients. We lost the battle with the insurance company, but I have certainly received an education that very few people have a chance to experience.
Dr. Tennant’s methods and approaches are not proprietary -- he's eager to share them. There are many good doctors out there who could learn to do what he does, instead of focusing solely on the treatment of pain as a symptom. It doesn’t require a fancy clinic, lots of money, and corporate or university infrastructures. What it takes is a doctor who is truly committed to relieving pain and practicing the art of healing.
It is possible to manage pain with medicine instead of injecting the spine, inserting stimulators and pumps, or using other invasive procedures. Instead of treating pain with these modalities, treat and relieve the pain with medication, stabilize the patient, and search for the underlying causes so that they can be addressed.
At age 76, Dr. Tennant could have retired and given up his practice many years ago. Why does he put up with the many challenges of operating a pain clinic? Because he truly cares about helping people who are suffering.
Kristen Ogden has advocated for her husband, a long-term intractable pain patient, for over 20 years. She is the co-founder of Families for Intractable Pain Relief, an advocacy group for pain patients and their loved ones.
Pain News Network invites other readers to share their stories with us. Send them to: editor@PainNewsNetwork.org.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.