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. Tennants 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 patients 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. Tennants 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. Tennants 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 patients pain remains undertreated, the likelihood of successfully treating the underlying causes is greatly reduced.

The Institute of Medicines 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. Tennants 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. Tennants 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. Tennants 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. Tennants 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 husbands 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. Tennants 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 doesnt 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.

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