Pain Doctor, Pain Patient

How chronic pain changed one doctor's career -- and life.

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On the night of March 28, 1986, Howard Heit's car was struck in a head-on collision. He left the scene of the serious crash thinking how lucky he was that he hadn't been hurt. "And then four to six weeks later, I started noticing twitches in the muscles of my neck and upper back. These progressed to marked spasms of my neck, shoulders, and upper back," he recalls.

The pain never ceased. All day, every day it plagued him. It became difficult for him to walk -- and almost impossible for him to work. He had to rely on a wheelchair and brace to get around.

Heit went to several doctors in the Washington, D.C., area. None of them could figure out what was wrong with him. His doctors tried a variety of treatments -- massage, physical therapy, and muscle relaxants -- yet not one of them offered him pain medicine to relieve his constant agony. "Nobody, despite this tremendous pain, offered me a pain pill, even though I wasn't sleeping and I was losing weight," he says.

Even worse, his doctors didn't seem to take his pain seriously. "I had silly things said to me, like, 'The pain is all in your head.'"

Heit wasn't just any patient -- he was also a practicing doctor. A board-certified internist and gastroenterologist, he served as chief of the Gastrointestinal Lab at Fairfax Hospital in Fairfax, Va., and as an assistant clinical professor of medicine at the Georgetown University School of Medicine. And Heit knew that if the medical community was disregarding his pain, there was no way patients who didn't have the benefit of his medical expertise were getting the pain relief they needed.

"I started thinking that if this was happening to me ... nobody offering to at least discuss pain management with me ... the average person didn't have a chance out there to get appropriate treatment," he says.

(Read WebMD expert blogs "A Different Normal: Living with a Chronic Condition".)

New Direction

Heit decided that he would become a pain management specialist and an advocate for people living with chronic pain. He realized that to become a pain specialist, he had to understand not only pain management, but addiction, as well, because painkillers can be habit forming.

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He earned his Diplomate in Addiction Medicine from the American Board of Addiction Medicine and attended continuing medical education (CME) meetings to learn about both specialties. At his former employer, Fairfax Hospital, he bartered his services -- educating doctors there about gastrointestinal care in exchange for hands-on training in addiction medicine.

"And I set up a practice at the time that was very unusual. Patients who had pain only, patients who had addiction only, and patients who had both," he says.

Living in constant pain gave Heit a special insight on his patients. "They could never tell me something that I didn't experience myself. It gave me great empathy for our patient population and how terribly the medical profession was treating them."

As a pain and addiction specialist, Heit distinguished himself in other ways, too. He kept his practice small so he could get to know his patients and provide them one-on-one care. "I made it clear that I was going to be the captain of their ship as far as pain management. I would coordinate their care, whether it was with their family doctor, their internist, or their surgeon in order to give them the best pain management possible." He referred patients when necessary to physical therapists, counselors, or other specialists.

Heit never dismissed his patients for admitting they had a history of addiction, as many of their previous doctors had done. If addiction became a problem during treatment, he offered counseling and guidance, but made it clear that he wouldn't enable painkiller abuse.

Finding Pain Relief

Heit, now 67, finally found his own pain relief in a deep brain stimulation technique administered at the University of Virginia. "I don't use a wheelchair, brace, or cane anymore. I had a response to the Deep Brain Stimulator that eliminated close to 90% of my pain and the majority of my spasms. I was able to resume a fairly normal life," he says. Deep brain stimulation is a technique that uses implanted electrodes in certain areas of the brain, which send out currents that essentially block the signals that cause pain.

After the death of his wife in 2010, Heit stopped practicing medicine, but he remains a staunch advocate of pain management care -- a practice he says is sorely lacking. "Pain is undertreated in this country," he says. "The pain clinics are more interested in procedures than in taking time to discuss things in detail with patients."

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Chronic Pain: Heit's Advice

So what should you do if you're experiencing chronic pain, as Heit was, or pain coupled with addiction?

Heit recommends searching for a doctor until you find one who won't dismiss what you're experiencing, someone who is willing to sit down and really talk with you about your pain. To find a pain management specialist, you can contact the American Academy of Pain Medicine or the American Board of Pain Medicine.

When you see a pain medicine specialist for the first time, it can help to bring a pain journal. In it, keep track of what makes your symptoms worse and what seems to relieve them. Also write down the names of any medicines you've been taking for pain, whether or not you needed a prescription for them, and how well they've worked.

Don't be afraid to ask the doctor questions. And keep pressing for treatment until you get the pain relief you need.

For Heit, finding a solution to the pain that had plagued him was life-transforming. He was able to provide that same kind of relief for his pain and addiction patients, who he says were among the most grateful people he'd ever treated. "I gave them a chance to have a quality of life," he says.

WebMD Feature Reviewed by Laura J. Martin, MD on May 21, 2012

Sources

SOURCES:

Howard A. Heit, MD, FACP, FASAM.

American Chronic Pain Association: "FAQs."

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