Healthy Beginnings

Treating the Patient, Not the Diagnosis

Some people do not understand the true makeup of chronic pain. For example, attorneys who represent chronic pain patients in disability cases, or a venture capitalist who invests in and owns startup companies that manufacture drugs for chronic pain. With no disrespect intended, neither one of them might really understand the true nature of the mechanisms that create chronic pain patterns and the devastation that these conditions cause on their client’s/customer’s lives.

According to a Time Magazine article, “recognizing a disease is only a prelude to treating it, and doctors admit that while they’re pretty good at relieving acute pain that occurs immediately after surgery or injury, they are usually stymied by the chronic kind. The most common complaint doctors hear from their patients is about pain that will not quit and more than 80 percent of those people never receive treatment—or at least an effective one. About a decade ago, physicians took the first step towards acknowledging the prevalence of chronic pain and their inadequate ability to address it.”

“As a clinician, I’m frustrated and I’m sure many patients are, because we do a very poor job in terms of providing relief from chronic pain” says David Borsook of the McLean Hospital and Harvard Medical School.

The largest drug screening lab says there are 50 million Americans suffering from chronic pain. The American Academy of Family Physicians says it is actually 70 million people, and the Institute of Medicine puts the number at 116 million. No matter who is right, it’s a lot of people. There are only 300 million people in the entire US. It is also clear these entities do not know what causes chronic pain syndromes!

The reason for this is chronic pain is chronic, not acute. That may seem absurdly overstated—like “duh”—but as referenced in the TIME article it cuts to the core of the problem. The medical model is an acute pain model. It teaches, practices, researches, eats, sleeps and drinks acute pain procedures and drugs, surgeries and electrical implants. These are bandages at best and do not address the complex combinations of physiological mechanisms that create the constellation of chronic pain syndromes; nor will they ever. It is physiologically impossible to address chronic pain with the acute pain clinical/research model. Here’s why:

As stated above, chronic diseases and pain syndromes are all a result of multiple various cycles. They are a complex combination of neurological, metabolic (think endocrine / hormonal system), nutritional and musculoskeletal system break downs that render your body incapable of healing itself—something which is clearly designed to do. It is beyond the scope of this article to discuss healing, but essentially it’s all about making ATP (energy). If you can’t make ATP in the body, nothing that you try to help heal yourself will work. Nothing— chiropractic, acupuncture, drugs, herbs, etc. All chronic patients have lost the ability to maintain cellular homeostasis (balance). When the cell is in balance, they heal themselves. When the cell is not, so damaged that it can’t regain its ability to create energy, it can’t heal itself. It’s too far gone and it can’t recover; you can’t heal. In general, a person whose cells have lost the ability to make ATP thus has lost the ability to heal themselves.

Different organ systems have different types of cells. So as each system subsequently becomes involved, more cells become affected. That system then starts to express its own unique set of symptoms. So a “Fibromyalgia” patient may have a “Hypo” or autoimmune thyroid, a sick gut (think IBS, Diverticulitis, Celiac), a fatigued adrenal (stress) gland, and a bad left brain (brain fog, loss of short term memory, etc.). These are multiple systems— breaking down—causing a mind-numbing constellation of symptoms that do not lend themselves to a “clean” medical diagnosis, or to a response from a pill that “might,” with alarge emphasize on “might,” help one of those symptoms.

The following chart is how chronic pain syndromes and cycles evolve and why they are a challenge to control with drugs, surgeries and electrical implants:

This chart represents the chronic pain conundrum. In the left column are the most common chronic pain syndromes seen in our office. They seem unconnected and unrelated. Especially to those whose frame of reference is the acute pain/specific disease-oriented diagnostic medical model. They are not. In the right-hand column are the causes and the commonalities of all chronic pain syndromes. The combination of the abnormal misfiring syndromes on the right break downs their individual cells abilities to create ATP and cause those cells dysfunction impairing their ability to “heal,” and this process results in pain.

So, you can have a Fibromyalgia patient who has abnormal neurological misfiring (brain), autoimmune attacks (thyroid, bowel) and food sensitivities or anemias, hormonal imbalances, and chronic neck and low back (musculoskeletal) degenerative discs. Both are diagnosed with fibromyalgia. But the mechanisms are completely different. You can have 10 chronic pain patients with the same diagnosis (fill in the blank— fibromyalgia, peripheral neuropathy, chronic fatigue, vertigo, migraines) and they will be physiologically different, while suffering from various combinations of the imbalances listed in the right hand column. Can you see why a drug, surgery or implant will never fix anything? You need to treat the patient and not the diagnosis. Drugs, surgeries and implants only interfere with these mechanisms, they do not help them to regain their balance and function normally again.

Chronic pain patients require the doctor to take a comprehensive history and use those findings to perform the appropriate indicated physical, neurological, orthopedic and generalsystems exams. That data should direct specific testing recommendations that should produce relevant clinically applicable information telling the doctor which of the imbalances in the right-hand column above are causing the diagnosis of the specific chronic pain diagnosis listed on the left. That takes time. This approach doesn’t fit into the five, 10, 15 minute office visits foisted upon the health care profession today by the insurance, acute pain model. But, this more comprehensive approach provides information that can then be used to craft a strategic, and most of the time, non-drug approach to substantially reducing and manage that particular patient’s pain syndrome.

It may sound like a fantasy, but the functional medicine/ functional neurological model is helping patients manage their specific pain syndrome each and every day in functional offices all over the country. The functional approach is, and must be, “treat the patient and not the diagnosis,” or it will fail.

Functional medicine is the chronic pain model of the present and the future.


1. Understanding Pain, Time Magazine, March 7, 2011.

2. (The Numbers Game: How Many Americans Have Chronic Pain)

3. Kharrazian, Datis. Introduction to Blood Chemistry. 2012.

For more info, or to schedule a free consultation with Dr. Rutherford or Dr. Gates call (775) 329-4402, or visit online at