Just before I moved to Sun Valley, I read a book, “The Promise of Sleep.”  It was an autobiography of William Dement, who started the first sleep lab at Stanford.  I become very interested in the effects of sleep on chronic pain.  One of his major points in the book was that less than five percent of physicians addressed sleep issues with their patients. I felt I should begin to systematically address insomnia.

After I moved to Sun Valley in 1999, I started to incorporate the treatment of sleep with most of my patients. If it were an acute problem such as a ruptured disc, I would use sleeping medications in addition to pain medications. It was much easier for my patients to wait it out until the disc healed if they were able to sleep. In chronic pain, the results were consistent.  Over two to four weeks, my patient’s mood and coping mechanisms would improve with a good night’s sleep.  If they did not get to sleep, I would aggressively keep switching meds until sleep was attained.  Not sleeping was not an option.  None of the rest of the DOCC program will work without sleep.

I had one businessman that had experienced chronic neck pain for almost two years.  There was no specific injury.  He continued work as an owner of a small accounting firm but was miserable.  He had been through multiple courses of physical therapy.  I started a strong sleep medication, which immediately allowed him to sleep a full night.  I saw him back at two weeks to check on how the medication was working.  I was planning on starting aggressive physical therapy six weeks later. When he came back for his eight-week visit, I was surprised to find he was completely pain free.

Incorporating sleep into my treatment of pain was my first step in conceiving the DOCC protocol.  I felt I had a whole new weapon that was very effective and yet simple.  Once I am successful in getting my patients to sleep, there is always some improvement in their sense of well-being if not also their pain.

I feel that my first obligation is to get my patients to sleep. Patients argue with me that it is impossible to sleep with the pain. There are very few situations where the right combination of medications cannot be found to yield a consistent good night’s sleep in spite of the pain.

BF