Intractable pain: nine steps for injured workers

This  “manual” by Forest Tennant M.D., Dr. P.H. from the renowned Veract Intractable Pain Clinic in Canada describes the therapeutic measures you must take particularly if you want pain free hours rather than a constant state of pain.  Intractable pain patients tend to think that simply taking opioid medication will solve their problems.  This is not true. So I have been told, and given that I am in excruciating pain again (the debridement gave me only 4 weeks’ “relief”) I am ready to give it a shot, are you?

Without the comprehensive measures given here, you will eventually find that your opioids don’t “work” , says Dr Tennant, and you are right back in constant, severe pain.

Nine steps are given here as a pathway to pain free hours.  These steps include your instructions on diet, dietary supplements, exercise, electricity control, and topical medications.

Why these nine steps for intractable pain patients/injured workers?

The nine step guide is for those intractable pain patients/injured workers who are deeply committed to achieving some pain free hours.  The material contained in this article is given to Dr Tennant’s private patients, and I wish to share it with other intractable pain patients as almost all of his patients have been able to experience some pain free hours.

However, do not expect your pain to totally stop although the steps given here will greatly reduce your overall pain.

Experience has shown that once you achieve the first pain free hour, more will come.

Be clearly advised that the achievement of pain free hours requires that an intractable pain patient diligently participate in a treatment program with multiple measures.

My best recommendation at this time is to focus and intensely practice the nine steps given in this guide.

The pain research breakthrough

In recent years medical science has learned that an injury or disease with severe pain, which does not immediately heal, may produce excess electrical impulses that travel from the pain site to the spinal cord and brain.  Initially the brain tries to cure the pain site by causing the body to produce essential hormones and immune enzymes.  If this step doesn’t work the brain rearranges its nerve cells, called neuroplasticity, to shield itself from the excess electricity produced by the injury or disease.

Unfortunately, the rearranging of nerve cells may trap or imbed the memory of the pain in a new, abnormal brain circuitry.  This is the mechanism for “phantom pain”, and we now know that this is the mechanism by which one develops intractable pain.

It is the trapping of the memory of pain in the new circuitry that makes the pain constant and produces other intractable pain symptoms including insomnia, depression, nervousness, lack of mental concentration, high blood pressure, elevated heart rate, abnormal hormones, and a feeling of hopelessness.

The nine steps given here are designed to at least partially heal the abnormal nerve cell circuitry in the brain as well as the damaged nerves at the site of pain.  This nine-step guide is Dr Tennant’s first attempt, given what he knows today, to help intractable pain patients achieve a “pain free hour”.

You can look forward to improved and more effective measures in the future.  Real hope is here, he says.

The meaning of a pain free hour

A single pain free hour has to be the main goal of an intractable pain patient who may have suffered constant -“24/7”- pain for a long time.

Why is this achievement so significant?  It means that you have healed some damaged nerve cells that have an abnormal electric circuitry, and it likely means you can achieve more pain free hours.

Thanks to research, Dr Tennant now knows that a patient who is selfdisciplined and closely follows the nine steps written here has an excellent chance of achieving many pain free hours.


  • PAIN MEDICINE : Take whatever medication you must take to be active, functional, and able to leave your house each day.
  • SLEEP MEDICATION: With IP you can only sleep about 2 hours unless you take some medication.
  • PROTEIN DIET: Pain control and mending your nerve tissue requires amino acids which only come from foods with protein.  You must avoid hypoglycemia which comes from too many sugars and starches.
  • DIETARY SUPPLEMENTS: Without certain daily supplements your medications may stop working and tissue won’t mend.
  • ELECTRICITY ELIMINATION: Your damaged nerves retain electricity in the body (“static”) and you must daily take measures to eliminate it or you will progressively deteriorate rather than achieve pain free hours.
  • TREAT YOUR SITE OF NERVE INJURY: You must daily stretch, massage, and apply medication to your pain site.  You must learn to make your own opioid topical medication.
  • ACTIVITY, MENTAL EXERCISES, MOVEMENT : You must daily be moving, talking with people, and exercising your brain or your tissues will atrophy and you will mentally deteriorate.
  • ANXIETY MEDICATION: IP causes the sympathetic nervous system to overstimulate resulting in a high pulse rate, muscle spasm, tremor, twitching, anxiety, blood vessel constriction (cold hands/feet), headache, nausea, fear, and lack of confidence.  You will likely need medication to control this complication.
  • HORMONES : It is specific hormones whose job is to grow nerve tissue (“neuro-genesis”).  Regrowth of damaged nerve tissue is essential to achieve a pain-free hour.



1. Take in extra proteins since the natural body pain relievers including endorphin, dopamine, serotonin, and gamma-amino-butyric acid are all made from protein.

2.  Avoid hypoglycemia since it may cause your pain to flare.

3.  Keep your weight down if your pain is caused by spine, hip, knee, ankle or foot problems.

  • Diet Key Point: Eat one or more of these protein foods every time you eat: Beef, Fish/Seafood, Poultry, Pork , Eggs, Cottage Cheese
  • Drink low sugar (Carbohydrate) drinks. Drink tea or coffee with  low calorie sugar. Diet drinks are acceptable.
  • Do not drink the following:  Milk, regular sodas, Coffee/Tea with regular sugar.
  • Eat any food you wish as long as you eat a protein food with it.  Especially eat some protein with rolls, donuts, pie, cake, ice cream,  candy, bread

Basic supplements


2.  EACH DAY – 1 0R 2 VITAMIN D – CALCIUM-MAGNESIUM TABLETS (Sold for Osteoporosis)

3.  EACH DAY – GLUTAMINE 1,500 TO 2,000mg (Chew a tablet or take a capsule on an empty stomach)


Special Notes 

All these supplements can be purchased at a Health Food Store.  Be clearly advised that your medications may stop working if you don’t take these supplements.

Additional supplements that help some patients: Carnitine, Taurine, Fish Oil, Phenylalanine, Folic Acid, Vitamin C.

Electricity elimination strategies

You must daily  eliminate the accumulation of static or trapped electricity in your body which results from damaged nerves.  Pain and its complications are fundamentally caused by excess electricity.

Mandatory each day:

1. Rub your pain sites at least 2 times a day with copper and a magnet;

2. Massage one of these topical (skin) medications into your pain site(s) at least 2 times a day: morphine, hydromorphone, carisoprodol, oxycodone: They work best under infrared, vibrator, ultrasound or heating pad

Do some of these each day

1. Take a tablet of magnesium, copper, or zinc;

2. Wear copper and/or magnetic bracelet, anklet, or necklace;

3. Soak in your bath tub or Jacuzzi with 2 tablespoons of Epsom salts placed in it;

4. Walk barefoot for at least 5 minutes

5. Use a TENS, microelectric current (Alph Stim®), or other electromagnetic device over your pain sites;

6. Stretch exercises which put pressure or “tug” on your pain site(s).

7. Frequently grab or touch metal objects.

How to use opioids to control intractable pain

1. You must learn the actual names and not just the trade name of your opioids.

Example: hydromorphone is Dilaudid®

2. You must take your opioids in such a manner that you are not sedated, impaired, sleepy, or have a clouded mind or memory.  Your family is the best judge, not you.

3. Most intractable pain patients must control their pain by use of a long-acting opioid plus a short-acting one for flares, surges, or breakthrough pain.  Some of the opioids listed here have long-acting, oral formulations which last 6 to 8 hours.  You must take a long-acting opioid on a regular schedule which means taking the same dosage at the same time each day.  The usual schedule is 7:00am, Noon, 6:00pm, and 10:00pm.

4. Use your short-acting opioids 30 to 60 minutes BEFORE  the flare or just breakthrough starts.


Opioids for intractable pain




How to make pain relief creams

Crush 1-3 tablets of the following and  stir in 1 ounce of cold cream.


1. Carisoprodol (Soma®) – 350mg

2. Morphine – 30mg

3. Hydromorphone (Dilaudid) – 8.0mg

4. Oxycodone – 30mg

5. Medroxyprogesterone – 10mg

6. Prednisone – 5mg

Massage one of these topical creams into your pain sites at least twice a day. You will not only get additional pain relief but help eliminate your trapped (static) electricity. You can mix topical medications and pick your own cream or base. These topicals work best under infrared, vibrator, heat, or ultrasound.

Download the Manual here (PFD)



The intractable pain survival handbook

Interested in reading more about intractable pain? Have a peek at this free book by Dr Tennant.

Click to view book (PDF)



23 Responses to “Intractable pain: nine steps for injured workers”

  1. Your thoughts are interesting and well intended. There seems to be a lack of General Practitioner referral to pain clinics. Too many Workcover and TAC injured workers rely simply on their GP’s and stay in that cycle of medication, rest and exercise. When I was at my wits end (literally)I googled pain and ended up at a very reputable pain clinic and having Radio frequency neurotomy for intractable neck pain radiating down one arm.It has been remarkably beneficial. My point is an injured worker must break away from the GP reliance. You have to be mercilessly proactive with your own pain.You must seek every possible reducing of your pain. Take no prisoners in this process. Depression and axiety will be your reward for inaction.

    Lindsay Adams July 7, 2012 at 1:43 am