I launched the concept of #CleanUpTheMess in January 2017. The mess was…

the over-reliance on prescription painkillers (especially opioids) to manage pain that reduced function and quality of life while increasing side effects and polypharmacy.

Cleanup was the journey we needed to embark upon to “help those whose use of legitimately prescribed painkillers is causing more harm than good to find a less dangerous treatment regimen.” I began to #CleanUpTheMess in 2003 so I’ve had a front row seat as workers’ compensation and broader society have increasingly taken on that challenge.

I have also talked about the concepts of #BioPsychoSocialSpiritual (a whole-person approach to pain management), #AllOfTheAbove (maximizing the variety of treatment options available for an individual), #Resilience (getting back up when you’ve been knocked down) and #WordsMatter (our words, along with our attitudes and actions, have a huge impact). Certainly none of these concepts are new, but in speaking around the country I found that thinking about them (and, more importantly, acting upon them) was unfortunately new to many.

So in January 2019 it’s time for a new concept…


Pain (physical, psychological, emotional, financial, relational, spiritual) is part of the human condition. It happens to everyone. Pain is inevitable. How you respond when it happens often dictates the outcome. Since the mid-1990’s we as a society have been told that “pain management” is sedation with pills when, in reality, “pain management” is the management of pain (moving the words changes the paradigm from passive to active).

Not creating a (personal, societal) mess means doing the right thing up-front.

The first rule in holes is to stop digging. The best way to cleanup the mess is to never create a mess. While #CleanUpTheMess will likely never be finished, fixing the issue upstream with better Day One treatment choices will help ensure the mess doesn’t get any worse. Or, even better, prepare for Day One at Day Zero (i.e. before the pain occurs) so when the inevitable happens you’re ready.

In other words, we cannot #CleanUpTheMess without #PreventTheMess.

So what does that mean?

  • RICE (rest, ice, compression, elevation)
  • Get an annual physical and do the follow-up
  • If prescription opioids or benzodiazepines help (benefits > risks), take only what you need for only the duration needed
  • Use more ibuprofen and/or acetaminophen … even (especially) during the acute phase
  • Change treatment if it’s not working (this seems like a no-brainer but unfortunately we have a lot of Einstein’s out there that keep doing the same thing and expecting a different result)
  • Choose active therapies like physical therapy or yoga before prescribing/taking a pill
  • Choose passive therapies like chiropractic, acupuncture, dry needling, massage therapy or medical devices to help promote healing
  • Promote medical literacy to help patients (“injured workers” in workers’ compensation) make better treatment choices
  • Educate all stakeholders, but especially clinicians, on all evidence-based non-pharma options for managing pain
  • Identify and deal with psychosocial co-morbid issues up-front using tools like CBT and mindfulness
  • Encourage wellness – physical, psychological, emotional, financial, relational, spiritual – so when pain happens the person is more equipped to handle the difficulties
  • Adjust the expectation of patients from “zero pain” (there is no such thing) to “managing pain” (living life in spite of the pain)
  • Change from a negative to a positive mindset about pain…and life

This is not an all-inclusive list but a good start.

A variety of states are helping set the stage – limiting the day supply of Rx opioids and/or MEDs during acute pain, providing more access to mental health treatment, providing (and requiring) more education for clinicians, requiring the use of PDMPs and sharing data across state lines, broader prosecution of illicit drug dealers, focusing more on clinical outcomes than fees, and many more strategic initiatives. Those are very helpful but will not solve the problem. We have to fix not just the supply but also the demand. Which means changing individuals.

Here are three words you will hear a lot from me during 2019 (and beyond) in relation to patients: EducatedEmpoweredEngaged.

  1. Educated on all of the options
  2. Empowered to make decisions
  3. Engaged in the implementation of those decisions

In order to #PreventTheMess we cannot count on somebody else (a clinician, caregiver or friend) or something else (a pill, procedure or injection) to take care of our problems. We need to count on ourselves. Each person needs to own their healthcare and be accountable for making the best possible choices. As I said in January 2017…

“I have been an advocate my entire life of personal accountability. You are responsible for you. While others might have influenced you (good or bad), only you can fix you by deciding to fix you. Choices have consequences. but ultimately the choice was made by you and the consequences are yours to bear.”

So what is your role (and mine) in #PreventTheMess? It’s very simple…

Start with yourself then help others make the best possible treatment choices on Day One.

#PreventTheMess + #CleanUpTheMess = The Answer.