GSMedicalCenterInc./ComprehensivePainReliefGroup NESP‐R versus Traditional “Detox Programs” By Gregory A. Smith, MD Chronic pain afflicts up to one third of the American population; and cost our society 100 billion dollars per year. It is estimated that 45 million people suffer from headaches on a regular basis spending an astounding 4 billion dollars per year on over the counter headache remedies. Hundreds of millions more are spent on prescription drugs for headaches. Low back pain “the mother of all chronic pains” affects an amazing 70‐85% of the population at some point during their lives. The vast majority of these patients are treated with addicting narcotic medications, many become addicted and go on to have devastating sequelae not only from unrelenting chronic pain but a simultaneous addiction to painkillers. Prescription addiction has reached epidemic proportions in the US and the problem is overwhelming the medical community who is ill prepared to deal with the magnitude of the problem. The NESP Program is a system that was developed by Gregory A. Smith, MD, QME. The system was developed over a 12‐year period. It involves treating the six aspects of the chronic pain experience: NESP is an acronym. The N stands for Nutrition, the E for Emotional/Psychological, the S for Social/Financial and the P for Physical. The NESP‐R program (R stands for Revised in 2010 to meet MTUS guidelines) is a program that targets patients with chronic pain or who were started on prescription narcotics for pain; that are now either addicted or dependent on opioid (narcotic) medications. However the program is just as effective for recreational users including Heroin. The vast majority of substance abuse programs tend to treat all addictions with the same therapies or program. In other words alcoholics, street drug addicts (methamphetamines, cocaine, etc.) and patients addicted to prescription pills basically get the same treatment and are placed in the same support groups or therapy. Patients are often forced to attend classes or group therapy several times per day whether that particular class is relevant to their situation or not. In contrast the NESP program is customized to deal with the unique issues that every patient has. Some patients’ major cause for addiction is simply an imbalance in brain chemistry; others have deep rooted psychological issues that are responsible. This is where customization becomes key to long‐term success and minimizing the likelihood of relapse. Although all addictions have basic similarities there is a usually a major difference between a person who is using street drugs vs. a person who was placed on an addictive drug by a physician due to an injury or after surgery. This fact is one of the main points that separate the NESP‐R program from everything else. The NESP‐R program addresses the 3 issues that are most associated with relapse. GSMedicalCenterInc./ComprehensivePainReliefGroup These are i. genetics (using DNA test results to customize treatment during the program and long‐term anti‐craving nutraceutical recommendations), ii. Treating underlying problems such as chronic pain, anxiety and depression that can lead patients to resume addictive drugs; and iii. Balancing brain neurochemistry that is often responsible for impulsive behavior and drug cravings. Talk therapy based programs that have up to a 90% relapse rate simply do not address these factors. Below is a summary of the unique features of the NESP‐R program:  4‐12‐week outpatient program (the first 72 hours patients have a 24/7 nurse assigned to them for medication and supplement management and for psychological support). Patients are seen every day 5 days per week for the duration of the program  Integrative reports on a biweekly basis as suggested by the MTUS guidelines (for worker’s compensation patients)  Simultaneously treats narcotic addiction or dependence and chronic pain.  Other collateral drugs (muscle relaxants, anti‐anxiety drugs, sleeping pills, etc.) can also be discontinued.  Utilizes DNA testing to identify predispositions to narcotic abuse and other collateral problems such as depression and anxiety. This information can help shape the treatment plan; this test can also help to identify candidates for the program.  Utilizes customized nutrition programs (Intravenous, sublingual and oral) that focus on replenishing nervous system neurotransmitters that cause drug cravings and increased pain. The program also focuses on weight loss for patients who have gained significant weight due to injury and a sedentary lifestyle from chronic pain.  Utilizes customized medical hypnotherapy and psychotherapy programs for patients that have certain collateral problems (anxiety, depression, etc.) that complicate simple narcotic detoxification.  Utilizes acupuncture techniques for addiction and in some patients for chronic pain.  “Pain School” is the educational portion of the program. It is Group therapy sessions that focus on the mechanisms of chronic pain and the role of psychogenic pain. This type of therapy alone has been successfully used for over 20 years by John Sarno, MD as a sole technique for treating chronic pain. This is nothing like NA (Narcotic anonymous) or AA (Alcoholics Anonymous).  A community volunteer program that enables patients who are not able to work a normal job to re‐enter the work place temporarily as a volunteer to build self‐esteem and confidence and prepare them to find eventual employment (patients who are currently on disability).  Functional restoration utilizing Yoga and home exercise program. We prefer GSMedicalCenterInc./ComprehensivePainReliefGroup   Yoga because it is low impact, emphasizes flexibility, mental clarity and well‐ being and can be modified to any fitness level and compensate for injuries and disabilities. It is taught so that the patient can continue the practice for rest of their lives. It can also help to improve muscle strength, coordination and accelerate weight loss. Utilize cutting edge technologies in the treatment plan; examples are Class IV laser treatment, Nano Spa (Nanotized hyper‐oxygenated rich water therapy available in only 2 locations in US ours is in the LA office) Nexalin cranial‐ therapy, ODIND 1 etc. Program can end with a Maximal Medical Improvement or Permanent and Stationary status (worker’s compensation patients) if we are made primary treater with commencement of the program. This goal would be explained and accepted by the injured worker prior to starting the program. Rev 4.13