By Gregory Alan Smith, M.D.
Chronic pain afflicts up to one third of the American population; and cost our society up to 635 billion dollars per year according to the American Pain Society. 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 opioid 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, M.D. The system was developed over a 12-year period. It involves treating the six aspects of the chronic pain and addiction experience: NESP is an acronym. The N stands for Nutrition, the E for Emotional/Psychological, S for Social/Financial and the P for Physical. The NESP program is designed for patients that are addicted or dependent on opioid prescription painkillers without pain.
The NESP-R program (R stands for Revised in 2010 to meet MTUS guidelines applicable to workers compensation patients) is a program that targets patients with chronic pain or who were started on prescription opioids for pain; that are now either addicted or dependent on opioid (opioid) medications. The NESP-R program is designed for patients that are addicted or dependent on opioid prescription painkillers with pain. The programs are identical in terms of opioid detoxification. The NESP-R program is longer and involves an emphasis of chronic pain control and for some patients functional restoration. The NESP-R program is usually utilized in worker’s compensation patients since they have sustained an industrial injury and may need pain control and functional restoration in order to return to work.
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 patient’s 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 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 program from traditional detox programs.
The NESP program addresses the 3 issues that are most associated with relapse. These are i. genetics (using DNA test results to customize treatment during the program and to develop a long-term anti-craving plan through nutrition, supplementation, cognitive behavioral therapy, etc.), 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.
Finally the NESP program utilizes unique modalities some of which are only available in a few centers in the world. It is customized to each patient’s needs. Patients have one to one overnight nursing care. Our success rate (outcomes) are high because we do things differently that work and get to the root cause of every patient’s unique problems. Once a patient is evaluated and accepted into the program he or she will have a treatment plan will be constructed for the patient.