Tackling Pain – The MPM Approach

Pain is a signal. When it’s new, it gives clear, simple information. When it’s long-standing or recurrent, the signal changes and layers of complexity develop. Many patients arrive with secondary or compensatory pains that can be worse than the original.

As a multi-specialty practice, we collaborate across each specialist’s zone of expertise. We look at the whole system, then reverse-engineer what generates the pain, how it started, and what prevents healing. Those answers guide what to fix, how to fix it, and how to keep it fixed.

The Journey

Our journey has three phases. Discovery identifies every factor involved—the diagnostic work. With a working understanding of the “what, how, and why,” we begin Treatment. After we reach a stable result, Maintenance ensures the patient understands what happened and how to manage their body going forward.

Sometimes the knot unties on the first visit; more often it takes several visits with iterative discovery, treatment, and maintenance. Each test and treatment response teaches us what’s happening, how the pieces relate, and which thread to pull next.

Discovery

We first work to understand the pain: what generates it, why it started, how it’s maintained. We assess the body broadly, then reverse-engineer causes.A key early step is checking for sensitization, an overreaction in the nervous system, immune system, or emotional processing. These systems shape both the signals sent to the brain and how the brain interprets them.

Neurologic Sensitization: When the nervous system holds a grudge.

Here, the nervous system reacts to lower-level stimuli with heightened reflexes, like light sensitivity during migraine, or light touch and cold intolerance in complex regional pain syndrome. After repeated pain signals, the system “re-programs,” amplifying input before it reaches the brain. This can occur at the peripheral nerve (DRG), within the sympathetic (“fight or flight”) system, the spinal cord, or the brain.

Immune Sensitization: The body’s inflammatory party-crashers.


Inflammation appears when it shouldn’t, or is disproportionate. A sprained ankle should be hot, swollen, and painful; waking with stiff, painful ankles or swelling after normal activity is not. Drivers include autoimmune disease (lupus, psoriasis), post-infectious states (Lyme, EBV, post-COVID), and immune dysfunction (immunodeficiency, MCAS). When the invite-only inflammatory “party” is crashed, control is lost, and everything runs hot.

Psychological Sensitization: When the brain no longer wants to engage.

Chronic, repetitive pain can push the conscious brain beyond coping or into disengagement (dissociation) from the painful area. Fear, anger, distrust, frustration, and sadness can limit granular thinking about pain, complicate decisions, and reduce tolerance for normal fluctuations. Patients may seek a single immediate fix and struggle with the patience the pain journey requires.

Pain psychologists help patients find areas of control and choice, build contingency plans, understand the treatment strategy, and track results. Supportive companions and groups help ground the process. Sometimes ketamine helps too.

Why we address sensitization first

Sensitization clouds diagnosis, like flames so big you can’t see what’s on fire. We determine which systems are involved and calm them so we can see the source.Then we identify focal anatomic contributors, joints, disc herniations, hernias, or other structural issues. Some cases are straightforward; others reflect cascading biomechanics. We sort “chicken-or-egg” questions (neck vs. shoulder; back vs. hip vs. hernia vs. endometriosis). Using physical examination, imaging, and diagnostic injections, we map which structures are involved and how they relate. Treatment responses add data and refine the plan.

Treatment

Treatment follows two paths in parallel: (1) improve comfort, and (2) confirm the what, how, and why of pain.

  • Neurologic sensitization: We may trial intravenous lidocaine when the whole body is affected, or targeted sympathetic blocks (stellate ganglion or lumbar). If migraine drives symptoms, we treat it first to reveal what else remains.
  • Immune sensitization: Short trials (e.g., a brief course of oral steroids or anti-inflammatories) can test autoimmune/inflammatory roles; cromolyn may be used for suspected MCAS. Because inflammatory and neurologic sensitization often overlap, we may test both.
  • Psychological sensitization: We start with conscious awareness and support—pain psychology, groups, and companions. Understanding the rationale, tracking responses, and steady, measurable gains build confidence. Hope isn’t required at the start; evidence of progress is. Planning for life after pain is part of the work.

Focal anatomic issues: We treat the cause, not just the painful structure. A cervical disc herniation may improve with an epidural, but without addressing the reason (e.g., segmental hypermobility), it may recur—sometimes the disc heals without the epidural once the driver is treated. Pain may also be referred (felt in one place, generated in another: shoulder joint pain felt mid-back; adenomyosis felt at the sacroiliac joints; L5 nerve root pain) or a mechanical trickle-down (pelvic floor dysfunction from a hypermobile hip; thoracic outlet syndrome from neck/shoulder guarding). Known patterns guide us; treatment confirms them.

Maintenance

Once we know which structures malfunction and why, and a plan has been tested and proven, we enter maintenance. Many patients feel relief; some feel anxious about recurrence. Some need little ongoing care; others require continued therapy (e.g., a biologic for psoriatic arthritis or a toxin for migraine). If something new appears, we’re here. Otherwise, patients know what to do and how to stay well.