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Complicated and Uncomplicated Chronic Pain

Updated: Oct 25, 2022


The National Pain Council Welcome's Dr Forest Tennant, below is a brief introduction:

Dr. Forest Tennant is the United States' leading expert on treating difficult-to-treat, painful disease disorders. For a long time, he has held to the issue that the brain modulates pain. His research has led him to believe that neuromodulation is the key to treating pain. Two years ago, the Massachusetts General Hospital and the Karolinska Institute in Sweden both came to the same conclusion that Fibromyalgia, and probably other painful diseases, are involved with the inflammation of the white cells in the brain

called glial cells and are not made up of conditions by “hysterical women.” Neuromodulation.

Since our brain is in charge of just about everything else, even nutrition, it is not unreasonable to believe that neuromodulation plays a significant role in controlling inflammation and the resultant pain.

We need to explain why systemic pain is modulated, but the injury still hurts. The brain is in the mix.

We present an essay by Doctor Tennant and Ingrid Hollis explaining this forward-looking pain mechanism and why centrally-acting medications, like opiates and only opiates, do the trick.

Dr. Tennant knows what he is doing, so much so that the federal drug police and the Department of Justice tried to shut him down with a 60-page search warrant by a hired DEA doctor - who did not know what he was doing. The DEA broke into Dr. Tennant's condo; the DEA knew he was away and testifying for another doctor. All of Dr. Tennant’s patient records, bank statements, and other personal items were taken away by the police. There was not enough evidence to begin a charge sheet. The federal government told Dr. Tennant they would continue to “watch him.” Dr. Tenant retired from practice and now does medical research into rare and painful diseases. The country lost a premier consultant for complex pain-related cases that no one else could figure out. Dr. Tennant was one of six “thought leaders” mentioned in PROP’s writings as contributing to the opiate crisis. All six were taken out of action and remained that way; a story for another time.


Complicated and Uncomplicated Chronic Pain

by Dr Forest Tennant

As 2021 comes to a close, we wish to summarize what we personally consider to be the

greatest issue in pain management. Physicians have observed for centuries that some chronic pain patients are not only more severe than others, but some have excruciating, constant pain that casts the poor suffering individual into a humbled, bed-bound state. Unfortunately, throughout the past half-century or so, many concerned parties, whether intentional or not, have tried to lump all chronic pain patients into one category and call them all persistent, or simply chronic. This has led to calls for “one size fits all treatment” and inflated statistical figures on the numbers of pain patients who need help (i.e., 50 million people).


Chronic pain has traditionally been defined as pain that continues past the normal

healing time for an injury or disease, which is about ninety days. There has been no generally

accepted separate classification as to the severity, constancy, or periodicity of pain that lasts

longer than ninety days. Consequently, chronic pain surveys and statistics always include

persons with the common, mild to moderate painful afflictions such as bunions, carpal tunnel, fibromyalgia, headaches, TMJ, irritable bowel, back strains, plantar fasciitis, and mild

neuropathies and arteriopathies.

Cries of undertreatment of these common chronic pain problems ring hollow since

every community has a plethora of medical practitioners, pharmacies, health food stores, and fitness centers that well tend to vast number of persons who have these common pain

problems. It may also be that all the recent lobbying and advocating for “chronic pain” doesn’t seem to connect with the “body politic” because the vast majority of chronic pain patients are getting good, adequate care in every community. This is not to say that treatment for their common, mild to moderate conditions can’t be improved, or that their treatment isn’t needed.

The real issue, however, is that there is a sub-set of chronic pain patients who develop

what can justifiably be called “complicated chronic pain.” Most have tried a plethora of

treatment options but are left with severe, constant pain that has a specific set of pathologic

complications. It is this group that is undertreated, poorly understood, and needs advocacy,

attention, and treatment for their “complicated chronic pain.”


The hallmark of complicated chronic pain is constant pain which is associated with

cardiovascular, metabolic, and hormonal abnormalities. Complications include hypertension,

tachycardia, glucose elevations (pre-diabetes, and diabetes), and adrenal-gonadal hormone

deficiencies including cortisol, estradiol, and testosterone among others. These complications can lead to heart attack, stroke, heart failure, autoimmunity, diabetes, obesity, depression, and dementia, among others.


Thanks to modern research and science, we now have a fundamental understanding of

why some unfortunate individuals transform from a mild, periodic, chronic pain, to a constant, ferocious, and disabling pain state. We now know that injured or diseased tissue from “whatever” initiating cause can generate bioelectricity that may enter the spinal cord and brain (the central nervous system CNS), create tissue destructive inflammation, and damage or “knock out” some critical tissue sites that normally eliminate or control pain. This development is now called “neuroinflammation.” The transformation process in now often called “centralization” or “central sensitization.” Some pain specialists like to call complicated chronic pain “neuropathic pain.”


A syndrome is a clinical state in which one pathologic defect causes multiple

abnormalities and symptoms. Hence, we recently began calling the complicated chronic pain state the “Intractable Pain Syndrome.” The term intractable was first used by British physicians in the last century who championed treatment of severe incurable pain. The term intractable is now used in some laws and is in popular use in some pain circles. There may be a better term than the “Intractable Pain Syndrome.” Maybe we should just call it “Complicated Chronic Pain.” Regardless, understanding that inflammation can develop in the CNS and cause complicated constant pain is essential, as these patients need a different treatment approach from the more common, uncomplicated chronic pain patient.


Going forward into 2022, we define the Intractable Pain Syndrome as “an inflammatory

disorder of the central nervous system that causes constant severe pain and is associated with cardiovascular, metabolic, and hormonal complications.” Furthermore, we will advocate that this tragic syndrome be understood, and that its proper treatment demands not only symptomatic pain relief, but specific treatment of the disease that originated the syndrome, along with specific treatment of its complications.

You can learn more about Dr Tennant and the Tennant Foundation at:

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