During my neurosurgical residency at the Massachusetts General Hospital, I was convinced that the neurosurgical approach to many chronic pain problems was unacceptable. At that time, Massachusetts General had a reputation as the center for intractable pain.¹ The major approach as either cordotomy or cingulotomy was an attempt to get around the word frontal lobotomy. I could see no future for either of these procedures in the management of chronic benign pain. Thus began over ten years of research into pain physiology. In 1965, I theorized that we should be able to control pain by stimulating the dorsal columns of the spinal cord and published my research paper on that in Analgesia and Anesthesia.² It was considered too controversial for the Journal of Neurosurgery. By the time I had done only six or eight patients, neurosurgeons were clamoring to be able to do this procedure, which I considered highly experimental. We set up a national dorsal column study group with the goal of inserting this glorified pacemaker-type equipment just dorsal to the spinal cord itself with a goal of following patients for five years before we could determine whether it was safe and effective. Unfortunately, two companies began marketing the procedure long before it reached its goal. This led to changes in the design of the electrode, which was not nearly as acceptable as our handmade electrode, and led me to discontinue the procedure on May 30, 1973. I have never recommended it or done it since that time.^3,4

Meanwhile, it was obvious to me that vast majorities of people suffering from chronic pain were actually the result of unnecessary back surgery. In one study, I demonstrated that at least 80% of those who had had lumbar surgery for a presumed ruptured disc had not had a ruptured disc before their first surgery.⁵ But by the time they had had between 5 and 7 unsuccessful back operations, they certainly were invalids. Meanwhile, I had introduced the concept of transcutaneous electrical nerve stimulation for relief of pain but I was never satisfied that any of the modern TENS devices gave the degree of pain control that the old Electreat®, patented in 1919 by a Naturopath, C. W. Kent, gave. Interestingly, ten years ago after a return from the Ukraine where they were using microwave frequencies, I discovered that the Electreat® put out exactly the same strength as the Ukrainian devices and although it has a much broader band than the ones they were using, it does have the 54 to 78 billion cycles per second output at approximately 50 to 75 decibels. Thus, it led me to redesign and receive permission from the FDA to market the SheLi TENS®; the only one that I know that includes these frequencies, which according to Ukrainian nuclear physicists are the frequency of human DNA.^6,7

Beginning in 1971, I focused my entire clinical work on management of chronic pain and over the next thirty-one years, treated some 30,000 patients with chronic, disabling pain. The majority were failures of back surgery but, of course, there are many other incapacitating chronic pain states ranging from migraine, chronic daily headache, various osteoarthritic pain problems, pain from compression fractures, sensory deprivation or deafferentation pain from major nerve or cord injury, rheumatoid arthritis and cancer.

As our work evolved in the 1970s, it became clear to me that we could easily teach a majority of pain patients how to control their pain using biofeedback, autogenic training and other similar approaches. From 1974 through 2002, our approach has included the following:

Acupuncture – I began doing acupuncture in 1967. I considered it one of the most important tools for managing both acute and chronic pain. In the last few years, it has been our impression that the SheLi TENS® is more effective than acupuncture. That will be mentioned briefly below. The Ukrainian physicists believe that the Giga frequencies of 54 to 78 billion cycles per second are twenty times as effective as acupuncture needles.

TENS – Even before we developed the SheLi TENS®, the commercial TENS devices were of some benefit.^8,9 Properly used, about 50% of chronic pain patients can have their pain reduced 50 to 100%. Essentially, this means placing electrodes on either side of or above and below the site of pain, not directly over the site of pain. Since the advent of the SheLi TENS®, we find that instead of needing to apply it 8 to 16 hours a day, most patients do very well with about 2.5 hours a day. If it does not work when properly applied around the area of pain, then application to the Ring of Earth is often effective, probably because this significantly raises calcitonin as we have reported.¹⁰

Biofeedback & Autogenic Training – I began using biofeedback in 1972. We have found temperature biofeedback to be the most useful for two reasons. Pain and temperature travel in the same part of the spinal cord, the anterior spinothalamic tract. If you can learn to control temperature, you essentially have mental control over pain. We, therefore, teach patients to control the temperature of fingers and then transfer that skill to areas of pain.

At the same time, autogenic training has a very long history of great success. Indeed, Schultz demonstrated that 80% of “psychosomatic” diseases could be controlled with autogenic training. Widely used in Europe, but virtually unknown in this country, autogenic training is a self-hypnotic tool that is the foundation for much of our work. However, I added to this a great deal of imagery, some of the psychosynthesis exercises, Edmond Jacobson’s concepts of progressive relaxation and a wide variety of Jungian and Gestalt-type exercises. This we called Biogenics®.¹¹

Depression – Virtually 100% of patients with chronic pain have depression. Often the depression was there prior to the onset of the pain problem. Through the years, we have used a very specific approach and can get 85% of depressed patients out of depression within two weeks without drugs. This includes the use of a Liss Cranial Electrical Stimulator, which by itself will relieve depression in 50% of patients. It has been clearly demonstrated to raise serotonin and beta endorphin levels. When we couple the Liss stimulator with photostimulation using the Shealy RelaxMate II® for deep relaxation, classical music and educational approaches, 85% of patients recover from depression without “side effects.” Interestingly, when they go home about 15% of patients fail to follow through with the techniques they have learned so our long-term success with patients followed up to three plus years has been 70 to 72%.^12-16

Counseling and Education – Through the years, we have always done some type of individual counseling. However, some ten years ago we demonstrated that patients could do their own insight just as well as receiving it from a lecture or a private counseling session. This became the foundation for my book, 90 Days to Stress-Free Living.

Other Ancillary Techniques – Massage, physical exercise and nutrition are all important components for management of chronic pain. For instance, we have demonstrated that 80% of smokers and 35% of nonsmokers are deficient in B6. Virtually 100% of patients with depression, which includes almost all chronic pain patients, are deficient in one to seven essential amino acids and 86% are deficient in taurine. These patients with chronic depression have abnormal blood levels of serotonin, melatonin, beta endorphin, norepinephrine and cholinesterase 92% of the time. Almost 100% of the time they are deficient in intracellular magnesium and all of them have a DHEA level that is either low or deficient.

Even in advanced rheumatoid arthritis, which has failed conventional therapy, and sometimes in advanced cancer, we have been able to help many patients bring their pain under control using these approaches. I have not personally found antidepressant drugs or any antianxiety drugs or antiepileptic drugs to be useful in the management of chronic
pain. We have totally avoided the use of narcotics/opioids.^17,18

In selective patients with back pain, we have found two significant problems: locked or degenerative facet joints or a sacral shear. A sacral shear is easily corrected most of the time with gentle and simple osteopathic manipulative therapy. In the facet joint syndrome, we simply do a temporary nerve block of the suspected facet joints and if this is successful on two occasions, then that joint can be safely denervated with an injection of 0.5 cc of 4.5% phenol and glycerin. We have a fifteen year follow up on hundreds of patients that had an excellent result with the initial approach. Some 80% maintain that long term.¹⁹

The failures of our program have given me the greatest challenge. Although virtually all of our 30,000 patients had failed conventional therapy, our success rate of initially 85% and long term 70% is remarkably good but I have spent more time trying to determine how to treat our failures. We have brought numbers of them back for soul retrieval, exorcism by a Catholic priest or twelve sessions of past life therapy and never found a single one who benefited from these additional interventions. Tentatively, I have come to expect that many of them have a karmic problem. I do not believe that placing them on mood altering drugs, opioids, tranquilizers, etc., is effective, as they have almost always failed that even before they came to see me. Nerve blocks other than of the facet joints are not recommended!

In summary, the vast majority of chronic pain can be managed successfully with the approaches that we have outlined in this brief article; transcutaneous electrical nerve stimulation, preferably with the SheLi TENS®, Biogenics®, nutrition, exercise; and occasionally other interventions such as facet nerve blocks and OMT.²⁰

I no longer see patients but I am happy to train physicians and their assistants interested in an approach that the American Academy of Pain Management listed as the most successful and most cost effective for three years.

Correspondence:
C. Norman Shealy, MD, PhD
Founding President, American Holistic Medical Association
Founder, Shealy Pain Institute
President, Holos University Graduate Seminary
www.normshealy.net

Organizations of Interest:
Two major organizations represent the majority of pain practitioners today. They are:
American Academy of Pain Management
13497 Mono Way, #A
Sonora, California 95370 USA
209-533-9744

International Association for the Study of Pain
909 NE 43rd St., Suite 306
Seattle, Washington 98105-6020 USA
206-547-6409

Two books present the broadest view of pain management. They are:
Textbook of Pain by Patrick D. Wall and Ronald Melzack. Churchill Livingstone, New York, 1984.
Innovations in Pain Management. Richard S. Weiner, Editor. Paul M. Deutsch Press, Orlando, FL 1990.

References
1. White, JC and Sweet, WH. Pain: Its Mechanism and Neurosurgical Control. Charles C. Thomas Publisher, Springfield, IL 1955.
2. Shealy, CN,Mortimer, JT, and Becker, DP. Electrical inhibition of pain by dorsal column stimulation: Preliminary clinical report. Anesthesia and Analgesia….Current Researchers 46:489-491, 1967.
3. Shealy, CN. The physiological substrate of pain. Headache 6:101-108, 1966.
4. Shealy, CN. Electrical stimulation of peripheral nerve, skin and spinal cord for control of pain. A six and a half years’ experience. Excerpta Medica International Congress Series 298:78, 1973.
5. Shealy, CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. Journal of Neurosurgery 43:448-451, 1975.
6. Shealy, CN. Facets in back and sciatic pain – a new approach to a major pain syndrome. Minnesota Medicine 57(3):199-203, 1974.
7. Shealy, CN. Microwave resonance therapy: Innovations from the Ukraine. Greene County Medical Bulletin, Vol. XLVII, No. 3:15-17, 1993.
8. Shealy, CN. Electrical stimulation: the primary method of choice in pain relief. Comprehensive Therapy 6(1):41-45, 1975.
9. Mannheimer, J, Lampe, G and Shealy, CN. Clinical Transcutaneous Electrical Nerve Stimulation. Chapter 2, pages 30-40, Davis Company Publisher, 1984.
10. Shealy, CN and Borgmeyer, V. Calcitonin enhancement with electrical activation of a specific acupuncture circuit. American Journal of Pain Management 13(1):29-32, 2003.
11. Shealy, CN. Biogenics: a synthesis of biofeedback and autogenic techniques for control of pain. New Dynamics of Preventive Medicine. Leon R. Pomeroy, editor. Medical Progress Through Innovation, 5:69-74, 1977.
12. Shealy CN, Cady, RK, Wilkie, RG, Cox, RH, Liss, S and Closson, W. Depression: a diagnostic neurochemical profile and therapy with cranial electrical stimulation (CES). The Journal of Neurological & Orthopaedic Medicine & Surgery 10(4):319-321, 1989.
13. Shealy, CN, Cady, RK and Cox RH. Pain, stress and depression: psychoneurophysiology and therapy. Stress Medicine 11:75-77, 1995.
14. Shealy, CN, Cady, RK, Cox, RH and Murrell, M. DHEA deficiency in patients with chronic pain and depression. The Journal of Neurological and Orthopaedic Medicine and Surgery 17(1):7-9, 1996.
15. Shealy, CN. Electromagnetic dysthymia. The Journal of Neurological & Orthopaedic Medicine & Surgery 17(3):193-195, 1997.
16. Shealy, CN. Transcutaneous electrical nerve stimulation: The treatment of choice for pain and depression. The Journal of Alternative and Complementary Medicine 9(5):619-629, 2003.
17. Shealy, CN. Cost effectiveness of comprehensive pain treatment. Insurance Adjuster, March 1984.
18. Shealy, CN and Cady, RK. Multidisciplinary pain clinics. Innovations in Pain Management. Richard Weiner, editor. Paul M. Deutsch Press, Inc., Orlando, FL, Vol. 1, pp. 4-1, to 4-20, 1990.
19. Shealy, CN, Cady, RK, Cox RH and Wilkie, RG. Facet rhizotomy/denervation: a fifteen-year experience. The Journal of Neurological & Orthopaedic Medicine & Surgery 9(4):305-306, 1988.
20. Shealy, CN. Thirty years of pain management. The Journal of Neurological & Orthopaedic Medicine & Surgery 18(1):27-30, 1998.