Local doctor quits practice, returns with a new vision for treating chronic pain
Kelley Otani was sitting next to a hotel pool in Las Vegas. It was 2008, more than a year after he’d stopped practicing medicine and sold his worldly possessions. He’d been restless for a long time, but found peace during that moment in the sun. “Everything was bright,” he recalls.
Was this feeling connected to his vision quest months before in Joshua Tree National Park? Or, perhaps, his studies with traditional healers? It was impossible to be sure, Otani said during a recent interview. In life and medicine, he observed, it’s never easy to trace relationships between the mind, body and spirit. “There is no direct, linear path,” he said. “There is no cause and effect.”
But he’s sure of one thing: It’s all connected.
Modern medicine generally accepts that physical conditions can contribute to mental ones, as with an athlete or laborer who becomes depressed after a major injury. Otani, however, embraces a somewhat more radical concept, at least in Western culture: The mind’s anguish can become bodily pain. In his book, Paradox of Conscious Healing, Otani writes, “Commonly in Western medicine, it is the symptoms (such as pain, anxiety and depression) that are treated—rather than the actual root cause or pathology. The root cause, however, may not be in the physical domain.”
It took decades to reach that conclusion. After completing his medical residency at the University of Washington, Otani began his career as a pain specialist in Chico in 1985. And, along with most American doctors of his generation, he regularly wrote prescriptions for opioid-based medications such as OxyContin, Vicodin and Percocet to treat chronic pain. However, he found that the pain actually became more severe for some patients, despite escalating doses of medication.
“I was dissatisfied,” he said. “I felt like I wasn’t impacting people. They’d go home and didn’t make an improvement in their lives.”
That realization changed Otani’s life—and the lives of the patients he treats today through Feather River Hospital in Paradise. But first, he quit his practice, sold his big house and sports car, and went to the desert.
On a recent Friday, a few dozen people gathered in a conference room on the basement level of the Feather River Health Center. They formed a circle with chairs, then Otani led the introductions. It was the first day of a new six-session course on chronic pain, but there were some familiar faces: the program’s alumni, the people who keep coming back despite having “graduated.” The patients in Otani’s program suffer from pain that can be incurable. Almost all are Medi-Cal recipients; 95 percent of them live in poverty.
The support group is one part of Otani’s comprehensive pain management program. He oversees a team of physical therapists, psychologists and nutritionists, about 10 people total. The program is built on the understanding that pain is multifaceted, and therefore covers just about everything—nutrition, weight loss, smoking cessation, meditation, sleep, spirituality and mental health. For the patients who are taking pain medication, there’s an emphasis on tapering down dosages.
It’s a holistic approach that treats the whole patient, Otani said.
“In the medical community, specialists look at somebody as a heart, or kidneys, or a stomach, and don’t take into account that the patient just got a divorce, or they lost their job,” he said. “Those aspects of stress can affect health.”
Take Debbie Bacon, 56, of Paradise. When she first showed up to the pain management support group, she was depressed and overweight. “All I’d been doing up until then was taking pain medication and lying in bed,” she said.
She was living with all sorts of chronic pain. Years of repetitive motion as a licensed vocational nurse at Stanford Medical Center had pulled the muscles in her elbows off the bone, which required surgery. She also suffers from nerve pain—a tingling sensation in her extremities—and a bad back. “My hips hurt, I assume as part of the whole back thing,” she said. “And I have bad knees.”
But the physical pain didn’t explain why she cried uncontrollably during each meeting. That had more to do with her estranged daughter, who left home as a teenager during Bacon’s stormy second marriage.
“I was unable to forgive myself for the problems that my daughter and I had,” she said. “I was also grieving the fact that I couldn’t be a nurse anymore. I had lost my identity.”
She was carrying tremendous guilt for not having done enough for her daughter—not enough in life—but with each class the burden became lighter. With the help of the program’s counselors, she confronted the mental aspect of her pain for the first time. She was provided a nutrition plan and started losing weight. With meditation techniques, she was able to stop taking Xanax, an anxiety medication.
By graduation day, her physical discomforts were much easier to bear.
“I’m the happiest I’ve ever been right now,” Bacon said. “I’ve lost weight. I still take pain medication, but I don’t rely on it. I’m out with friends; I laugh. I don’t lay in bed and suffer.”
Another alumnus is Richard King, also of Paradise. He drove big-rig tanker trucks for 25 years, and he’d always had a high threshold for anger. “People doing stupid stuff in their cars didn’t make me mad,” he said. “I always tried to be understanding.”
As the years passed, however, he started losing his patience. Maybe it was from the heart attack, being unable to work, or just living for 68 years; somehow, he had become angry. It manifested in his interactions with his granddaughters, which often turned into arguments. It showed when he dropped them off at school, and parents would just sit there in their cars, letting traffic back up into the street. He could barely keep his cool.
King’s physical ailments were perhaps to be expected, he said, after decades of what he called “bad living”—smoking, drinking, eating red meat, not exercising. His lifestyle came to a head one day in 2005 when he was hauling oil from the Bay Area to the Central Valley. He was heading south on Interstate 580, near where it connects to Interstate 5, when an intense pain gripped his chest.
There was an exit ahead, but he didn’t make it; he pulled onto the side of the highway, set the brakes and called 911. Later, at the hospital, an ultrasound revealed that he’d had a massive heart attack. His arteries were clogged and he needed bypass surgery.
Then came the medical bills, and chronic pain began to settle in. The years spent at the wheel had ruined his back, and he still suffered from leg injuries sustained from falling off a truck more than a decade before. No longer able to work enough to make payments on his rig, he sold it and was forced into retirement five years ago, at age 63.
For the pain, King was prescribed OxyContin, but if he missed taking it every 12 hours, he’d go into withdrawal. His pain specialist’s solution was prescribing a lighter dose to take before the time-release pill kicked in.
“The logic of taking medication to stop the pain caused by taking medication … I just couldn’t square that up in my mind,” he said.
He wanted something different, so his primary care doctor referred him to Dr. Otani.
There’s a major problem with the opiate-only approach to pain management: It’s killing people at a staggering rate. About 40 Americans die each day from overdosing on prescription painkillers, and prescription-happy physicians are helping fuel the epidemic, according to the U.S. Centers for Disease Control and Prevention. From 1999 to 2015, more than 183,000 people died in the U.S. from overdoses related to doctor-prescribed opioids.
Doctors want to help, to do something for patients debilitated by pain, Otani said. “There was basically a federal mandate to treat people’s pain. It became the fifth vital sign. That’s part of why there was so much overprescribing. Now it’s reversed.”
Indeed, last year, for the first time, the CDC issued guidelines to primary care physicians who prescribe powerful opiates. The agency advises doctors that patients living with chronic pain should avoid those medications entirely—clinical research suggests they’re not effective—and prescriptions be given only to patients receiving cancer treatment or end-of-life care. The CDC recognizes that opiates can also effectively treat acute, short-term pain from injury or illness, but urges physicians to prescribe them in the smallest dosages for the shortest periods of time.
That’s another problem. According to a survey conducted last year by the National Safety Council, when American doctors give their patients narcotic painkillers, 99 percent of them write prescriptions that exceed the federally recommended three-day dosage limit. Given that some medications, such as OxyContin, are as addictive as heroin, prescribing more than necessary can do patients a grave disservice.
Otani reached that conclusion individually, after years of private practice and working his way up to rehabilitation medical director at Enloe Medical Center.
It was a position of enormous responsibility, he said, and toward the end of his tenure at Enloe, he had a growing sense of his own inadequacy. Otani knew by then that prescribing lots of painkillers wasn’t working, but he didn’t have a better answer. The feeling took hold that, despite his training and experience, he didn’t have the knowledge and skills to be a good doctor.
“I was doing nothing but covering up the pain with large amounts of medications, which did nothing to improve the person’s quality of life beyond the basics of self-care,” he writes in Paradox of Conscious Healing.“Why didn’t people heal? What was I missing?”
In 2006, at age 52, he walked away from his six-figure salary and sold his house and car.
“I wasn’t who I thought I was,” he said. “It was very humbling. I walked away from materialism, the respect and prestige. We all identify with our jobs.”
Trisha Cantrell relates. Before she got hurt, the 45-year-old mother of three took pride in being a certified nursing assistant at a local convalescent hospital.
Lifting a particularly heavy male patient was “the straw that broke the camel’s back, so to speak,” she said. That was in 2007, and Cantrell still lives with a herniated bulging disc in her spine, nerve pain, arthritis and chronic migraines. She tried to keep working, but the pain kept her from even light duty. “I wanted to get back to what I was before the accident,” she said. “I wanted to be fixed, and I thought that was the doctor’s responsibility. I was very angry.”
That was an unrealistic expectation, Cantrell said. At the time, she could hardly get out of bed or walk up stairs. “I didn’t understand the full injury,” she said, “and the workers’ comp doctors just wanted to pump me full of medication. My life, essentially, was stuck, and the doctors weren’t helping. They were just prescribing.”
She became dependent on OxyContin and terrified of going through withdrawal. She hit a low one day when she was driving on Highway 99. Her eyelids became heavy, then they snapped back open and she realized she had fallen asleep.
Cantrell pulled over to the side of the road and waited for her husband to pick her up. She was badly shaken.
Native American healing always interested Otani, and after hanging up his stethoscope, he embarked on a years-long journey to study it. He started by spending a week in Arizona with a Yaqui shaman, who inspired him to go a vision quest at Joshua Tree in Southern California. He took only a tent, a flashlight, some firewood and enough water for three days.
Each day, he walked under the sun until nightfall. Then he gazed into the campfire and up at the stars, looking for the lost sense of himself. He grappled with the fear of “discovering who you are,” he said. “My fear was that I was never going to be good enough, never worthy enough.”
Such expectations for himself may be related to growing up in the 1950s as a minority in Loomis, a small farming community on the outskirts of Sacramento. “I had felt like I had to be better than other people in order to be accepted,” he said. “I never felt accepted. All of that was in my own mind.”
As he searched through spike-leafed yucca trees and cacti, he recalled memories of being subjected to prejudice and racism and contemplated regrets—friends he’d hurt, employees he’d let go, major life events that didn’t go his way. He imagined what might have been.
At the end of his vision quest, Otani hadn’t found himself. That was more of a long-term process. “I had to build myself back up again,” he said. He was, however, utterly exhausted after fasting for three days.
After recuperating, he continued traveling to study with different healers. His main mentor was David Hawkins, a renowned psychiatrist, spiritual lecturer and researcher of consciousness. Otani further eschewed traditional medicine and sat in a sweat lodge with an Inuit medicine man in New Mexico; went to a training camp with healing experts called kahuna in Hawaii; and studied with traditional Navajo and Lakota Sioux healers.
Drawing from the modalities of different cultures and religions, he began to write Paradox of Conscious Healing, which explores the connection between emotional/physical pain and disease. He wanted to see if the perspectives in his book-in-progress would apply in the clinical setting, and in 2011 he was contracted as a pain specialist at Feather River Health Center.
Jennifer Niswonger was director of the clinic while Otani built the program from scratch. During a phone interview, she said its spiritual aspects fell in line with parent company Adventist Health’s faith-based mission to improve the community’s health.
“As a general rule, Adventist Health believes in taking care of patients even if it’s not a sound financial decision,” she said. “We can lose money so long as it’s in the best interest of the patients.”
Bill Redondo, 56, is grateful that he signed up for the program. He’s hurt so much, for so long, he says pain is like an old friend. “I know that sounds odd, but it’s manageable at the level it’s at now,” he said. “If it got any worse … I can’t tell you exactly what I would do.”
Due to his condition, Redondo has effectively been retired since he was 31 years old. As a highly trained electrician and master painter, his last project was painting a California Coast Guard pursuit boat. He was working on a ladder on the ship’s top deck when the paint booth’s ventilation system failed; despite wearing a mask, he lost consciousness in the cloud of industrial chemicals and fell.
His back was broken in three places and one vertebra was fractured. The pain was incredible; placing any weight on his left leg shot daggers from his foot up his backside. His life since has been defined by MRIs, CT scans, surgeries and an endless parade of chiropractors promising to fix his back with the latest gizmos.
“Not one of them could,” he said. “In fact, they exacerbated the problem.”
For 15 years, he saw a doctor in Chico who specialized in chronic pain. He wrote prescriptions for narcotics and didn’t offer any other form of support.
Redondo found that the drugs dulled his intellect. “It masked my problem and kept me in a state of unclarity,” he said. “I’m a fairly intelligent person, but I just didn’t feel as sharp as I was, and it was directly related to the painkillers. They kept me in a fog. I’d have to work extra hard to speak and be concise.”
When his doctor retired, Redondo was referred to Dr. Otani. With the support of his program, he’s weened himself off narcotic medication and just started his fourth support class. All things considered, his quality of life is high. “[Otani] touches on many different aspects of pain—the emotional, the spiritual, the clinical and the nutritional; the well-being of the mind,” Redondo said. “It’s all tied together. I was skeptical at first, but it’s not hocus-pocus or wishful thinking.
“From what I’ve seen and experienced, the connection is real.”
King, the retired truck driver, is managing his anger with the breathing exercises he picked up from Otani’s program. Deep breathing before bed helps him sleep, which improves his mood throughout the day. The program has also taught him to appreciate certain aspects of his life.
“As much as it can be a struggle, I’m grateful that I’m able to be with my granddaughters, to teach them what I know,” he said. “We don’t fight anymore because I’m not getting angry.” He still lives with chronic pain—and still gets ticked off at bad drivers—but he’s found a more positive mindset.
“I still hurt,” he said, “but it doesn’t bother me as much because I’m a happier person.”
Cantrell, the caregiver, has gotten off OxyContin and drastically reduced her dependency on prescription narcotics by managing her weight and stress. She’s lost 60 pounds since joining the pain management support group, and started with basic advice: Eat three meals a day.
“It was that in combination with the meditation techniques,” she said. “My stress was toxic. Now I can handle it with breathing.” Most important, she said, she doesn’t feel alone in her pain anymore: “In the group, you always connect with somebody.”
That’s the spiritual aspect of the program, Otani said, and it’s good medicine for him, too. He’s at every meeting of the support group, helping newcomers break the ice and telling alumni he’s proud of them. The last five years, he said, have been the most fulfilling of his career.
“Most of these people are in poverty. They barely have enough money to buy gas to come and see me, but they’re doing the work. To watch the people who have the dedication, the commitment and courage to change their lives, is inspiring.”