Forest Tennant MD, DPH

Internal Medicine, Pain Medicine


Veract Intractable Pain Clinic
338 S Glendora Ave
West Covina, California, 91710-3043
Phone: (626) 919-0064
Fax: (626) 919-0065
Conditions Treated
  • Cancer Pain
  • Carpal Tunnel Syndrome
  • Diabetic Neuropathy
  • Fibromyalgia
  • Gout
  • Low Back Pain
  • Lupus
  • Lyme Disease
  • Migraine and Headaches
  • Neck Pain
  • Osteoarthritis
  • Plantar Fasciitis
  • Post-herpetic Neuralgia
  • Post-surgical Pain
  • Psoriatic Arthritis
  • Rheumatoid Arthritis
  • TMJ Disorders
  • Visceral Pain
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About Our Practice

The cornerstone of treatment is long-acting opioid preparations - morphine, fentanyl, methadone, hydromorphone, or oxycodone. Long-acting means a drug that is effective for at least 6 or more hours. The long-acting drug is repeated at regular intervals throughout the 24-hour day. Physicians, pharmacists, and nurses refer to this procedure as "round the clock dosing".

Why is this critical? Since the pain of IP is constant and even present during sleep, the patient must maintain a minimal amount of opioid in their blood at all times to suppress their basic, baseline, constant pain.

Once an IP patient identifies one or more long-acting opioids they can take "around the clock" and get at least some pain relief, they can enhance their treatment with diet, exercise, and non-opioid medication. They can take short-acting opioids which help the long-acting opioid suppress their pain and help to control pain flares commonly known as "breakthrough" pain.

In addition to potent opioid drugs, proper IP treatment will require muscle relaxants since IP causes muscle spasms, and elevated pulse rate and blood pressure. Sleeping aids are a must to help overcome the pain which keeps patients awake. Certain hormone replacements will be necessary, since IP depletes adrenal hormones. Topical or skin treatment with lidocaine patches and opioid creams may be very helpful unless the pain site is deep inside the skull or abdomen.

Standard pain treatments such as cortisone injections, nerve blocks, physical therapy, acupuncture, psychotherapy, anti-inflammatory agents, anti-depressants, anti-seizure, and nerve block medications may all assist IP, but these simple measures CANNOT by themselves, control true IP.

Implanted spine devices to deliver opioids into the spinal column may be necessary, but the patient will still require other medications. Also, there are now implanted electrical spinal, stimulators which give some patients great relief.