Pain and Fatigue

At our Center, we don’t just medicate your pain – we treat the problem that’s causing it.  It’s our goal to return you to your normal level of activity as quickly as possible.

We manage complicated pain cases and partner with GW Pain Center when specific intervention modalities are needed.


Pain is a complicated condition that affects some 75 million Americans. It can be:

  • Acute (sudden and short-lasting)
  • Chronic (lasting three months or more)
  • Cancer-related pain

Patients who live with pain know that it can cause considerable suffering. And if left untreated, it can devastate lives and cause profound psychological distress.

Most people with pain have been living with it for more than five years, and seven million Americans are either severely or partially disabled by it. Some 70 million doctors’ office visits each year involve pain complaints.

Pain may be your main condition, or it may be a result of surgery, illness, or an accident.

We treat most common types of pain. Our unique approach to pain is deeply rooted in very comprehensive multidimensional assessment by our physicians. Subsequently, we may suggest modalities or approaches that would address the underlying causes. Here are a few examples:

Chronic pain management program treats mostly the following common pain syndromes:

  • Fibromyalgia
  • Chronic tendinitis and bursitis
  • Back and neck pain
  • Carpal tunnel syndrome and other repetitive motion injuries
  • EDS and related connective tissue problems. Dr Kogan is one of few local providers who developed effective EDS management program that starts with genetic testing via Invitae (link) and address all EDS related issues such as disathonomia (spelling??), insomnia, chronic pain, digestive issues, and others.  Medical Cannabis and IV Ketamine as well as IV Infusions are often key parts of the program, in addition to nutrition, close collaboration with EDS knowledgable Physical Therapists.

At the Center for Integrative Medicine we treat chronic pain in the context of the whole person. Many patients may have already pursued treatment with orthopedics, neurology or other specialties without relief. At the Center, we will learn more about previous treatments and about the patient’s perception of her/his condition. Recommendations will then be made for an integrative care plan that combines complementary modalities aimed at relieving painful symptoms while addressing their underlying causes.


Occasionally everyone feels fatigued and tired, but if you are one of over one million people living with chronic fatigue in the U.S. you know how devastating this condition can be. While at our center we treat a variety of different conditions, we feel that our unique method of addressing chronic fatigue has been very successful. We have a long list of patients whom we have guided from disability to a fully functional healthy life.

The first step for any patient with chronic fatigue syndrome is to assess the causative category. Usually it belongs to one of the following:

  • Chronic hormonal deregulation – most commonly adrenal or thyroid, while stress may play into this issue there are often other triggers, such as one of listed below
  • Chronic mild systemic infection such as chronic Lyme disease
  • Chronic gluten or other food sensitivities
  • Chronic autoimmune conditions such as lupus or rheumatoid arthritis and others
  • Cancer or cancer treatments related fatigue
  • Depression or other psychological factors
  • Nutritional deficiencies
  • Spiritual distress
  • Variety of chronic medical conditions

Whatever the cause is, our approach will address it. Instead of looking for an underlying diagnosis, which is often not found, we concentrate on the systemic issue. Below are some illustrative examples.

So called adrenal fatigue is a common condition, and we see many patients with this condition. There are debates as to whether or not it represents a medical syndrome. We have found that some herbal or mushroom adaptogens (Rhodeola Rosea, Ashwaganda, and Cordyceps are just a few common examples), combined with acupuncture and specific nutritional approaches (such as high potency combination of Vitamin B, complex vitamin C, and zinc), are often helpful.

Nutritional deficiencies that cannot be diagnosed by routine blood tests are a frequent problem that can be assessed and addressed effectively by looking into an individual’s nutrient requirements. Depending on individual metabolism, different people have different needs for a variety of nutrients. Even the same person’s requirements for many nutrients varies depending on a level of activity and the general state of health. For example, the needs for vitamin B6 and zinc increase dramatically (often tenfold or more) during high stress situations, yet the established blood level thresholds and the U.S. Recommended Daily Allowance (RDA) numbers do not take this fluctuation into account. Once a person develops a nutrient deficiency, the intake amount to correct it may need to be very high. If specific therapeutic doses are not given (and we found that often IV or IM vitamin injections are more effective and easier absorbed), the deficiency cannot be corrected, even if appropriate RDA dosage is consumed.

Cancer treatments are very well known for causing severe fatigue. When we combine therapies such as acupuncture, massage, Reiki during/after chemotherapy or radiation therapy, we often  see some improvement. We are in the process of establishing a research protocol to study the effectiveness of Reiki on fatigue during cancer treatment. There is at least one well designed randomized study to support this gentle energy modality utilization during chemotherapy treatment for breast cancer (read the abstract).

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