To Suffer or Not?
The answer to the question, “To suffer or not?” depends on the source of suffering. For a pain medicine specialist there are many sources and many answers. We are still a new specialty — patients and even physicians don’t really know exactly what we do. In fact, we are a growing specialty composed of anesthesiologists and physiatrists (among others) with specialized fellowship training who use a multi-disciplinary approach for the diagnosis and treatment of pain-related problems. While most simple pain problems are handled well by primary care physicians and many specialists, we focus our attention on the challenging cases. Our most common problems deal with spine pathology, but we handle everything from headaches to cancer pain to complex regional pain syndrome.
Like most physicians, our first challenge is to get an accurate diagnosis. Some problems, like fibromyalgia, can be very difficult to diagnose and ultimately treat. Other problems, like an L5-S1 herniated disc, are easy to diagnose and fairly straightforward to treat. After diagnosing the problem, we must make decisions on utilizing the best treatment options. The strength of our specialty is the depth and variety of available treatment options. This issue will highlight two different courses of treatment alternatives within our specialty.
Bill McCarberg, MD, from Kaiser is a very well-respected, internationally known figure in our specialty. While initially trained in family practice, he went on to develop and specialize in the conservative treatments of many chronic pain problems. His article [see page ?] highlights the incidence and under-treatment of pain. Furthermore, it highlights the importance of many primary care approaches using a variety of techniques. We are also fortunate to have Mark Wallace, MD, from UCSD, director of the Pain Medicine Fellowship Program and a full professor in the Department of Anesthesiology (and Pain Medicine). He is well known for his research and presentations around the globe. His article highlights interventional techniques, using the most modern technologies available. Some of these are specialized injections and some are more advanced, including the use of implantable stimulators and pumps.
While the use of a spinal cord stimulator or intrathecal infusion pump seems a far cry from conservative therapy, it is, in fact, simply another option on a long and complicated treatment algorithm. By necessity, the conservative and interventional techniques complement each other in the overall management of a complex pain patient. Both authors would agree that we must remain open-minded regarding the many therapeutic options required to meet our patients’ needs. These two brief articles can only scratch the surface of many of the treatment options that we use in our specialty
They also don’t cover the multiple treatment options available to the general public that are not endorsed by most physicians. This includes everything imaginable — from magnets to medical foods to copper bracelets. While we may shun many of these, we must accept that they are heavily used and accepted by the public. Most have never been studied scientifically so may potentially have some efficacy despite our “scientific intuitions.” This is certainly true if one includes the placebo effect. While this may be short-lived, it highlights the power of suggestion, especially if it is from a trusted source.
As scientific physicians, we need to promote the best treatments based on studies and proven outcomes. As healers, we need to listen to our patients and see what works for them in their world. As pain medicine specialists, we need to try to bridge this gap to get the best and most satisfying outcomes for our patients. Most physicians are very good at this, but I hope the two pain articles in this issue stimulate some interest in the variety of new options available to our suffering patients.