Chronic Pain PDF

Preface

When I began to practice pain medicine there were no national clinical pain societies and a distinct paucity of books on pain management.

Other doctors didn't even know what I did.

Since those early years, the subspecialty has grown and evolved into something we could not have foreseen: "We" were the original thirty docs who got together in Washington, D.C., at the behest of neurosurgeon Ben Crue in 1983, to start the American Academy of Algology (later known as the American Academy of Pain Medicine).

In the beginning, there was an amorphous group of doctors with multiple specialties, all interested in treating pain patients. Now, the multiple types of physician specialties treating pain only barely exist. The way the first generation of pain specialists treated pain—using a conservative, frequently interdisciplinary medical model—has changed dramatically for many reasons, some good (to accommodate new technology) and some bad (what the insurance companies, HMOs, and PPOs deign to cover).

In the quarter century that I've specialized in the treatment of chronic headache and pain of all etiologies, I've had the good fortune to be asked to write for and lecture to my colleagues around the country and overseas literally hundreds of times. I've found great interest and need for headache and pain-related information from physicians in all specialties and have gladly acted as a resource for these physicians. I've endeavored to explain to them what I do. Because as times have changed, too many patients have not been permitted to see a pain specialist or visit a tertiary-care specialty interdisciplinary pain management clinic such as those I've run for over twenty-five years.

No one person, physician or not, is smart enough to treat a chronic pain patient by themselves. Unfortunately, the medical community's understanding of this fact, which was so marked when pain management/medicine became a specialty, has dramatically changed. Today, some believe that they can, individually and independently of anyone else, "cure" chronic pain patients. This makes little sense when the patients, as a group, carry the wrong diagnosis 65 percent of the time; have to be weaned off of inappropriate and unnecessary medications 85 percent of the time; and have seen an average of 5.6 physicians and endured an average of 1.6 surgeries prior to reaching the pain specialist (my statistically typical patient over the last several decades).

In spite of new technology, it still doesn't work that way: it takes more than one person to help identify and deal with the biological/psychological/sociological aspects that make up, in good part, the complexity of the chronic non-cancer pain patient.

Chronic non-cancer pain is a disease like diabetes and hypertension, in that for the most part it cannot be cured. It can, however, be successfully treated and controlled. Patients can lead exceptional, full lives, with their pain under significant or even excellent control.