HOW I TACKLE PROBLEMS IN PAIN MEDICINE

Pain medicine is torn apart by opinions, guidelines and regulations. Interventional pain practice and opioid prescriptions appear to be the most vulnerable and volatile topics. I believe that the standpoint of our discipline is the fundamental knowledge of anatomy, which, unfortunately, often receives minimal attention in the education of non-surgical specialists. Any biomedical problem has an anatomical reason, and chronic pain starts from a particular injury, surgery, trauma, or illness. Initially, surgical and other specialists try to investigate and treat the problem. Often, it is successful, but at times, it is not. Patients receive more medications, tests, physical therapy, etc., but all are in vain. The pain does not subside. Evaluating a person in a pain clinic as soon as possible is imperative. Occasionally, addressing acute pain relating to conditions such as tendon or nerve injury, shingles, and disc herniation, effectively prevents the development of chronic pain and disability. Indeed, multiple biopsychosocial factors coexist and maintain chronic pain. However, it is unlikely that interventional techniques or surgeries would resolve psychological distress and suffering. Over-medicalization of social and personal problems is a slippery slope that leads to unnecessary medical interventions, long wait time, addiction, and swelling of health care expenditures.  

I believe that only those who seek help can truly be helped, and only those with clear goals can hope to achieve them. It is counterproductive to ask physicians for assistance while continuing self-harming behaviors. However, everyone has the freedom to live as they please, and I will never refuse to offer my expertise to those who are passive healthcare consumers. That said, I do not expect these individuals to achieve significant long-term benefits or a cure.

My approach begins with diagnosing the root cause of the problem and identifying barriers to recovery. I involve patients and their families in decisions about the recommended steps and their potential consequences. I always welcome second opinions, provided they come from reputable sources. I utilize procedural methods to alleviate pain and, when possible, promote the regeneration of injured or fatigued tissues.

It is important to convey that any procedure is merely the first step toward recovery. Pain reduction and symptom alleviation must be followed by a team-based rehabilitation process and diligent self-management.