PAIN MEDICINE

Since the dawn of our civilization pain was considered an evil and humans were in the constant pursuit of pain-relieving remedies. Electric fish was prescribed for headaches, and blood-letting was practiced for gout, along with a myriad of other reasonable and absurd recipes. Officially, Pain Medicine was born in 1947, when a military physician John J Bonica started treating veterans of WWII in Tacoma, WA. Later this clinic was relocated to the University of Washington, Seattle, WA, and from that time Pain became a matter of scientific and clinical inquest. I had the privilege to practice in this clinic and lead this clinic for two exciting years. I learned several important lessons that sharpened my personal view on pain management:

a.      Patients without motivation to get better will not get better

b.      There are no miracles; the results are achieved when the right treatment is offered to the right patient by the right physician.

c.      The result is always an achievement that has two parts – motivated patient and skillful medical professional at the right time.

Thus, I developed my personal “DO and DON’T DO” list.

THINGS I DO

  • I review documents prior to scheduling an appointment: a vague referral letter is a symptom of mismanagement

  • I ask to complete medical questionnaires: self-assessment provides the best information

  • I evaluate each patient, including physical examination and imaging: never rely on reports, MRI notes often miss the problem

  • I make an anatomical diagnosis: without it, no intervention is possible

  • I use image-guided procedures to diagnose and treat chronic pain: aka "blind" injections deceive both the patient and physician  

  • I discuss with patients and their families possible approaches: I always start with a simple one

THINGS I DON’T DO

  • I do not accept patients without a clear referring letter and supportive documentation

  • I do not see patients who refuse to provide essential information

  • I do not rely on written reports without original data (MRI, CT, etc.)

  • I do not practice “trial and error” methods

  • I do not do multiple frequent "nerve blocks" that harm patients and game the system

  • I do not prescribe opioids excluding special circumstances

  • I do not make patients "addicted" to my services; when goals are achieved, they are discharged but welcome to come back