I’m Going To Change My Way Of Thinking

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CMP, originally uploaded by rsdscrpsnews.

I’m gonna change my way of thinking

BioMechanics
July 2006
By: Anthony R. Edwards

Bob Dylan might have had something else in mind when he wrote that song, but in the biomechanics mainstream, an area in which we might need to change our way of thinking is how patients with chronic pain are treated.

There is so much we don’t understand about pain, its origin, and its treatment. We understand that some pains are easily treatable by stretching, ice, time, and over-the-counter or homeopathic treatments. But we also understand that there is much pain that will not fade so quickly.

I am certain you’ve had any number of patients whose pain has become chronic and debilitating. Maybe it’s from an injury or damaged nerves; maybe it’s a lack of some key chemical in their body. It could be arthritis, or something that was misdiagnosed. Maybe it’s complex regional pain syndrome. Who knows?

This is often exactly the problem. There are literally thousands of pain syndromes (OK, there are 12,598 entries on PubMed for “pain syndrome”) and isolating the exact one can be a long, difficult, and costly process in all definitions of the term.

In fact, in an article in The New York Times on May 30 (“Doctors struggle to treat mysterious and unbearable pain,” page D5), Russell K. Portenoy, MD, chair of the pain medicine and palliative care department at Beth Israel Medical Center in New York said pharmaceutical treatment is a “trial and error” process.

“In many cases, doctors need to perform sequential trials to find out which drug or combination of drugs helps the most,” he said.

It should be noted that he was specifically talking about complex regional pain syndrome. I have no reason to question Dr. Portenoy’s hard-earned clinical experience. But, if you were a patient with chronic pain, would you be pleased to essentially be an ongoing trial? Of course not. And yet really, what else can be offered? Ketamine treatments, which may potentially put patients into a coma (see the same NYT article)?

And sometimes the best treatment isn’t a pharmaceutical. It may be acupuncture, a change in diet, a new rehabilitation regiment, electrical stimulation, Chinese herbs, massage, regular treatments of something the body is missing, or a new device. The list could go on and on.

And a further issue is that we can’t yet define what role the mind plays in dealing with pain. This complicates an already difficult situation, as living with chronic pain must be incredibly debilitating.

Yet, without doing a double-blind study, I would guess that at some point, most patients get the message that “it’s all in their head.” Maybe those aren’t the exact terms, but the implication is that they “need to get on with their lives.” And when a patient’s pain doesn’t respond to initial-or even to longer term-treatments, everyone gets frustrated. You wouldn’t be a practitioner if you didn’t want to help people get better. Becoming frustrated when your patients don’t is understandable.

I want to genuinely ask, has telling a patient that it’s in his or her head ever helped anyone? Maybe it has, I don’t know. I’m asking in hopes of sparking a conversation. Maybe there are patients who respond to this, but if so, it seems like those case reports don’t make it to the peer-reviewed journals I read.

I’m not holding BioMechanics above reproach. We give each article a “running head,” essentially listing the general category it fits into (sports medicine, wound care, and so on). And we label articles about treating pain “pain management,” instead of “pain treatment,” “pain solutions,” or something more optimistic. Well, no more.

What I am hoping for is a revised approach to treating pain; i.e., no longer limiting our goals to “managing” pain, but instead, treating it with the goal of eliminating it, or as much of it as possible. It might well be that in many cases, the pain needs to be “managed,” but let’s start with language that isn’t limiting; language and treatment that aim to restore and heal, rather than manage.

Click Here For The Original Article Online

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