Confiram:
CHRONIC PAIN IS A DISEASE
Health care has always been a social convention and has never been driven primarily by outcomes based evidence. We need to work very hard to get the medical community to agree that chronic pain is a disease and not a byproduct of illness. Acute pain can be considered a byproduct, for it almost always abates when healing occurs. The role of the physician in acute pain is to hasten healing and provide analgesia until nature terminates the painful period of illness.
Like all diseases, chronic pain occurs in the context of a human being and becomes, therefore, an illness. Like all illnesses, it is influenced by factors extrinsic to the originating disease, some of which may even lie outside of the patient. It is a mistake to treat chronic pain as if it was acute pain; nature is not going to stop the pain by healing the injury or disease. Symptom relief for a brief period is nice, but it rarely restores the chronic pain patient to well being. A huge treatment industry has grown up around chronic pain with very limited outcomes data. Indeed, the best data can be found for multidisciplinary pain management; very few other treatments have reported six or twelve month or even longer follow-up data. Several attempts to review the literature on injection procedures for chronic pain have come to the conclusion that evidence for efficacy is mainly lacking.
We need to advance the paradigm shift that John Bonica started and insist that all chronic pain patient treatments be based upon a biopsychosocial model. We must mandate that patient assessment include a review of psychological and environmental factors that can contribute to chronic illness and disability. We need to insist that all chronic pain patient treatments be based upon a biopsychosocial model. Patient assessment must include a review of psychological and environmental factors that can contribute to chronic illness and disability. Single modality treatment programs should treat only after patients have been thoroughly evaluated in a multidisciplinary format. Medical students should adopt a biopsychosocial model for the diagnosis and treatment of chronic pain.
John D. Loeser, M.D. jdloeser@u.washington.edu
