It's the Pain Education Season, but We're Teaching the Wrong Lessons to Physicians

AUGUST 27, 2014
B. Eliot Cole, MD, MPA

As I finish my third decade in pain management/medicine, I am perplexed to see so much illogical care, so much denial of what was clearly shown to work so well in the 70s, 80s, and early 90s. We finally recognize the risks and long-term consequences associated with injections, opioids, or any other form of monomaniacal care, yet we have no national agenda to offer comprehensive care for people who have complex pain conditions. Instead, we struggle to get prior authorization for some newer medication, procedure, or even a couple of days in the hospital after a failed suicide attempt.
I see statistics claiming that thousands of people are dying from opioid overdoses, hundreds are dying or sick from fungal contaminated steroids, tens of millions live with unrelenting and disabling pain, our returning veterans are strung out on prescription medications (assuming they get care at all), and the state of pain management education for most health care professionals is “brainstem” or minimal at best.
How is it that the number-one reason people go to health care providers for assistance is only minimally discussed during professional education? If 50 percent of primary care visits are related to pain problems, as is frequently described, shouldn’t more time be spent in professional education on such problems? If procedures and/or opioids alone don’t “cure” or adequately remit pain, shouldn’t more comprehensive methods be taught? At what point do we ask “What else can I offer my patient than just another injection or prescription?”
As you attend the upcoming meetings, ask yourself what you will do before you write the next prescription, perform the next injection. Will you consider a referral to a psychologist, dentist, chiropractor, acupuncturist, massage therapist, dietician, physical or occupational therapist, or someone else? Without being part of a comprehensive pain management program, can you cobble together the elements of a multidisciplinary pain program with two or three well-placed referrals? Would you consider being the “hub” for your patient, and “case managing” him or her through a series of referrals to create a “network” multidisciplinary program? Do you know a few providers in other disciplines who would agree to an occasional conference call to discuss challenging patients? Is there a workable solution?
I wish there could be more opportunities for collaborative care and reaching across disciplinary boundaries to help those in pain. I entered the field of pain management in 1985, naively hoping my lower back pain would be “cured” along the way. Thirty years later, my back still hurts, but now I also have joint pain, headaches, heartburn/abdominal discomfort, and the realization that as I get older it really does matter what I eat, that I adhere to a regular exercise program, stretch daily, do meditation, receive an occasional deep tissue/myofascial release massage, and get a few acupuncture needles strategically placed. I have stopped believing that complex problems respond completely to monomaniacal approaches and look for synergies where I find them; a little of this, and a little of that, 10% gain from this, 15% gain from that. It’s the combination that matters more than the individual components. 
What do you think? Too outside the box for you? Send your comments to
B. Eliot Cole, MD, MPA, is a member of the Pain Management editorial advisory board. He has served in executive positions for several prominent pain management organizations and societies, including the American Society of Pain Educators and the American Academy of Pain Management. He has been a pain management fellow, clinician, educator, and advocate for nearly 30 years and has practiced in a variety of settings serving a wide range of patients.

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