Pain is complex. There is no doubt about that. Through insatiable research efforts we’ve uncovered more and more layers to the pain experience, more than we perhaps expected. Sounds scary right? Well never fear! The field of pain medicine is in its best shape ever. Over the past decade, I’ve seen the field of pain medicine grow in many ways to become more comprehensive than any of us could have imagined, but with that comes one singular challenge. We, as pain practitioners and patients, need to evolve our current understanding of pain and its treatment.
Let’s face it, over the course of the past three decades, the way we diagnose and treat pain has evolved from one extreme to the next. Believe it or not, there was a time when opioids were largely restricted for cancer pain, and advanced interventional procedures like epidural injections were considered a novelty. For better or for worse, in the subsequent decades, the absolute number of opioid medications prescribed for pain, the number of interventions performed for the diagnosis of pain, and the number of health care practitioners identifying themselves as pain management practitioners, has increased exponentially. Within this progress, advancements in the subfields of interventional pain and regenerative medicine aim to provide new hope to those afflicted with acute and chronic pain conditions.
It hasn’t all been positive however. Ongoing research into the validity and safety of opioid medications has uncovered safety-concerns especially with long-term use. The subsequent sweeping changes over current opioid prescribing practices may make many patients feeling lost or abandoned. In these cases especially, we need to rethink our strategy for treatment.
During my years practicing pain and musculoskeletal medicine, I’ve experienced a duality; extreme satisfaction when successfully helping a patient achieve pain relief and regain function, and sometimes disappointment when our treatment strategies do not deliver. Either through successes or failures, I do hope to impart a greater understanding of what pain is to my patients; that pain is much more than just a bodily injury. That pain, especially if chronic, can have multiple components.
I was first drawn to this concept through reading an article by Dr. Ronald Melzack on the Pain Neuromatrix. Long story short, the Pain Neuromatrix proposes that each one of us have a similar but unique sort of “circuitry” in our brains that processes our pain experience. In simpler terms, no two people experience the same pain in the same way and this is largely due to a combination of our genetics, our emotional state, and our memories or past experiences. These are just some of the components that influence how much pain and stress and overall disability we feel. This neuromatrix has, in a piecemeal fashion, been validated to some degree in current research.
Why this is important is that it highlights the notion that our experience of pain is subjective. There are in many cases, actual bodily injury or inflammation that absolutely needs to be addressed, however we cannot ignore that a portion of that pain may be influenced by our emotions, our memories, and our sense of loss (in this case, loss of quality of life) or suffering. We (all of us) need to rethink pain and only then can we develop proper holistic strategies to heal.
The field of pain medicine is growing, and with it we are gaining a better understanding of what drives pain and suffering. In the majority of cases, there unfortunately is not just one silver bullet. One miracle cure. At any step of recovery, one must always entertain the combination of therapeutic strategies including exercise-therapy, advanced interventional procedures, complementary medicine practices, pain psychology, and a degree of medication management with a goal to reduce and cease usage at an appropriate time.
Pain has multiple components, and likewise, so does treatment.