Pain medicine is torn apart by opinions, guidelines and regulations. The interventional pain practice appears to be the most vulnerable and volatile topic. I believe that the standpoint of our discipline is the fundamental knowledge of anatomy, which unfortunately, often receives minimal attention in the education of non-surgical specialists. Any biomedical problem has anatomical reason, and any chronic pain starts from certain injury, surgery, trauma or illness. Initially, surgical and other specialists make an effort to investigate and to treat the problem. Often it is successful, but at times it is not. Patients receive more medications, tests, physical therapy, etc., but all in vain. The pain does not subside. It is very important to evaluate a person in a pain clinic as soon as possible. Occasionally, addressing acute pain relating to conditions such as tendon or nerve injury, shingles and disc herniation, effectively prevents development of chronic pain and disability. Certainly, at times, multiple biopshychosocial factors coexist and maintain chronic pain. However, it is unlikely that interventional techniques or surgeries would resolve these problems. Over-medicalization of social problems is a slippery slope that leads to unnecessary medical interventions, swelling heath care expenditures and worsening of suffering.
My clinical duties include consultations and management of the most complicated cases of chronic pain disorders, where the majority of patients have already been seen by multiple health care professionals, and have undergone multiple procedures and surgeries. They often turn to a pain clinic as their last resort, and unfortunately, they hear the same “We can’t help you” line. However, I believe in helping a person, regardless of how severe the situation is. It might be limited to an opportunity to talk and share the patient's experience. Occasionally, sophisticated image-guided procedures can help break the chronic pain cycle. Any patient has a right to know what is wrong, and what can be done to make it better. The quest is to find the most appropriate individual approach.