Since the dawn of our civilization pain was considered an evil and humans were in the constant pursuit for pain-relieving remedies. Electric fish was prescribed for headaches, and blood-letting was practiced for gout, along with myriad of other reasonable and absurd recipes. Officially, Pain Medicine was born in 1967, when a military physician John J Bonica opened the first Pain Clinic in Tacoma, WA. Later this clinic was relocated to the University of Washington, Seattle, WA, and from that time Pain became a matter of scientific and clinical inquest. I had a privilege to practice in this clinic and to lead this clinic for two exciting years. I learned several important lessons, that sharpened my personal view on pain management:
a. Patients without motivation to get better will not get better
b. There are no miracles, the results are achieved when right treatment is offered to right patient by right physician.
c. The result is always an achievement that has two parts – motivated patient and skillful medical professional at the right time.
Thus, I developed my personal “DO and DON’T DO” list.
THINGS I DO
- I review documents prior to scheduling appointment: a vague referral letter is a symptom of mismanagement
- I ask to complete medical questionnaires: self-assessment provides the best information
- I evaluate each patient including physical examination and imaging: never rely on reports, MRI notes often miss the problem
- I make an anatomical diagnosis: without it, not intervention is possible
- I use image-guided procedures to diagnose and treat chronic pain: aka "blind" injections deceive both the patient and physician
- I discuss with patients and their family possible approaches: I always start with a simple one
THINGS I DON’T DO
- I do not accept patients without a clear referring letter and supportive documentation
- I do not see patients who refuse to provide essential information
- I do not rely on written reports without original data (MRI, CT, etc)
- I do not practice “trial and error” methods
- I do not do multiple frequent "nerve blocks" that harm patients and game the system
- I do not prescribe opioids excluding special circumstances
- I do not make patients "addicted" to my services; when goals are achieved they are discharged but welcome to come back