Pain Specialist, eh?

A pain specialist, a specialist in chronic pain management, an algologist - all these and other definitions of a doctor who deals with individuals suffering from chronic pain do not make sense for the public. Does a family physician treat chronic pain? Yes, of course, as well as orthopedic surgeons, neurologists, oncologists, and the rest of medical specialties. Even dermatologists and ophthalmologists. So what makes this Pain Medicine special? Why can't each and everyone manage the pain of her/his patients? Perhaps, my view is unconventional, but I believe in accountability and commitment to patient well-being. If my esteemed colleagues did the same, many chronic pain conditions would be extinguished. For example, if spine surgeons would commit to staying with their patients, no surgeries for low back pain would ever happen. The reality is different: patients are promised miracles and cure, and then are thrown away back to their family doctors loaded with narcotics and more pain issues than before the surgery. But, let me come back to definitions.

Chronic Pain Specialist is the one who should be finally able to make a correct anatomically sound diagnosis and treat the problem. Unfortunately, patients get to us after months and often years of physical and, subsequently, emotional suffering. When a clear bio-anatomical cause is not addressed, pain is transformed brain of the sufferer, starting off a vicious cycle of pain-depression-social isolation-drug dependency-pain. Therefore, we, Pain Specialists, should have seen patients with sciatica, acute back and neck pain, and other conditions, way before orthopedic and other surgeons; we should have consulted patients with shingles and traumatic nerve injuries before it is too late. Pain Specialists should be seen as a new Palliative Care model. Just until recently, only dying cancer patients would be referred to Palliative team. With the paradigm shift, these patients are being routinely assessed by palliative care doctors to address their symptoms - pain, fatigue, constipation, etc. It resulted not only in better care, but in significant improvements in the quality of life and, often, survival.