Rethinking the Pain Puzzle
Dr. Lillie Rosenthal
Pain is a puzzle to be solved. Pain deserves our attention -- our full attention. Pain is not merely a symptom to be suppressed; it is a signal arising from a complex system of integrated networks known as the human body. In order to comprehensively and responsibly understand and treat pain, we need to listen very carefully.
As a pain management physician for more than 25 years, I have thousands of stories of pain emanating from every location in the human body. I treat patients with back pain, joint pain, muscle pain, headache and various other pain syndromes. My goal as a physician is to identify the root cause of pain and recommend a treatment plan to help my patients feel and function optimally. I rarely prescribe medication or recommend a procedure. How is this possible? What can a pain medicine physician offer if she is not prescribing painkillers? The answer is elegantly simple and deeply effective. The practice of excellent patient-centered, hands-on medical care is more potent than a pill or a procedure, and comes without side effects. Pills and procedures are required for some conditions, however certainly not with the frequency prescribed.
We have a national epidemic of opioid addiction that has created a fiscal and social crisis. Doctors must rethink the pain puzzle and patients must advocate for better care that identifies the root cause of pain and actively involves the patient in the treatment plan.
5 Solutions to Unravel and Address the Pain Puzzle
1. Root Cause Medicine: Pain is not the diagnosis. The doctor has the responsibility to identify and educate the patient on the source of the pain. All pain is not created equal. Is the pain originating from a problem with a disc, joint, nerve, muscle or internal organ? A thorough taking of the patient's history as well as a physical examination is essential. The physician's most powerful diagnostic tools are her eyes, ears and hands. The body doesn't lie! It will guide us if we listen.
2. Mechanical Problems/Mechanical Solutions: The body is an elegantly designed machine. Pain is a signal that there is an imbalance. Often the imbalance is structural. For example, low back pain is often caused by tension in the hamstrings. Stretching of the hamstrings is a much more effective response than taking a pill as a chemical band aid. Treatments that address and effect change at a structural level are powerful and permanent. Osteopathic manipulation, stretching and strengthening programs address the root cause. The body responds optimally to a mechanical solution for a mechanical problem.
3. Patient 360: Pain is a subjective experience. The unique and dynamic landscape of the patient's mind, body and spirit shape the presentation of their pain puzzle. The investigation and treatment on a multifactorial level are critical in successfully treating pain.
4. Risk/Reward: Pain deserves respect as well as an adequate response. The medical community often reflexively treat pain with potent medication when ice, heat, arnica and gentle stretching would work just as well without the side effects. We must remember our oath of "first do no harm" and have a reliable arsenal of non-pharmacological treatment options to support the natural healing of the body.
5. Power to the Patient/Medicine as a Verb: As I remind my patients daily, "you are with me for your one hour appointment and with yourselves for the rest of the 23 hours of the day. Your choices matter -- immensely!" Fitness, food, stress and sleep are powerful regulators of the pain puzzle. Lifestyle choices have a dramatic impact on the frequency and intensity of illness and injury. We should "live our medicine."
Pain should not be ignored, rather, explored. We should seek and demand a deep dig for the source of the complex nature of pain. We need to understand its roots. Only then can we begin to unravel the pain puzzle and effect sensible and long-lasting change in how we feel and function.