Some suggestions for pain physicians working in real-world clinical settings
Article information
Abstract
Musculoskeletal pain is a common reason for patients visiting hospitals or clinics. Various therapeutic tools including oral medications, physical modalities, and procedures have been used to alleviate musculoskeletal pain. Numerous clinical trials have been conducted to demonstrate the therapeutic effect of each treatment and compare the efficacy of different protocols. These trials were conducted under controlled conditions with specific endpoints and timeframes, and the individual constraints of each patient were not considered. We believe that the findings of such studies may not accurately reflect clinical reality in real-world settings. In this article, we propose treatment principles for patients in pain clinics. We propose two principles for pain treatment: first, “Healing, in the end, is not healing.” and second, “The patient’s job is not a patient.” The main role of pain physicians is to quickly and actively reduce pain and help patients focus on their work and lives.
Introduction
Musculoskeletal pain is a common complaint among patients that decreases their quality of life and ability to work. Many treatment protocols involving different drugs and interventions have been used to treat such patients. Numerous studies have compared the efficacies of different protocols. These studies were conducted under controlled conditions with specific endpoints and timeframes, and the individual constraints of each patient were not considered. The findings of such studies may not accurately reflect the clinical reality in real-world settings. Here, we propose two treatment principles for patients in pain clinics.
First principle: healing, in the end, is not healing
Pain control should not be measured by a reduction in pain between two specific time points. Instead, it should be assessed based on the overall pain-free period achieved during this time interval. Previous studies have shown that repeated epidural injections at regular intervals of 2 to 3 weeks are better than injections administered only when patients with cervical and lumbosacral spinal diseases experience severe pain [1,2]. Repeated epidural injections can prolong the pain-free period and reduce the number of injections required. Incomplete eradication of acute pain results in the development of chronic pain, which is difficult to eradicate using current therapeutic modalities [3].
Second principle: the patient’s job is not a patient
We would like to begin this topic with the Greek mythological figure Procrustes. Procrustes had an iron bed. He forced his guests to lie on this bed. If they were shorter than the bed length, they were stretched forcibly to fit the bed. If they were longer than the bed length, their legs were cut off to allow them to fit the bed. “Procrustean bed” refers to a situation of arbitrarily forcing someone or something to fit into an unnatural scheme or pattern.
It is well known that musculoskeletal pain often occurs due to prolonged repetitive movements, excessive use of force, and inappropriate working postures. Several studies have reported that avoiding repetitive use of force and maintaining the correct posture can reduce pain [4,5]. Therefore, clinicians advise patients to avoid the repeated use of excessive force and educate them to adopt correct postures to prevent harmful effects on their bodies. For example, physicians frequently educate patients to avoid repetitive waist flexion or a prolonged sitting posture to prevent lumbosacral disc degeneration. However, patients who visit the clinic might be baggage-delivery workers, taxi drivers, or engineers developing new software, for whom success in their job is more important than their posture during work. The main reason for visiting a pain physician is to seek help to eliminate factors that hinder their work. Considering the nature of their jobs, it may not be practical for them to adhere to advice regarding posture and movement restrictions provided by their doctors. It should not be forgotten that any advised treatment should be based on patient needs and limitations, and not solely on physician satisfaction or textbook teaching. The musculoskeletal system plays a vital role in daily life and cannot be allowed to rest indefinitely. In particular, the lumbar spine is essential for most daily work and must be flexed whenever needed. It is well known that too much stress on the lumbar spine by way of repetitive flexion movements can lead to disc degeneration. However, the ultimate aim of any pain-relieving therapy is to improve the patient’s quality of life by relieving pain. Asking patients to maintain a good but impractical posture at all times adversely affects their quality of life. This is one example of a “Procrustean bed.” Therefore, it is preferable to allow patients to focus on their work and life rather than constantly paying attention to their movements or postures while working. It may be more realistic and helpful if pain is managed by focusing on quick and complete pain control rather than educating patients to minimize repetitive use of the musculoskeletal system or to adopt correct postures.
Conclusion
We propose two novel approaches for pain treatment. We believe that the main role of pain physicians is to quickly and actively control pain and help patients focus on their work and lives.
Notes
Conflicts of interest
Min Cheol Chang has been Associate Editor of Journal of Yeungnam Medical Science since 2021. He was not involved in the review process of this manuscript. There are no other conflicts of interest to declare.
Funding
None.
Author contributions
Conceptualization, Methodology, Validation: JHL, MCC; Formal analysis, Supervision: MCC; Writing-original draft: JHL, MCC; Writing-review & editing: JHL, MCC.