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HOME > J Yeungnam Med Sci > Volume 40(Suppl); 2023 > Article
Communication
Some suggestions for pain physicians working in real-world clinical settings
Jung Hwan Lee1orcid, Min Cheol Chang2orcid
Journal of Yeungnam Medical Science 2023;40(Suppl):S123-S124.
DOI: https://doi.org/10.12701/jyms.2023.00255
Published online: May 23, 2023

1Namdarun Rehabilitation Clinic, Yongin, Korea

2Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea

Corresponding author: Min Cheol Chang, MD Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4682 • E-mail: wheel633@gmail.com
• Received: March 14, 2023   • Revised: March 24, 2023   • Accepted: April 5, 2023

Copyright © 2023 Yeungnam University College of Medicine, Yeungnam University Institute of Medical Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
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.
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].
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.
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.

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.

  • 1. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with lumbosacral diseases when first epidural injection results only in partial response? Pain Physician 2016;19:E283–90.ArticlePubMed
  • 2. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response? Medicine (Baltimore) 2016;95:e4131.ArticlePubMedPMC
  • 3. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain 2019;160:53–59.ArticlePubMedPMC
  • 4. Buchanan BK, Varacallo M. Tennis Elbow [updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan;[cited 2023 Mar 14]. https://www.ncbi.nlm.nih.gov/books/NBK431092/.
  • 5. Kripa S, Kaur H. Identifying relations between posture and pain in lower back pain patients: a narrative review. Bull Fac Phys Ther 2021;26:34.ArticlePDF

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    Citations to this article as recorded by  
    • Protocol for lower back pain management: Insights from the French healthcare system
      Lea Evangeline Boyer, Mathieu Boudier-Revéret, Min Cheol Chang
      World Journal of Clinical Cases.2024; 12(11): 1875.     CrossRef
    • Effectiveness of transcranial alternating current stimulation for controlling chronic pain: a systematic review
      Min Cheol Chang, Marie-Michèle Briand, Mathieu Boudier-Revéret, Seoyon Yang
      Frontiers in Neurology.2023;[Epub]     CrossRef


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