There comes a point in the treatment of any problem when the doctors decide nothing more can be done. Let’s say you were unlucky in a traffic accident and, despite surgery and physical therapy, you will be left with a limp. At first, the pain was severe but, with constant attention to the underlying cause, it has eased a little. Now is the time for a change in the medical team. The problem remaining to be treated is the pain. The best people to treat it are those doctors who specialize in pain management. That’s what happens in other countries. It does not happen here but we can come back to this lack of specialists in another article. First, what is pain management?
Once you have decided to treat the pain as if it was a completely separate illness in its own right, the first step is for the pain specialists to review all the treatment to date. A fresh set of eyes is needed to make absolutely sure nothing has been overlooked. Why is this necessary? Well, let’s say you have been treated for your injuries by the orthopedic surgery department. They have patched you up and sewn you back together. But these are doctors who specialize in the skeleton, joints and muscles. They might not have noticed if you were growing depressed and this was having a negative effect on your perception of pain. So the first step in pain management is to review everything done so far and, if anything has been missed, this can be put right first. Only when the pain specialists are confident nothing more can be done to treat the underlying cause can they focus on the pain itself.
Now comes the team approach. Pain is partly physical and partly psychological. Some people find any continuing pain a threat to their quality of life. They feel unable to cope unless there’s a high dosage of painkillers. Even with the help of medication, they retreat into themselves and turn themselves into invalids. Others have a positive attitude and, even though there’s a little pain, they work round it to enjoy life. In other words, unless you treat the person and understand how each individual responds to pain, there’s little chance of a successful outcome. This highlights one of the difficulties in the conventional hospital department. Even though you can get to see the doctor or surgeon responsible for your treatment, it tends to be only for a few minutes. There’s little tine to discuss your problems in detail and the most usual outcome is a prescription for a painkiller.
In a specialist pain management clinic, there’s a team of doctors, psychologists, counselors, physical therapists and cognitive behavioral therapists. Everyone is potentially different. Some patients may prefer treatment in their own homes so a community-based team can visit. Others may live close to swimming pools and other facilities where they can exercise. Those that live in exurbs with no recreational services may need help to travel to places where they can exercise under supervision. All the research shows this focus on the individual produces the best outcomes. If there’s still too much pain, Tramadol in short bursts is the usual strategy. But the aim of the team is always to avoid using drugs, even those as mild asTramadol.