Pain Management. Current Issues and Opinions

Preface

Recently, the Institute of Medicine in the United States assembled a panel to look at the issue of pain and its treatment. The comprehensive report has outlined that there is a great deal of suffering, and an excessive amount of money is being spent on many ineffective treatments for treating pain, and the associated costs with the disability that is the consequence of poorly-treated pain is even more staggering.  

Despite this, significant gains have indeed been achieved over the past 20 years in the treatment of pain by interventional pain and other pain specialists. The evidence is accumulating, and the etiologies of painful conditions are also better understood.

Policy makers need to include input from physicians recognized in interventional pain training and experience, as well as other practicing physicians, in order to avoid excluding data from studies regarding one camp of pain practitioners which may be unknown to another camp of practitioners. Interventional pain management should not be isolated from interdisciplinary and pharmacological pain management camps, and the field should evolve to a point where patients are evaluated and treated using the best of all worlds.

The reader must always be careful and maintain personal selectiveness for incorporating those areas that are indeed in the best interest of the patient that suffers from pain. The material contained within this book has been assembled more for quality rather than completeness. One may wish to have other and different areas covered, but there is only so much that can be accomplished in a limited amount of time and space. There is a significant amount covered in the various parts on opioids which must be looked at, as treatment of pain in many parts of the world is heavily opioid dependent.  

It is interesting to note that in the United States over the last couple of years, the mortality rate from prescribed opioids has exceeded that for motor vehicle-induced mortality. When opioids are used, the nature of the medication is such that it is subject to diversion and abuse. Disciplining patients should not be the responsibility of the physician, but verifying the use interestingly helps to maintain the appropriate use. For example, urine tests two to six times per year, qualitative and quantitative is followed by a one-third reduction in the inappropriate use of the medication. Physicians need to look at whatever is in the best interest of the patient, and clearly the unintended overuse is not.  

Dr Noe and myself go back for many years in the arena of interventional pain evaluation, research, teaching, and treatment.The clear recognition is that we could not have fulfilled the rolls that one has to fulfill without the complete devotion to our partners, Laura, Dr Noe’s devoted wife, and Enid, my beautiful wife of 50 years this year. After a very brief discussion between my friend, Dr Carl Noe, and myself, we felt that the most appropriate way for us to express our gratitude is by dedicating this book to them.  

We hope that the readers will find information that will make them think and improve their outlook on a fair and balanced vision of pain and its treatment, regardless of which branch of medicine they practice.

The purpose of this project is to bring the best minds together from around the world quickly and on an ongoing basis to make a world with less pain, hence the title Painless. The electronic format will leverage technology to allow for rapid additions of new material and updates of this initial presentation. We look forward to this global conversation with you.

Gabor B. Racz, MD, FIPP, ABIPP
Grover E. Murray Professor
Professor and Chairman Emeritus
Texas Tech University Health Sciences Center
USA