AANS Neurosurgeon | Volume 27, Number 3, 2018


The Challenge of Pain

As medical students, there is a lot to learn. Pain management — specifically the use of opioid medications — is currently a hot-button issue, reaching every burgeoning physician across the nation. According to the Centers for Disease Control and Prevention (CDC), overdose deaths involving prescription opioids and heroin in the U.S. have quadrupled since 1999. Prescription opioid sales have increased by nearly the same rate over this time period and are widely considered to be the driving force behind the rise in deaths (1).

Faced with this undeniable public health crisis, hospital systems, physician groups, law enforcement agencies and local, state and federal governments are all clamoring for solutions. Often, the proposals involve introducing guidelines and laws directed at decreasing dosage and duration of treatment. While these are certainly reasonable places to start, focusing solely on reduction may well have the unintended consequence of under treating pain. While no physician wants to play a role in creating an addict, it is also paramount to ensure appropriate management of pain in our current and future patients.

Pain is Not Objective
The fundamental problem is pain is not objective. There are no tests or studies to quantify pain. There are some outward signs, but they are not always present, nor do they quantify the severity. It is easy to write off patients complaining of pain as drug seekers based on a subjective presentation and the context of our relationships. We are taught about and warned of drug seeking behavior as students, and a single experience with a drug-seeking patient can begin the erosion of naivety and slide into cynicism. Add to this the increased pressure to reduce opioid prescriptions. Many of us will either be reluctant to or will be skeptical of prescribing opioids to future patients. This may result in the under treatment of pain, especially in those who have become dependent during the era of overprescription. As future physicians, we must acknowledge that our profession shoulders a portion of the responsibility for the opioid epidemic. Simply becoming stingy with prescriptions and saying that we have done our part is insufficient.  

What Does the Future Hold?
Looking forward, I think we will all benefit from a more aggressive and multi-disciplinary approach to pain education and to the nuts and bolts of pain management. From physical therapy to anesthesia to behavioral health, many different providers have a role in treating patients struggling with pain. The problem of addiction is physical and psychological – not moral – and we all have a duty to treat these patients with dignity and respect. Our hope is that we can be compassionate when treating pain, as well as addiction that may have resulted from treatment. The goal is to aid all patients in achieving a better quality of life.

1. CDC. (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics. 



2019 Mayo Clinic Advancements in Surgical & Medical Management of the Spine
Jan. 13-17, 2019; Kohala Coast, Big Island, Hawaii

Pituitary Education Day
Jan. 16-18, 2019; Orlando, Fla.

Innovations in Endoscopic Minimally Invasive Brain Surgery
Jan. 16-19, 2019; Celebration, Fla.

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