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Tuesday, January 24, 2012

Why I like Pain (management that is)

For the past two weeks, I've had the opportunity to do a pain management elective. I picked this elective rotation because pain management is a field of medicine that has interested since before arriving at medical school. 

I'm going to talk about that experience in the next post, but for now, let me explain why I find pain management interesting. 

  • Pain is a universal problem that touches all people of every age. There will always be people in pain who need relief. 
  • Watching someone else in pain is just viscerally disturbing. When I see someone in pain, I feel it too. Like watching another guy get kicked in the nuts. You can feel it! Therefore, it would be supremely rewarding to alleviate someone else's pain.
  • Pain is a problem that current medical practice handles sub-optimally. There are drugs that reduce pain effectively, but not without significant side effects and addiction. I'm thinking mostly of the opioids. To be sure, there are people who do get relief from what we have to offer, but many, particularly those with neuropathic pain, or with intractable pain syndromes like fibromyalgia, don't get much relief from the current therapies.
  • Chronic pain is huge issue that doesn't get enough attention. There are over 100 million chronic pain sufferers in the US alone, according to some estimates. 
  • From both a clinical and basic science perspective, there are huge gaps in knowledge in pain. There have been great advances made in the past few years about the neurobiology of pain, but there is still a lot we don't know. And for what we do know, translation of that knowledge into new therapies for patients has been very slow. So for someone wanting to be a physician-scientist, pain is an ideal arena. The entrepreneur in me goes to where the unmet needs are and where there are opportunities. More mature areas of study where there are a lot of smart people already working, such as heart disease and cancer, don't really attract me. 
  • Because pain is such a pervasive and underserved problem, it is now starting to get a lot of attention from the people who control the funding (NIH). The institute of medicine (IOM) just put out a position paper called Relieving Pain in America, in which it calls for more research and more physicians to treat pain. It seems like pain is starting to get hot, so now would be a good time to enter the field. Hopefully during my PhD, I can make my entry by doing some basic research into the mechanisms of pain.
  • Since pain is a such a multidimensional problem, so too is the clinical practice of pain management. People come to pain management from anesthesia, neurology, psychiatry, PM&R and even internal medicine. That works because pain requires knowledge in all of these areas. The majority of pain management practitioners are from anesthesia, and thus current pain practice is heavy on interventional techniques, but most everyone acknowledges that excellent pain care requires a multidisciplinary approach. The versatility of pain management is very appealing to me. Depending on my preferences, I can do interventional procedures (epidurals, joint injections, stimulator implants, etc), and non-interventional, medical management of pain. I think such variety in a practice would be intellectually satisfying for sure.
  • Pain management is usually not high acuity, unless one is working on an acute pain service. Therefore, I can manage my time more easily and make time for research and see patients when time permits. 
  • I'd be remiss not to mention the lifestyle is appealing. Pain management is practiced in an outpatient setting. Hours are regular work hours (8-5, usually). Compensation is commensurate with the time it takes to train to be a good pain physician. No call. Practicing pain would allow me to have a lab, be a clinician and have time to be with my family and live a semblance of a life. I like that :)
  • Lastly, a personal reason. I was keen on pain management even before medical school because for years, I watched my mother and brother suffer with chronic pain issues. I don't suffer like they do, but watching them be in pain everyday is nearly as bad as having the pain myself. Through their struggles, I became aware of how big a problem chronic pain is and I felt like pain would be as good an area as any to dedicate my efforts to. So I feel an emotional pull toward pain. In working toward becoming a better pain physician, I'd be doing a service for my family too. Perhaps I can bring them relief someday.
I think that's it for now. As time goes on, I'll probably find even more reasons to like pain. And who knows, perhaps something will happen in the next few years that will make me do a complete about-face, but for now, pain is top of the list for the reasons above. 

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