I recently was at a meeting on designing a model of pain care delivery. The meeting was filled with clinical and operational experts. In the course of the meeting, one healthcare provider made the case that high quality pain care starts with “finding the pain generator.” By this phrase, he meant that the delivery system should support the use of scans and diagnostic injections to identify the orthopedic structure(s) responsible for any given patient’s pain. From there, he insisted that a foundation could be laid for establishing successful treatment plans to resolve the identified pain generator, presumably through interventional and/or surgical means.
Once having made his case, another provider spoke up and asked how he’d square the care delivery model he proposed with the fact that so-called “pain generators” lack any significant correlation with pain. She cited common evidence showing that findings on MRI scans do not correlate with pain, and that diagnostic injections lack reliability and validity (cf., Vagaska, et., 2019; Kreiner, et al., 2020). In so doing, she used science to challenge the whole foundation on which the previous speaker had advocated for his model of pain care delivery.
In reaction, it was apparent that the original speaker didn’t quite know how to respond. The challenge seemed to catch him by surprise. He seemed unaware of the common research findings she referenced.
It was one of those awkward moments that sometimes happens in meetings when someone says something patently untrue, but doesn’t know it, and when called out on it, they don’t know what to do, and so you end up feeling bad for them, despite knowing that they shouldn’t have said it in the first place.
In all, what the second speaker did was to make public the fact that the initial speaker had failed to keep up with scientifically-based progress in our understanding of pain and its causes.
This simple anecdote puts in a nutshell the current state of affairs within the field of pain management. It is not uncommon for providers practicing in the field to base their practice on models that are unsupported by current scientific research. Indeed, large swaths of pain management lack sufficient evidence to consider them empirically supported.
Moreover, people seeking pain care commonly don't know about this unfortunate state of affairs within the field of pain management. It seems reasonable to assume when seeking care that your healthcare provider is up to date on latest scientific findings and that any therapies the provider recommends has been scientifically shown to be effective. However, it is not always the case. In fact, it is not always the case, all too often.
This central problem within pain management is the reason for the Institute for Chronic Pain. Everyone wants to make pain care more
effective. As such, it would seem a worthy endeavor to put more time, attention and money towards advancing our scientific understanding of pain and how to best treat it. However, it would also be insufficient, as the above anecdote illustrates. We also need to more widely proliferate scientific understanding to patients and provider communities. Healthcare providers need to know what to recommend and patients need to know that they can trust the recommendations they receive. A greater understanding of pain, its causes, and treatments, in other words, is also needed.
To this end, the Institute for Chronic Pain provides academic-quality information on pain and pain care, but in a manner that is approachable to all. Our hope is that you will find it useful.
Our latest webpage attempts to clarify in everyday language the generally accepted definition of pain that comes from the International Association for the Study of Pain (IASP). The IASP is the world’s largest interdisciplinary professional organization devoted to pain science and pain care. They recently updated the definition and we attempt to break it down for you.
You can access the article with the following link: What is Pain?
Kreiner, D. S., Matz, P., Bono, C. M… & Yahiro, A. M. (2020). Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of low back pain. The Spine Journal, 20(7), 998-1024. doi: 10.1016/j.spine.2020.04.006
Vagaska, e. Litacova, A. Srotova, I., Vickova, E., Kerkovsky, M., Jarkovsky, J., Bednarik, J., & Adamova, B. (2019). Do lumbar magnetic resonance imaging changes predict neuropathic pain in patients with chronic non-specific low back pain? Medicine, 98(17), e15377. doi: 10.1097/MD.0000000000015377
Date of publication: October 16, 2021
Date of last modification: October 17, 2021
About the author: Dr. Murray J. McAllister is the founder and publisher at the Institute for Chronic Pain (ICP).