The American Board of Pain Medicine defines the specialty of Pain Medicine as “a discipline within the field of medicine that is concerned with the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain.” The Pain Medicine physician, or algiatrist, treats conditions in which patients may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy. Alternatively, the pain specialist sees patients in which pain constitutes the primary problem, such as neuropathic pains or headaches. The pain physician’s objective is to provide quality care to persons in pain. He (or she) uses a broad-based approach in the development of comprehensive treatment plans for the treatment of this difficult disorder. The pain physician may serve as a consultant to other physicians, but more often than not, is the principle treating physician and may provide care at a variety of levels. The pain physician typically may prescribe medications, perform pain relieving procedures, prescribe and supervise rehabilitative services, as well as counsel and educate patients and their families. The pain physician may also direct a multidisciplinary team as well as provide consultative services the public and private agencies. Thus the physician involved in the treatment of pain may do so in a variety of environments and from a variety of perspectives.

 

The word pain has several origins. It stems from the Greek goddess of revenge, Poine, who was sent to punish the poor souls who had angered the gods. There are also the Latin words ‘Poena’ and ‘Patior’ whose definitions are “punishment” and “to endure suffering”, respectively. Ancient treatments for pain span back thousands of years and included votive offerings and sacrificial animals, as well as rattles and gongs. One of the earliest surgeries was a surgery primarily for pain, trepanation, cutting holes in the skull to rid the body of evil spirits and disease. Egyptians took electric eels from the nile river and laid them across the wounds of the injured, an early form of electrical stimulation for the treatment of pain. Pharmacologic treatments started with Hippocrates, the ‘founder’ of Western Medicine, who utilized popularized the concept of chewing on the leaves of the Willow bark tree during childbirth. This tree is a member of the Genus Salix and contains a form of salicylic acid, the ingredient in aspirin. More sophisticated pharmacologic treatments emerged during midieval times when complex combinations of minerals and herbs were used in oral compounds. One such compound, theriac, contained 64 herbs, many of which contained natural opiate substances.

 

The treatment of pain today is significantly more complex, as is our understanding of the phenomenon itself. In 1994, the International Association for the Study of Pain adopted the following definition by characterizing pain as “an unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage.” The defintion highlights the complex biology of the phenomenon and separates the straightforward concept of nociception being the simple afferent transmission of a potentially noxious stimulus, with the more abstract concept of pain comprising conscious awareness, interpretation, attributed meaning, and learning. Chronic pain, in it’s most pervasive form, may also involve interpersonal disruption, occupational problems, psychological distress, and, if untreated, may contribute to a person’s psychological and physical deterioration. 

 

Pain is a significant problem in this country. It is said that up to 45 percent of americans require treatment for pain each year in the united states at a cost of well over 100 billion dollars annually. One-third of americans suffer from some element of a chronically painful disorder. Additionally, it is estimated that 700 million work days are lost to pain-related disabilities every year. The Pain Care Coalition, a joint effort by several prominent pain societies took up a resolution detailing the 2000’s the ‘Decade of Pain Control and Research.’ This resolution was signed by then President Clinton in November, 2000. The decade is now over, and a new one begins but we are still far from our goals. For those of us who dedicate our professional lives to Pain Medicine, we continue to advocate for our specialty and for our patients.