What Is Pain Management?

By Author: Steven Johnson
Total Articles: 494
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It's always interesting to compare how other countries approach the question of treatment. The Brits have the National Institute for Health and Clinical Excellence (shortened to NICE). There were no national standards for treatment so there was a ZIP code lottery, people receiving the care thought best by their neighborhood hospitals. Some did very well. Many did not. But, from 1999, NICE has been responsible for the evaluation of all treatments. It balances patient outcomes against the financial cost, always looking for the best value-for-money. If NICE finds a drug, device or treatment strategy to give poor value, it refuses certification and no public money can be spent on it. This leaves it to those with the cash in hand or an insurance policy to decide whether they will pay for the given treatment privately.

In the US, we have no national body to offer clinical guidelines. In theory, this leaves everything to the individual doctors but, in reality, doctors are influenced by the drug companies and device manufacturers. So many hospitals are set up to deliver treatments where there is no evidence they are effective. ...
... For example, the Brits believe in pain management centers. These are multidisciplinary teams of specialist doctors, therapists, counselors, and nursing professionals. When a patient continues to experience pain after treatment by a specialized hospital department, the local center takes over. The strategy is to review the patient's medical records looking for anything not done or not done well. If this rediagnosis finds possible remedial work, it is done first. Only when all physical avenues have been exhausted does the center treat the pain itself by a mixture of counseling and drug therapy. The idea is to get the best quality of life possible with the lowest long-term costs. This means pain management without depending on drugs wherever possible.

In the US, the individual hospital departments are too powerful. No one is allowed to take over patients and look for faults in their treatment to date. If a patient is still in pain, the original specialist simply gives more painkillers. That way, their reputations are protected and they keep all the money flowing from the insurance companies. This means patients come out second best and, for the most part, dependent on painkillers to get through the day. You will only find pain management centers in a few hospitals and, for the most part, they are underfunded and understaffed. The pharmaceutical industry has too much to lose if doctors treat patients with less drugs. The hospitals make less money if people are treated at home or in the community. So it's going to take a revolution to change hospital culture and focus on the actual patients' needs rather than the financial interests of the doctors and the hospitals. As it stands, there's little sign of enthusiasm for this change. Patients are given Tramadol for moderate to severe pain. If they continue to complain, they are prescribed the more powerful opiates even though this is likely to lead to addiction. While the British system is not perfect, it's better than what we have. They prescribe Tramadol and cognitive behavioral therapy and do well on it.