The Evolution of Pain Management – A Blessing With Caveats

Pain is often referred to as the “fifth vital sign”, meaning patient pain is both more recognized and treated more frequently than ever before in the United States. By some estimates, more than one third of the entire population suffers from one form of chronic pain or another – that’s more than 116 million people. That number doesn’t even include sufferers of acute pain or children suffering with pain. Surprisingly, a generation ago, chronic pain wasn’t considered an affliction that even needed treatment. In today’s society, however, it’s a central part of overall treatment. The rise in treatment options for pain of all types is evident just by looking at the number of prescriptions written for narcotic pain medicines – these are the most widely prescribed class of medicines in the country; more than $600 billion is spent each year on them.While the statistics seem shocking, this shouldn’t lead us to assume that all pain treatments are bad or that they all reflect a growing addiction problem amongst patients. On the contrary, patients who undergo surgery in 2013 are much more likely to be comfortable during and after the procedure than those patients who underwent surgery in the 1970s, for example. As recently as the 1970s, it was considered unnecessary to treat postoperative pain – even quite moderate pain. Today, failing to make patients comfortable after a surgical procedure would be considered cruel or even worthy of a malpractice claim. Today, patients’ perspectives and expectations have shifted so that they expect to be made comfortable after surgery.Perhaps the most stunning example of changing trends in anesthesia is the treatment of pediatric patients. It’s hard to believe, but in the mid-1980s, it was thought that infants didn’t feel pain. Infants who needed surgery were given muscle relaxants so that they wouldn’t move during surgery, but no effort was made to ease their suffering during the procedure. Physicians would slice them open to perform surgery (even heart surgery!) with no numbing agents. That seems completely barbaric by today’s standards, and of course all infants today are appropriately anesthetized for surgical treatment.Laboring women also enjoy the benefits of modern anesthesia. The epidural (also known as a spinal block) was first developed in 1942, and the ability to deliver continuous anesthesia through the epidural during labor was established by 1949. Nevertheless, its use was not common even in the 1960s, when it was assumed that most women either wouldn’t want this type of treatment or didn’t need pain medicine. Today, women have different ideas – anywhere from 60-70% of women receive epidural pain management during labor, and in some hospitals the figure is closer to 90%.These are only a few examples of the ways in which patients’ experiences have improved thanks to modern anesthesia (imagine what dental care must have been like before pain medicine!). Nonetheless, pain management is a confusing subject for the public and the medical community alike. Recent news articles lament the rising numbers of prescription drug -addicted individuals, who may obtain these drugs illegally or from a licensed doctor (sometimes by feigning chronic pain conditions). Physicians, likewise, are monitored by the government and must justify their prescription-writing habits. In order to remain in good standing with their licensing agency, pain management physicians must balance their need to keep patients comfortable with the risks of over-prescribing narcotics; this balancing act can be challenging and sometimes frustrating for busy doctors.As the field of anesthesiology continues to evolve, it will be interesting to observe how all of these influences interact. There are more options than ever before for treating pain, but more responsibility falls on physicians to ensure they are used appropriately.

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