The Specialty and Future of Pain Medicine

While ever finer and more targeted anatomical treatment for pain continues to become more prevalent, it is important to recognize that perhaps the greatest advance in modern thinking about pain medicine has come not in the form of choosing a single modality or approach or pain concept, but rather is the recognition that multiple pain theories, anatomical processes, and therapies must coexist. Although this joining of previously dichotomous thinking has been advocated for some time, as recently as a decade ago, French sociologist Isabelle Baszanger noted the presence of two disparate types of pain clinics in Paris: one based on "curing through techniques" and the second based on "healing through adaptation (Baszanger 1992)." Rather than our making a choice between the mind and the body, a holistic concept of patient-centered pain management has emerged. Initially this was devised by the mother of hospice medicine in Great Britain, Dame Cicely Saunders, through her idea of "totalpain (Clark 1999)." After his experiences treating the pain ofWorldWarll veterans, the founder of interdisciplinary pain care, Dr. John Bonica, organized an early large-scale mul-tidisciplinary conference of 300 clinicians and researchers, which ultimately gave rise to the International Association for the Study of Pain (IASP) (Liebeskind 1997). Now, more than 60 scientific disciplines are represented by the IASP. This multidisciplinary trend has continued with the establishment of formal subspecialty Board certifications in Pain Medicine through the American Board of Anesthesiology in 1991, followed by subspecialty certification from the American Board of Psychiatry and Neurology (ABPN) and the American Board of Physical Medicine and Rehabilitation (ABPMR) in 2000 (Fishman et al. 2004). Currently, in the United States, the expectation and preference of interdisciplinary pain care has impacted the training of physicians, and the Accreditation Council for Graduate Medical Education established new guidelines to provide for multidisciplinary pain education as a requirement for subspecialty pain fellows in 2007 (Official website of the ACGME 2008).

Pain is essentially so much a part of our common humanity and so central to the practice of medicine that without understanding of the assessment, diagnosis, and treatment of pain, our care of patients would be woefully inadequate. The dramatic breadth and depth of the field of pain medicine makes it a fertile ground for future innovation. In every aspect of pain care, from the subcellular to the community-wide level, advances are being made that not only influence theory but also practice. The rapid current acceleration in molecular biology, genetics, imaging modalities, and high technology provides constantly growing potential for discovery. At the same time, renewed interest in old world ideas and techniques encourages the development of the art of healing among caregivers. It is the goal of this chapter to provide a mental framework to understand the evolution of our current concepts and therapy for pain and to foster professionalism in this newly emerging and exciting focus of scientific and clinical study.

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