Pain management and pain medicine are considered relatively new disciplines compared to some of the older disciplines in medicine. Actually, they aren't as as new as many people think. They only seem new because they fell out of favor some 30 years ago. But now, both are making a comeback.
For the record, pain management is a treatment philosophy while pain medicine is the actual practice of implementing that philosophy. Together, they help patients suffering from both chronic and acute pain live their best lives.
An anesthesiologist by the name of John Bonica is credited with being the father of modern pain management. He was trained in what was known at the time as the "specificity theory of pain". To make a long story short, he was unhappy with the results of his own treatment of pain via regional anesthesia. This was during WWII. After the war, he began a quest to find a better way treat pain.
By consulting with other clinicians involved in disciplines ranging from psychiatry to neurology, Bonica decided a better approach to treating pain was managing it through a multidisciplinary approach. This was in stark contrast to his training, training that taught him the best way to relieve pain was through anesthesia and analgesia.
Bonica's efforts resulted in the very first multidisciplinary pain clinic being opened in the 1950s. That first clinic was located at Tacoma General Hospital. It was later moved to the University of Washington, Seattle.
For the next four decades, Bonica and a number of colleagues who believed in his approach developed what would eventually become modern pain medicine. They enjoyed great success in state after state. Multidisciplinary pain clinics were opened all across the country. So what happened?
The adoption of CPT codes in the 1980s for medical billing put a heavy emphasis on the fee-for-service healthcare model. This particular model is counterproductive to a multidisciplinary approach because it favors single therapies and procedures that are easily coded and billed. The use of CPT codes made it very difficult to bill for multi-disciplinary treatments.
In addition, the rush toward managed care through the 1980s and into the early 90s led insurance carriers to drop coverage for certain types of treatments in the primary care setting. The managed care model required GPs to refer patients to specialists for treatments and therapies that used to be available in the primary care office.
Falling reimbursement rates and fewer referrals from GPs resulted in multidisciplinary pain clinics closing their doors. By the mid 1990s, there were only a few left. Doctors were content to treat pain by writing pain med prescriptions. Unfortunately, prescription writing all but eliminated the practice of pain medicine by the end of the decade.
Fast forward to the 2010s and we observe pain management beginning to make a comeback. Unfortunately, it took a crisis to encourage the medical community to once again consider a multidisciplinary approach to managing chronic pain.
It's unfortunate that prescription drugs became the big problem they did, but the silver lining is that pain management and pain medicine have returned. Multidisciplinary pain clinics are once again opening their doors to patients who desperately need their help.
This comeback is a good thing for the simple fact that there's no good reason to allow pain to ruin someone's life. Pain can be managed. It can be controlled. Best of all, doing so doesn't always require a prescription. Finding alternatives is what the multidisciplinary approach is all about.
