Is the pain real ?

"Is the pain real ?".

It is a dilemma for practically every medical profession everyday.
The truth, in many cases, is that we can not prove for sure it is
not real.

Many years ago, ? 20 or 30, we had to be very careful when we
prescribed narcotic analgesic medications for the patients. We could
be disciplined if we prescribed "unnecessary or excessive" narcotics.
Then the tide changed. Pain management became a most important
issue in the caring for the patients.

I recall there was once a physician in the Bay area who was sued for
not prescribing adequate dosage of narcotics for his cancer patient.
It became a big issue then , and ever since, the California Medical
Board started to demand all physicians practicing in the State of
California to show proof of 12 hours CME credit, in addition to the
regular yearly 25 hours CME credit, when they renew their medical
license every two years.

Then there were various CME seminars or courses of "Pain
Management" offered to the physicians to help them practice the
best medical care for their patients. And a new breed of specialist
called"Pain Management Consultant" came along. In our hospital,
we have one such specialist available for consultation, and besides
taking the routine "vital signs", the nursing staff also need to ask
the patients if they have any pain of any kind, and if they do, they
record the "pain scale" from 1 to 1o according to what the patients
say.

Now it came to the problem: " Is the pain real ? or the intensity of
pain they reported to the nurses is genuine. As a physician, we often
want to see the evidence for the disease or symptom, that is the so
called "organic" pain. Then if we don't see the organic evidence, we
call it "psychogenic". Without the "evidence", it is obviously hard to
"prove" the "psychogenic pain" is real. Even the advanced diagnostic
technology such as MRI would still not help you to prove that the
pain is real. (Our classmate D.J. from Johns Hopkins would probably
agree with me in this respect).

But in this current medical care era, even if we can not prove the
pain is not real, we still need to believe the patients, of course we are
not talking about those who have psychiatric illness or drug seeking
behavior. And when prescribing the pain medications, prescribe an
adequate dosage with reasonable interval of administration.

Yeh Tze