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12 Articles in Volume 18, Issue #4
A New Frontier in Migraine Management: Inside CGRP Inhibitors & Migraine Prevention
Assessment of Patients with Rheumatoid Arthritis or Osteoarthritis
Biosimilars in Rheumatology: How Popular Will They Be?
Case Studies in Regenerative Cellular Therapy: Tendinopathy and Osteoarthritis
Commentary: Make the Easy Choice for Care
Editorial: The Emergence of Trackable Pill Technology: Hype or Hope?
Editorial: The Practicality of Pain Acceptance
How to Avert Government Scrutiny When Prescribing Opioids
Letters to the Editor: DEA and Prescribing, the War on Statistics, Failing Treatments, Patients' Options
Meet the Migraine Game-Changers
Platelet-Rich Plasma and Stem Cell-Rich Prolotherapy for Musculoskeletal Pain
With concerns over opioids, could novel receptors be useful?

Editorial: The Practicality of Pain Acceptance

We asked our editorial advisors for their take on the subject of pain acceptance and whether this should be asked of patients.

 


A recent article1 proposed that more people should accept the intractability of chronic pain. Not surprisingly, this piece sparked a lot of passionate discussion on PPM’s social media feeds, especially among patients living with chronic pain conditions. Below are our editorial advisors' thoughts.

Leonard B. Goldstein, DDS, PhD

My belief is that all of us who treat patients with both acute and chronic pain should do our best to weigh the benefits and risks related to any treatment. I believe that most patients will, in fact, be willing to accept treatment that limits pain to a personally acceptable level, without the complete absence of pain.

While I do not specifically advocate for the concept of ‘pain acceptance,’ patients must realize that the complete absence of pain may be unattainable, or the ‘cure’ may be worse than the problem. This is why we should always use the term ‘Pain Management,’ whether the management includes pharmaceuticals, biopsychosocial interventions, complementary and alternative treatments, or a combination of many inter-professional collaborative treatments. We should continue to advocate for the successful management of pain, utilizing techniques that ‘first, do no harm.’

Gabriel E. Sella, MD

The topic is very apropos to our time and needs. New or improvement in our armamentarium to fight pain is not coming fast enough. While ‘pain acceptance’ is not a new topic, the opioid addiction crisis we are living through demands more paradigm changes. My suggestion is to qualify bona fide pain practitioners in the subject. There could be several components to such qualification.

The first component might include a series of weekend seminars in appropriate locations. In this way, people would not miss much work. The seminars would need to be CME qualified.

The second component would involve insurance acceptance and appropriate current procedural terminology and international classification of disease coding. Insurance providers need to enlist full payment for the services rendered and not bundle them with other codes or payments.

The third component would require large-scale divulgation of the subject and its benefits. The present mentality is one of instant improvement with a magic pill. The population is too influenced by television where incredible things are resolved within an hour, including within the commercials. Reality is quite different.

In summary, we need a well-organized qualification for interested practitioners, on a continuous basis, as the case may be. We also need insurance companies to treat seriously the effort of these practitioners. Finally, we need a will for a paradigm change in our pain sufferer population.

Courtney Kominek, PharmD

While reading the first half of the article, I was thinking about Acceptance and Commitment Therapy (ACT), and happy to see these approaches being discussed. However, it seems the title of the article was meant to get people’s attention and more explanation was needed in the article about what this model entails.

I read through many of the online comments and can see how some people reacted negatively to this idea. The psychologist I work with uses the ACT model in addition to cognitive behavioral therapy (CBT) for chronic pain management and I have seen numerous patients benefit from this approach.

David Cosio, PhD, ABPP

Learning to accept is a coping mechanism and a treatment approach. ACT has received strong research support for chronic pain management and has been found to be comparable to other treatments that give a moderate reduction in pain, such as CBT. These treatments may play a role because one part of the brain responsible for pain is also responsible for emotion. Chronic pain is not a simple phenomenon, but rather a holistic one. When simple methods of treatment (eg, prescription drugs alone) are used on a holistic phenomenon, they do not work.

As there is no cure for chronic pain, the goal is to make the patients feel better and improve their function and quality of life. Chronic pain should be approached using a biopsychosocial model of treatment, which encourages practitioners to focus beyond biomedical factors and on the psychological and social elements. Chronic pain management is a matter of coping. Some people do not like the idea of accepting their pain, but for every moment it is not accepted, an additional moment of suffering may be added.

Kern A. Olson, PhD

My experience with ACT tells me it is appropriate for a limited sample of pain patients. It is not a widespread therapy for all patients as die-hard ACT therapists would have you believe. It can be a useful CBT tool if you select the patient carefully.

Don L. Goldenberg, MD

This concept is not really new since it is well accepted that optimal pain management is linked to a patient’s coping ability and strategies. The specific term ‘pain acceptance’ is the new buzzword for a key component of cognitive behavioral therapy, a cornerstone for treatment of fibromyalgia, and other chronic pain disorders.

Of course, these tools are most relevant in chronic pain conditions, not acute pain or cancer-related pain where the goal is to get rid of pain as much as possible. There has been a growing move away from the intense focus on documenting the level of pain, such as pain rating faces as a vital sign in hospital records. As the Japanese writer Haruki Murakami said, ‘pain is inevitable but suffering is optional.’

Jay Joshi, MD, DABA, DABA-PM, FABA-PM

It is okay to accept a new reality, as we do that every day. As we get older and experience life, things change. We must always adapt to our new reality, good or bad. However, I do not agree that a patient should have to learn to ‘deal with it.’ We see so many patients who have been to substandard physicians who fail the patient in multiple ways. Then, the patient is blamed for failing treatment.

There are very few truly talented, trained interventional pain physicians who understand and implement a multimodal, responsible treatment plan. Perhaps, patients need to accept that fact and fight to find the best pain physician that they can.

Last updated on: June 8, 2018
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Letters to the Editor: DEA and Prescribing, the War on Statistics, Failing Treatments, Patients' Options
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