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Articles  |   September 2005
Editor's Message Patient-Centered Care for Chronic Nonmalignant Pain
Author Notes
  • Address correspondence to Katherine E. Galluzzi, DO, CMD, FACOFP distinguished, Professor and Chair, Department of Geriatric Medicine, Philadelphia College of Osteopathic Medicine, 4190 City Ave, Suite 315, Philadelphia, PA 19131-1633. E-mail: katherineg@pcom.edu 
Article Information
Pain Management/Palliative Care
Articles   |   September 2005
Editor's Message Patient-Centered Care for Chronic Nonmalignant Pain
The Journal of the American Osteopathic Association, September 2005, Vol. 105, ii-S1. doi:
The Journal of the American Osteopathic Association, September 2005, Vol. 105, ii-S1. doi:

Pain has an element of blank; It cannot recollect When it began, or if there were A day when it was not.

It has no future but itself, Its infinite realms contain Its past, enlightened to perceive New periods of pain.

Emily Dickinson (1830-1886) from Part One: Life. XIX

 
Much has changed since Emily Dickinson's time, yet the human experience of pain spans centuries. Not so long ago, relief of pain was all physicians could offer. Before antibiotics, advances in sanitation, hygiene, nutrition, and development of medical technology that we now take for granted, physicians had little in their armamentarium other than drugs to ease the pain of conditions that today have been essentially eliminated, such as smallpox and polio. 
Although many diseases have been conquered, people continue to suffer from pain. Despite our level of medical sophistication, we occasionally find ourselves struggling to do what physicians have always done, ie, offer comfort. Many reasons exist for this struggle. Physicians face scrutiny from managed care providers, federal agencies, and the public regarding pain management. Forced to select from formulary lists or obliged to obtain preauthorization for prescribed treatments, physicians may find caring for patients with chronic pain time-consuming and frustrating. Certain patients fear the onus of addiction, and, conversely, we sometimes fear litigation or doubt the credibility of our patients who require escalating doses to achieve pain relief. 
This JAOA supplement approaches the complex subject of persistent pain from several perspectives and draws on the expertise of practicing osteopathic physicians from anesthesiology, family medicine, geriatrics, gynecology, internal medicine, and osteopathic manipulative medicine. Such diversity reflects the variety of our special patients, and caring for them warrants a multidisciplinary approach in our clinical practices. 
Based on clinical experience in interventional anesthesiology, Stephen S. Boyajian, DO, provides a detailed view of options available for chronic pain sufferers who fail to respond to standard osteopathic and allopathic medical therapy. As a primary care physician, R. Michael Gallagher, DO, FACOFP distinguished, discusses chronic headache from prophylactic and abortive treatments to acute interventions. In my article on neuropathic pain, I clarify current thinking about mechanisms for neuropathic pain and the resultant rationale for specific treatment. Melicien A. Tettambel, DO, FAAO, FACOOG, explores causative factors precipitating pelvic and low back pain in her female patients, and she offers osteopathic therapeutic interventions. Bernard R. Rubin, DO, MPH, offers a detailed overview of the chronic pain syndrome associated with osteoarthritis of the knee. Michael L. Kuchera, DO, FAAO, gives a comprehensive overview of the mechanisms of pain amenable to treatment with osteopathic manipulative modalities. 
These authors discuss chronic pain management options ranging from prevention, osteopathic priniciples and practice, pharmacologic treatment, and surgical intervention. All osteopathic physicians should approach treatment of patients in pain with competence and empathy, drawing from their training and experience as well as the expertise of colleagues. No osteopathic physician should ever have to say, “I'm sorry, there's nothing more I can do.” We may never fully eliminate the human experience of pain, but we should always be ready to offer comfort. 
 Dr Galluzzi is on the speakers bureaus of Pfizer Inc and Purdue Pharma LP.
 
 This continuing medical education publication supported by an unrestricted educational grant from Purdue Pharma LP