Free
Letters to the Editor  |   January 2018
Chronic Pain Management: Perspective of an Osteopathic Medical Student in New Mexico
Author Notes
  • Burrell College of Osteopathic Medicine, Las Cruces, New Mexico 
Article Information
Medical Education / Pain Management/Palliative Care
Letters to the Editor   |   January 2018
Chronic Pain Management: Perspective of an Osteopathic Medical Student in New Mexico
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 6-7. doi:10.7556/jaoa.2018.002
The Journal of the American Osteopathic Association, January 2018, Vol. 118, 6-7. doi:10.7556/jaoa.2018.002
To the Editor: 
I appreciate Dr Jerome's recent article, “An Osteopathic Approach to Chronic Pain Management,”1 for its immediate relevance to my education and for enhancing my perspective of the opioid epidemic. 
As an osteopathic medical student attending the Burrell College of Osteopathic Medicine in Las Cruces, New Mexico, I directly witnessed the significance of this public health problem when I attended legislative proceedings for increasing naloxone dispersal in the southwestern region of the United States in an effort to reduce deaths related to opioid overdose. New Mexico has the eighth-highest drug overdose death rate in the nation, with prescription opioid-induced deaths accounting for nearly 50% of unintentional overdose deaths in the state.2 Of course, the opioid epidemic spans the nation. A few years ago, as an emergency department volunteer in Terre Haute, Indiana, where I completed my undergraduate training, and in my hometown of Oceanside, California, I encountered patients addicted to opioids. 
According to the US Department of Health & Human Services, 2 million people in the United States have prescription opioid use disorder.3 With awareness of opioid abuse increasing across the country, particularly in states like New Mexico, health care professionals are struggling to find the balance between managing overdoses and preventing them. Dr Jerome's article, however, offers a solution rooted in osteopathic principles and practice. Chronic pain management is a multipart problem for which the secondary side effects are commonly treated rather than the underlying issue. This aspect highlights the unique challenge associated with pain management: delaying treatment to diagnose the specific pathophysiologic cause of existing pain is not an option. 
Opioids certainly play an important role in managing active cancer pain and providing palliative care.4 For other patients with chronic pain, however, many physicians find themselves fine-tuning medication while concurrently deciphering the problem at hand, which contributes to opioid overprescription as a quick and “painless” fix. Dr Jerome points out that the response has been to severely decrease opioid distribution for chronic pain but with limited focus on identifying suitable alternative methods of treatment.1 
Dr Jerome emphasized the osteopathic medical profession's unique approach to chronic pain management that should reduce opioid overprescription and abuse. As an osteopathic medical student, I was encouraged to grasp the core tenets of my chosen profession, to “treat the whole person rather than simply addressing the pain symptoms.”1 As the founder of osteopathy, Andrew Taylor Still, MD, DO, sagaciously wrote: “To find health should be the object of the doctor. Anyone can find disease.”5 I am wholly responsive to this principle as I form habits to put into practice and further osteopathic medicine. 
Mastering the management of chronic pain starts with education and communication of expectations between patients and their health care providers. In fact, 2 of the New Mexico Department of Health's 4 tips for patients to prevent overdose involve talking to health care providers and pharmacists about treatment options.6 This communication makes possible the cognitive behavioral strategies that Dr Jerome details in his Figure 3.1 These intriguing, straightforward approaches maximize patient understanding of pain, which greatly increases treatment effectiveness.1 
Whereas George Orwell's protagonist in 1984 concludes, “in the face of pain, there are no heroes,”7 Dr Jerome anticipates that osteopathic physicians across the nation can alleviate this experience, one patient at a time, by returning to the roots and core principles of their vocation. I am grateful for this reminder as I continue my education in an ever-advancing field. 
References
Jerome JA. An osteopathic approach to chronic pain management. J Am Osteopath Assoc. 2017;117(5):306-314. doi: 10.7556/jaoa.2017.056 [CrossRef] [PubMed]
New Mexico Substance Abuse Epidemiology Profile. Santa Fe: New Mexico Department of Health; 2017. https://nmhealth.org/data/view/substance/2067/. Accessed November 27, 2017.
About the epidemic. US Dept of Health & Human Services website. https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed November 27, 2017.
Groninger H, Vijayan J. Pharmacologic management of pain at the end of life. Am Fam Physician. 2014;90(1):26-32. [PubMed]
Still AT. Philosophy of Osteopathy. Kirksville, MO: A.T. Still; 1899: 28.
Prescription opioid safety. New Mexico Dept of Health website. https://nmhealth.org/about/erd/ibeb/pos/. Accessed November 29, 2017.
Orwell G. 1984. New York, NY: Harcourt Brace and Company; 1949.