Mississippi State Board of Medical Licensure
Source: MSBML Newsletter - Fall 1997 - Vol.1, No.10
Pain, Pain Management And Mississippi State Board
of Medical Licensure Scrutiny
The skillful management of pain is one of the most valuable services a physician can provide.This service calls into play many components of the art and science of medicine and the technological skills that physicians possess. The result of pain management, skillfully done, is most rewarding to the patient and physician alike.
In many respects, the mechanism of pain is a mystery, but it is a mystery that is being progressively untangled. There have been many advances in our knowledge, allowing a better understanding of pain mechanisms and the therapeutic approaches to pain. We now know that:
- The patient's general situation with his family, employment, finances, spirituality, marital status, et al.;
- The patient's previous responses to pain and to pain medications;
- The patient's disease, whether it is due to an acute problem where healing and return to normal is expected, a terminal problem where progression of the disease to death within an estimated six (6) months or less, or a chronic non-terminal source of the pain where neither of the outcomes stated above is expected; and
- The patient's attitude toward the pain.
- Behavior modification-psychological evaluation and intervention;
- Physical therapy ranging from therapeutic exercises and joint manipulation to a variety of modalities including hydrotherapy, thermotherapy, manipulation to change threshold of sensory nerve ends (TENS), and others;
- Analgesics to include NSAIDS, antidepressants and anticonvulsants;
- Where indicated, a variety of maneuvers ranging from nerve blocks to ablative surgery; and
- Controlled substances, including drugs for anxiety and depression, as well as opioids of appropriate strength.
With a working knowledge of all these things, the physician, using good clinical judgement, can create and carry out a plan that will satisfactorily resolve most pain problems and minimize the side effects and potential side effects of all these modes of therapy.
Many physicians are astute in the management of acute pain associated with surgery, trauma, and procedures. A growing number of physicians are becoming adept in the management of the pain of terminal disease. These terminal diseases include a number of cancers, AIDS, a number of progressive neurological diseases, end-stage heart and lung disease, and a variety of other disorders.
Adequate relief of acute pain requires regular doses of an ample amount of medication, as well as supportive measures with physical therapy therapeutic exercises, i.e., walking and breathing exercises, et al. Here the physiologic injury is soon repaired, and the patient returns to normal.
Palliative terminal care requires much supportive treatment involving psychosocial, pastoral care,
physical therapy, family therapy, and a degree of occupational therapy. Compassionate care on the part of all care givers to the patients and their families is a must. Medication must be managed skillfully to assure that increasing amounts are appropriate. Therapy and medication are required for the wide variety of problems that inevitably arise with these situations. The ability to help patients to die graciously and in comfort has traditionally been an outstanding asset of physicians who care for these patients.
The Mississippi State Board of Medical Licensure supports the adequate treatment of all pain. In the acute and terminal categories of pain, the Board's concern is that they not be under treated.
Chronic pain of the non-terminal disorders is where problems arise. It is here that skills in pain management are stretched to the limit. All of the skills embodied in the art and science of medicine and the technologies involved in pain management are called into play.
Successful management in the case of chronic non-terminal pain requires:
What Does the Licensure Board Require of You?
(a) an appropriate good faith history and physical, along with other appropriate studies to make a diagnosis and to understand so far as is possible the mechanism of the pain;
(b) a plan of therapy is evolved and utilized using all the available modes of therapy available and appropriate for each particular patient;
(c) appropriate consultation is obtained;
(d) controlled substances are used only after all other measures and non-controlled analgesics are found to be ineffective; and
(e) all of this is timely and appropriately documented.
NOTE: This broad overview is intended as a beginning effort to deal with a complicated subject. Response from anyone who has ideas will be welcomed. The Board will ask for a formal response by several of the pain specialists and addictionologists around the state to appear in succeeding newsletters.