Guest Post from Deborah L. Benzil, MD, FACS, FAANS
Chair, AANS/CNS Communications and Public Relations Committee
Mount Kismo Medical Group
Columbia University Medical Center
Mt Kisco, New York
“The greatest evil is physical pain.” – Saint Augustine
“The aim of the wise is not to secure pleasure, but to avoid pain.” – Aristotle
“Of pain you could wish only one thing: that it should stop. Nothing in the world was so bad as physical pain. In the face of pain there are no heroes.” – George Orwell
As eloquently stated by philosophers and writers, pain is a universal and ubiquitous enemy. In the long and arduous battle to defeat this tenacious foe, neurosurgery has fought hard and can count many crucial victories. In today’s social media fueled world, the intricacies and complexity of pain have been reduced to a cliché: “the opioid crisis.” While there is no doubt that the rise in opioid abuse and related deaths is a serious concern, limiting engagement just to this topic is unlikely to prove the right tactical maneuver. However, the recent focus of attention provides an excellent opportunity to enhance public awareness to less appreciated aspects of this, “enemy of human happiness” (Arthur Schopenhauer).
The spectrum of important concepts about pain include:
- Understanding pain generators (mechanical, inflammatory, degenerative, vascular, tumor, etc.);
- Investigating the neurophysiology and neurochemistry of pain, particularly for translation to prevention and treatment of pain;
- Optimizing treatment interventions spanning prevention, nonsurgical and surgical-including innovations that enhance quality outcomes (minimally invasive, surgical adjuncts, surgical safety, and more);
- Studying components that impact outcome to ensure the right treatment for the right patient at the right time;
- Designing meaningful education programs that span from medical school through graduate to postgraduate levels;
- Developing safe and effective mechanisms to control acute (especially post-surgical) pain;
- Enhancing utilization of proven non-narcotic interventions, particularly for chronic pain, such as spinal column stimulators and alternative medication; and
- Making available appropriate programs for those who need help with opioid abuse and addiction.
The pivotal contributions of neurosurgery to this field are too numerous to elucidate fully (see additional resources section for more information) some notable highlights are:
- Spine surgery techniques to combat the painful sequelae of degenerative conditions including herniated discs, stenosis and scoliosis;
- Innovative spectrum of interventions (microvascular decompression, radiofrequency, glycerol and balloon rhizotomy, and stereotactic radiosurgery) for patients suffering the debilitating pain of trigeminal neuralgia;
- Application of spinal column stimulators as a proven and effective intervention for chronic neck, back and limb pain;
- Elucidating the need for multidisciplinary pain management and meaningful education;
- Scientific and surgical leadership from pioneers including William H. Sweet, MD, DSc; Peter J. Janetta, MD, DSc, FAANS(L); Kim J. Burchiel, MD, FAANS; Carol A. Miller, MD; David G. Kline, MD, FAANS(L); Blaine S. Nashold, Jr., MD; Krishna Kumar, MD; John C. Oakley, MD; Yucel Kanpolat, MD; Yoshio Hosobuchi, MD, FAANS(L); Richard B. North, MD, FAANS(L); and John Adams, MD.
“My focus is to forget the pain of life. Forget the pain, mock the pain, reduce it. And laugh.” – Jim Carrey
“Mysteriously and in ways that are totally remote from natural experience, the gray drizzle of horror induced by depression takes on the quality of physical pain.” – William Styron
Jim Carrey and William Styron poignantly identify that there is always at least some psychological contribution to the physical manifestation of pain and this further complicates the study, treatment, and understanding of the subject. To name just a few:
- Many patients have pain with no definable anatomic source;
- Patients require remarkably different doses of medication for seemingly similar problems; and
- Some patients are clearly more prone to opioid dependence, addiction or abuse.
As you have just read, there are a lot of things to discuss when it comes to pain. Make sure to stay with Neurosurgery Blog throughout September as experts share insights into the complex and important topic of pain. Neurosurgeons are an integral part of establishing optimal care for pain patients, and we will continue to lead the charge to ensure they get the best treatment possible.
Editor’s Note: During the month of September, we encourage everyone to join the conversation online by using the hashtag #painfacts.
Selection of Neurosurgery’s Contributions to Pain: