Pain: friend or foe?

Abstract

As concerned and caring physicians, we appropriately hope that our patients do not experience undue pain and suffering. Indeed, as orthopaedists, our goal in the majority of the surgical procedures that we perform is to relieve pain and to restore comfortable function. However, there is increasing expression, in both the lay and the medical press, of a desire to alleviate ­essentially all pain by pharmacological means. A subspecialty, initially comprising mostly anesthesiologists and later including various other specialists and health-care professionals, has arisen to meet the challenge of managing musculoskeletal pain in the non­operative as well as the perioperative setting. As orthopaedists, some of us have been asked to abrogate our responsibility to control this aspect of ­patient care or, motivated by convenience, have done so willingly. Unfortunately, this may engender risk to our patients, especially when pain is the only symptom or sign available to cause suspicion of an impending or long-term problem, particularly in the postoperative period. In recent years, I have both witnessed and been consulted about many such cases. The following examples are illustrative. A twenty-three-year-old male motorcyclist sustained severe ligament injuries in the right knee and closed ­spiral fractures of the left tibia and fibula. Within the next eight hours, the fractures were easily reduced and the extremity was immobilized in an above-the-knee cast. The ligament …