Personalized pain therapy: basic consideration of an old concept with new scientific basis

Abstract

In 1914, Crile introduced the concept of individualized or personalized pain therapy as well as demonstrating that good postoperative pain control greatly decreased postoperative mortality. Schweitzer equated severe pain associated with a disease to torture, and in 1953 Bonica clearly elucidated the serious deleterious effects caused by severe acute pain. Nonetheless, the medical profession devotes very little attention to this disease. The majority of medical school’s curricula and graduate medical education have refused to teach the advances made by clinical and basic research in pain medicine, or algology, and misconceptions continue to be perpetuated in spite of new scientific knowledge. A 2009 study, reported that only 32.5% of the Canadian medical students receive an average of 16 h of formal education in algology while the other 67.5% have no formal pain education. During the last 45 years, clinical and basic research has made many discoveries. Most important among them is that pain is a disease in its own right, that it is largely under treated and that genetic differences among people greatly influence the response of individuals to the perception of pain and analgesic therapy. Crile’s clinical observation regarding the need for individualized pain therapy is now strongly supported by the scientific discoveries of genetic heterogeneity and is at the core of present pain therapy. However, pain medicine education is so limited that the research discoveries made in algology are unknown to most physicians and other health care professionals and, in most of the cases, pain is still poorly treated.