Abstract
SUMMARYMedical progress is measured by advances in science and technology. The pace of discovery will surely accelerate. We are increasingly challenged not only to assimilate new information, but also to reconcile our learning with our art. We present the common clinical problem of managing pain in osteoarthritis as a paradigm for this dilemma in contemporary patient care. We do not yet have the understanding and interventions to do this optimally for all with osteoarthritis, leaving us with uncertainties as we struggle to care for these patients. In a world of growing complexity and sophistication we must not overlook the person who is our patient. It is easy to be seduced by electronic and informational advances, to be entranced by machinery, and to forget the unique individuality and needs of each patient. Osler taught that "the practice of medicine is an art, based on science". This doesn't change.
Highlights
How can we address this? What is your attitude about new surgical approaches, often without long-term validation data? I don’t want these, desperate I may be, and hope your judgment is critical here
I know there’s exciting work being done on pain – mechanisms, physiology and interventions [Perret D et al Managing pain in patients with osteoarthritis (2013), Manuscript in preparation] [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]
No writing assistance was utilized in the production of this manuscript
Summary
There are promising advances in the understanding of the etiopathogenesis of osteoarthritis and in developing better interventions for palliation of symptoms, to retard or reverse disease, and to alleviate its pain. “The essence of medicine is the reduction of uncertainty.” Perhaps you thought this would be an erudite, state-of-the-art exposition of advances and insights into understanding and managing pain in patients with rheumatic disease, replete with helpful new technologic, biologic and pharmacologic therapeutic interventions. Maybe try intra-articular corticosteroids; I’m underwhelmed with what I’ve read about hyaluronan injections [19], and have been unimpressed with data about prolotherapy It looks to me like there is limited evidence that treatments beyond the basics provide documented, consistent, further therapeutic benefit [1,21].
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