The Promise of Effective Pain Treatment Outcomes: Rallying Academic Centers to Lead the Charge.

Abstract

### The Pain of the Mind is Worse Than the Pain of the Body #### Publilius Syrus The dramatic impact of chronic pain was captured in a recent European study that followed patients suffering with chronic pain for 1 year: 40% of those patients had more pain and 40% had less pain, but 100% reported major, negative impacts of chronic pain on their quality of life ⇓. Half of patients believed that everything possible had been done to manage their pain. This insight into how patients with chronic pain fare reveals a number of salient points, perhaps most importantly highlighting this condition that persists without cure. Furthermore, accumulating evidence suggests that emotional processing in brain networks is more involved in chronic pain ⇓ alluding to the nature of the associated suffering with the condition. Despite significant advances in pain neurobiology, there remains an urgent need to define outcome measures for treatment options and to understand both short-term (i.e., symptom control) and long-term (i.e., disease modification) approaches to treatments that really work. Unfortunately, pain remains one of the most difficult conditions to live with and to treat. One of the major problems is that because treatments are not highly effective across populations, a wide variety of approaches is frequently used combining various pharmacological, interventional, and behavioral treatments outside of the setting of a coordinated interdisciplinary program. In academic pain clinics, where a more rational approach to treatment may be possible because of hospital standards and relevant lack of financial conflict of interests, financial pressures remain a factor. Patients will continue to reach out in hope that some current or new treatment will be highly effective. Without question, some patients receive treatments that are highly effective such as spinal cord stimulation for chronic radicular leg pain in the setting of postlaminectomy syndrome, but this is generally not defined in a rigorous way as compared to treatment for an …