The field of pain management has often been criticized because of the lack of “prospective randomized controlled double blind clinical studies”. To the person in chronic pain, there is but one request: relief of suffering.
Unfortunately, the very nature of chronic pain frequently makes it difficult to do the types of comprehensive medical studies that would be considered “necessary” to study the effectiveness of treatments for other medical conditions, such as diabetes or high blood pressure, where there are easily measurable endpoints such as blood pressure or blood sugar levels.
Dr. John Loeser, the former chairman of the Neurosurgery Department at the University of Washington, once remarked that requiring “prospective randomized controlled double blind clinical studies” for some of the treatments done in medicine, is like demanding that a rigorous “prospective randomized controlled double blind clinical study” be done to document that parachutes work before we pay for parachutes for people jumping out of airplanes. In other words, to know for certain is not always possible and statistically significant evidence to support treatment protocols, while ideal, is not always possible.
Those of us who work daily treating those in chronic pain see the degrees of success of the various therapies for alleviating pain. We as physicians are, of course, not always immune to bias in our own observations. Using the argument, however, that a lack of evidence that a therapy works is the same as evidence that a therapy does not work is flawed logic. This argument is, however, frequently employed by payers of healthcare (private insurance companies and State and Federal Government programs) trying to decrease their outlay for medical care.
Our specialty, particularly in Washington State, has been subject to increasing scrutiny and regulatory review, and third-party payers (insurance companies and government entities), have tried to limit or stop their payment for many of these services.
It is imperative that patients suffering from chronic pain and their families rally and participate in the political process to make sure that these array of therapies are available in the future. Otherwise, patients and their families will bear the burden of the costs for treatment, or worse, be unable to obtain those services because physicians providing those services will have had to abandon their practices for lack of payment.
In my mind, simply increasing medications that numb pain is simply not the right solution. Having alternative therapies that are covered by insurance available is always going to be my preference.