Is Sean Mackey, MD, PhD justified saying this???

[drusso]

"Pain is incredibly personal. It's subjective. It's unique to that individual."

Is pain treatment the domain of personalized/precision medicine or population-based health care?

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[Disciple]

1. (Title of the thread) Yes

2. 2nd question: Specific to population based healthcare, the answer is no. The key words being “subjective” and “individual”.

 

[SeniorWrangler]

Isn't it both? There is way more chronic pain out there than all the pain doctors in the world could ever see, it's a major public health issue.
I don't like the way Dr. Mackey says it, because it sounds like going back to the old days of "the patient's pain is whatever they say it is" that worked so well.

 

[Orin]

I don't think anything has changed the fact that the patient's symptoms are what they are.

The change is more with regards to the treatment of those symptoms due to lack of safety, lack of efficacy, concerns for society, etc.

There's no reason to invalidate the patient or their experience/perception/etc in this

 

[Aether2000]

Agree with the statements, but not with his own clinical interpretation and response to these statements.

Pain is personal- the psychological overlay of patients claiming chronic pain are often the driving force in the maintenance of a state of chronic pain. For others, they embrace and personalize their perceived pain by using possessive pronouns to describe their condition: "my fibromyalgia"

Pain is subjective- therefore the multiple facets of pain cannot be distilled into a single scalar digit, and such measures are meaningless clinically and scientifically. It is akin to assigning a single numeric value to a patient in the ICU in multi-organ failure, then applying a generalized treatment of that number rather than focusing on the individual components that causing multi-organ failure.

It is unique to that individual- therefore wholesale employment of population treatments are destined to fail in a significant portion of the population. The NNT for many chronic pain treatments are very high prompting many pain patients to seek untested alternative medicine treatments or fringe treatments that may be overtly dangerous.

 

[Ducttape]

I find it singularly amusing how people are so adamant that "no one knows my pain" and "my pain is so bad (fill in blank)", yet when confronted with their exact same quote, they are incredulous that someone else could have their degree of pain.

 

[lobelsteve]

I find it singularly amusing how people are so adamant that "no one knows my pain" and "my pain is so bad (fill in blank)", yet when confronted with their exact same quote, they are incredulous that someone else could have their degree of pain.

Stare at them squarely in the eyes and say, " pain is weakness leaving the body." Then get up and just walk out of the room.

 

[cowboydoc]

Stare at them squarely in the eyes and say, " pain is weakness leaving the body." Then get up and just walk out of the room.