thats part of the problem. the metrics we use are entirely subjective, unlike spine surgery where they can point to "improved canal capaciousness" (the exact words taken from a spine surgeon's notes on a patient with persistent pain after 3 level fusion) to show that their surgery "worked".
in addition, pain scores may be altered based on a patient's expectations or desires. how many times do we do an injection that not-so-surprisingly prompts the response "well, the shot didnt work. can i get percs now?"
we need a marker to use that is objective. CRP? catecholamine levels? CNTN1?
or these:
An exploratory identification of biological markers of chronic musculoskeletal pain in the low back, neck, and shoulders - PubMed
common misconception, one that is derived from how we practice pain medicine.
it is about doing what is right for the patient. for a significant portion of the population, our focus on injections is not the right modality. neither are pills. lifestyle changes, changes in perception of pain, changes in expectations on pain control, improvement in functional capacity are much more important in the long run than an injection or a pill, particularly if it is an opioid.
unfortunately, we get blinded by $$$ to decide what treatments to "offer". in fact, im willing to bet a sizeable proportion of docs here will discharge a patient if they refuse shots - the modus operandi in the local community.
if i didnt feel i was making a difference, i would have just become a grouchy old guy that doesnt bother posting to encourage introspection on pain management, just does his 9-4 job, checks out mentally during the day, browses WSJ or tik tok etc., and spend the day musing on his golf swing and where to get good barbeque.
