Pulling Together a Fragmented Industry: The Future of Pain Medicine


Four experts discuss what they believe is in store for pain medicine in the coming years.

On Day 4 of the American Academy of Pain Medicine's 26th annual meeting, Drs. Kenneth Follett, Scott Fishman, Rollin Gallagher, and James Rathwell discussed what they believe is in store for the future of pain medicine in the coming years. Here is a summary of the talking points of the four presentations.

My prediction ... pain.

- Mr. T

The past will predict the future, which should give us a sense of optimism.

There's been a paradigm shift. In the past, pain has been ignored and undertreated, and clinicians have been undereducated. Pain specialists didn%u2019t exist 50 years ago, but there are now laws that guide us, though this is a double-edged sword because there appears to be no end in sight to regulation of pain management. However, one of the most important developments in recent years is that pain is no longer being viewed as just a symptom.

Unfortunately, pain management remains a fragmented industry. In order for the business of pain management to be viable going forward, there needs to be a coordinated effort to bring together disparate specialties in order to integrate principles of care. As it stands now, pain management is a subspecialty with no one appropriate parent.

Though there is no evidence supporting that such an undertaking will succeed, emergency medicine stands as a promising example. It was once practiced by disparate fields, each bringing to it their own perspectives, with none invested in the total care of patient, and is now a full-fledged, viable specialty internationally.

What will get the field there is a more optimal organization of science and medicine. Pain specialists are paid a fair amount relative to other fields, which will inevitably trigger investigations into why rates are what they are. Unless it can be proved that treatment outcomes are successful, current rates will not be justifiable. Further, if science is unable to tell explain the underlying causes of pain and what to do about it, pain medicine will be exposed as incapable of handling the task with which it is charged.

Unfortunately, it may also be that society needs to reach a tipping point where pain becomes a big enough problem that the public calls for structural change.

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