The Importance of Pain Theory

In my 14 years as a medical care provider, I have gone to more than my share of medical conferences.  I have attended conferences in primary care, emergency care, internal medicine, cardiology, urology and other specialties.  Uniformly, they are a blend of theory and practice.  One must have some grasp of the theory behind a disease process to make sense of the promises and pitfalls of the interventions.
 
So it was quite a surprise to me that at the annual conference of the Western Pain Society, very little was said about the definition of pain, and even less about the theories regarding it's pathophysiology.  It was as if I had gone to a conference on the common cold and the presenters simple talked about the need for hydration, the merits of antihistamines, the role of antipyretics, etc without any interest in talking about the cold as a viral infection.

If we are going to talk about how to alleviate pain, we must present our definition and explicitly state the theory of we are using in our discussion.  How else are we going to evaluate relative efficacy?  How else are we going to discuss the mechanism of action?

The primary care provider might not recognize the need to examine a definition and theoretical explanation.   Typically, we simply accept what the experts give us.   For example, with type 2 diabetes we uniformly assume these needs are met with the A1c and the idea of insulin resistance.  But chronic pain has no clear definition, no way to measure it, and no universally accepted pathophysiology.

The conference of the Western Pain Society left me with the feeling that the pain specialty is in confused disarray.  The realization that the medical profession is actively seeking the participation of non medical providers initially gave me some hope.  But then I realized that the reason we welcome others is that we have so little to offer that is safe and effective   The medical providers, and the patients, are desperate.

To understand the present state of pain theory, I'll briefly review a history of pain theory.