What is a pain clinic?

A “real” Pain Clinic is a medical practice that focuses on the treatment (relief and management) of chronic pain by medical means.

The ‘official’ definition of chronic pain is “pain that has been present for more than three months”. But this is an oversimplification and, in fact nonsensical. This implies, incorrectly, that chronic pain is acute pain lasting longer than expected. Truth is that acute pain and chronic pain are two different entities, issues or pathologies.

The pathology of chronic pain can be present from day one – e.g. nerve injury.

The pathology of chronic pain is sensitisation of the pain processing system in the spinal cord and brain – resulting in a facilitation of pain transmission from the body to the brain. This sensitisation is almost always the result of neuro-inflammation of the brain and spinal cord.

Neuro-inflammation can be the result of various factors, but usually it is to an immune reaction. The immune reaction can be due to a nerve injury, either peripheral or central, or to the leaking of immunogenic substances from the so called “leaky” gut due to a malfunctioning microbiome (bacterial population) in the gut as in fibro-myalgia.

Because acute and chronic are two different pathologies, their treatments should be different as well. Treating chronic pain the same way we treat acute pain rarely brings relief to the chronic pain.

In what ways do we treat chronic pain, incorrectly, like we do acute pain?

1. Using the drugs and medications designed for short term use to help a patient get over the acute pain which is almost always temporary.
2. By treating chronic pain ONLY as a symptom – like acute pain:
   1. using drugs which have been found to bring marginal, if any, relief to chronic pain – the symptom
   2. not addressing the underlying pathology of chronic pain.

More and more ‘pain clinics’ are springing up everywhere each offering a certain therapy that it claims works and will and should work for everyone and all pain. This because they believe, incorrectly, that “PAIN IS PAIN” and that all pain can be treated the same. It is almost a case of ‘so many pain clinics, so many “therapies”  ’.

When someone claims that a therapy or device works for all pain in all patients all the time, it should immediately be regarded as a gimmick for reasons below.In medicine and the human body there is no one therapy that works, and works the same, for every person 100% of the time.

1. For example: a certain drug may work well for, say, blood pressure in most people, but there are people that will not respond to it at all. In fact in order for ANY pharmaceutical to be licenced and reach the market – it just has to ‘beat the placebo effect’. This means: with every drug up to 30% of people taking part in a trial benefit from the drug even though they are in the group taking sugar pills. Simply believing they are taking the drug when they are actually not taking it, causes them to experience benefits of the drug. So let’s say in a trial, 30% of people taking the sugar pill can feel benefit and 50% of those actually taking the drug experience benefit, the drug beats placebo effect and so is released to market because it helps 50% of people (30% could STILL be placebo but then at least 20% of people are actually benefited by the drug) That means if you gave this same drug to every patient with the same problem – only 50% of then will benefit. What about the other 50% – yes, we try a different drug for them! No drug or chemical works for everybody every time. A doctor has different drugs even in the same class of drug at their disposal.

1. Certain operations are successful in most people but there are people in whom the same operation is unsuccessful and nobody knows why because the operation was done well.

1. Certain procedures for pain, also called interventions, also help most people; but not everyone the same and here and there it does not help someone at all even though it was done correctly and well. A real pain clinic, therefore, has a range of procedures and interventions to offer a patient – not just one gimmick which it claims will help everyone all the time.

In order to get a broader spectrum of treatment options it is better to attend a pain clinic where a medical doctor is running the clinic or is at least involved. While the medical doctor can offer a range of medical procedures for the pain they should also be able to offer some of the so-called ‘alternative therapies’ or refer patients for alternative therapies as some of these therapies can very well bring some of the patients remarkable relief some of the time. To ithhold a therapy that might work for a certain patient because it is not ‘mainstream medicine’ is not in the patient’s best interest.

Not all pain clinics or pain management practices are created equal or are the same thing.