Editor's Memo
by Forest A. Tennant, MD, DrPH
 The sage physician learns with experience that
patients and their family and loved ones actually do better physically and emotionally
when they clearly understand that their medical condition is not curable. Honesty is
clearly the best policy when it comes to dealing with incurable and intractable medical
conditions. Once patients realize the truth, they can devote their energies to controlling
their problem and building a better quality of life rather than chase the illusive rainbow
that supposedly has a cure at the end.
While physicians in such medical specialties as cardiology, geriatrics, oncology, and
rheumatology are quite adept and accomplished in relating the sad message of incurability,
the pain field is not only embryonic in this regard, it might, instead, be regarded as
destructive. Everywhere one turns, incurable pain patients are being overtly or covertly
led to believe that there is a cure “just around the corner” at the next
practitioner’s office, clinic, or hospital. For starters, some non-physician
practitioners, who are completely unqualified to diagnose nerve damage and even legally
and rightfully barred from examining patients, are propagating blatant fraudulent claims
of cure. Chances are you’ve received some misleading, slanted advertisement that
proclaims some physical manipulation, device, counseling, cream, or dietary supplement is
going to cure one’s spinal stenosis, migraine, adhesions, fibromyalgia, or
neuropathy. Even more insidious, some physicians and hospitals make inflated,
unsubstantiated claims regarding invasive interventions to treat pain. It is not unusual
to encounter a patient who has literally had dozens of invasive interventions but not
prescribed enough medication to reduce a pulse rate below 100 or escape the bed or couch.
Perhaps the most malignant claims are physicians and hospitals who tell patients they will
be cured if they simply detoxify from medication, because “medication” is the
cause of their pain, since it presumably hypersensitizes the nervous system.
We pain physician should take a tip from the emerging group of American bariatricians.
They don’t even claim to cure or treat obesity. For the most part, they give a caring
and succinct message of “medical weight control.” We like to use the term
management rather than control, but we need to make it very clear to patients when
evidence of permanently damaged nerves and neurochemical systems rules out the possibility
of a cure. If we don’t give a simple, straightforward message to patients when they
have an irreversible, incurable pain condition, the patient and their surrounding circle
of stake holders—including their insurance company—will simply reject a program
of lifetime management and control. Perhaps more important, the patient will not be aware
of their true condition and remain confused, agitated, and depressed, while pursuing a
quixotic mission in search of cure.
Relief of suffering and attainment of tranquility for incurable, pain patients can only
be achieved when the patient, family, and physician have placed their cards honestly on
the table and developed an ongoing plan of control, relief, and a better quality of life.
For a bioethicist’s view of this subject, read Dr. Giordano’s article in this
issue.
— Forest A. Tennant, MD, DrPH
Editor in Chief
— Nov/Dec 2005
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