To the Editor: 

We commend Dr. Ballantyne for the excellent editorial on pain medicine that accurately and succinctly identifies the problems of pain management that arise from biomedical/technical approaches.1Her call to reject “production-line medicine” and revive the multidisciplinary model challenges anesthesiologists to lead pain medicine in a new direction.

Having identified the problems, it is necessary to formulate solutions. Our medical intelligence article in ANESTHESIOLOGY comprehensively addresses the challenges and opportunities facing anesthesiologists who seek to move “beyond the needle.”2Although our suggestions were not embraced at the time, they may now merit reconsideration.

Interventions and opiate medications are not fundamental modalities for the management of complex chronic pain. When administered in an appropriate context they serve as useful adjuncts that facilitate self-directed patient efforts at rehabilitation/reactivation. Used in isolation they may provide short-term benefits but create long-term problems.

The risks of interventions and opiates transcend physical complications and side effects. These treatments are powerful communications. Patients are taught that medical solutions are possible, doctors hold the power, and cure is possible if they can just find the right doctor with the right treatment. These messages are antithetical to multidisciplinary models of care based on self-management, rehabilitation, and the biopsychosocial model.

The challenge for anesthesiologists is how best to complement traditional skills and expertise to provide more comprehensive pain management services. Further progress requires that anesthesiologists learn new conceptual models of chronic pain, acquire nontraditional skills, and become comfortable in different professional roles.2 

Unless we adapt, we risk becoming part of the problem rather than central to the solution. For anesthesiologists to remain the dominant specialists in pain medicine it is necessary that we work within the complex world of collaborative care and patient-centered medicine. It is insufficient to limit our roles solely to technical skills. We ought to embrace new roles as physician-healers, educators, and leaders guiding the team in care of the total person.2 

Ballantyne JC: Pain medicine: Repairing a fractured dream. ANESTHESIOLOGY 2011; 114:243–6
Jacobson L, Mariano AJ, Chabal C, Chaney EF: Beyond the needle: Expanding the role of anesthesiologists in the management of chronic non-malignant pain. ANESTHESIOLOGY 1997; 87:1210–8