PAIN MANAGEMENT
John Bonica deserves credit for devoting time, effort, and interest
in the understanding, diagnosis, and treatment of pain (see Chapter
73
). Despite his entreaties, until recently most anesthesiology departments
had devoted few resources—human, financial, or otherwise—to this area.
Today, almost every medical facility (community, academic, and governmental) has
the capability to treat acute and chronic pain, including cancer pain.
The recent development of acute pain services is yet another example
of the expanding role of anesthesiologists in the medical center. We can now offer
patients the prospect of a surgical experience that is totally (or almost totally)
pain-free. The availability of intravenous patient-controlled analgesia, followed
by other modalities such as intrathecal, epidural, and intrapleural infusions and
continuous nerve blocks, mandated that acute pain services be developed. The anesthesiologist's
role in limiting postoperative pain by the appropriate use of drugs and devices is
a very positive aspect of our specialty.
Interest in training in pain management continues to increase
( Fig. 2-3
) although there
was a slight decrease in 2003. About 230 residents are taking an additional year
of training in about 100 pain programs. It is notable that 18% of the trainees in
the field of pain medicine have their primary certification in Physical Medicine
and Rehabilitation.
