The Legacy of Pain
One Professional’s 20-Year Perspective

A pain professional with Texas Medical Center ties has spent two decades recognizing, studying and treating pain, both as a symptom and a disease.

Richard Patt, M.D., president and chief medical officer at the Patt Center for Cancer Pain and Wellness, was the guest presenter at the July 25 meeting of the Texas Medical Center’s Pain and Palliative Care Grand Rounds. An anesthesiologist by trade, Patt practices the art of pain management as a clinician, investigator, educator, author, advocate and consultant. In conjunction with several Texas Medical Center institutions, including St. Luke’s Episcopal Hospital’s Cancer Institute, The Methodist Hospital and The University of Texas M.D. Anderson Cancer Center, he has collaborated with some of the best pain practitioners in the world.

Twenty years of experience have led him to many observations in the pain field, which he shared with the Grand Rounds participants.

"Pain is everybody’s business and nobody’s business," Patt said.

He cited pain as the second most common reason for medical consultations, and historically, it is those without a formal education who are seeking relief.

"Pain," said Patt, "is one of the few fundamental disorders for which there is no cure."

Physicians without specialized pain training tend to view patients seeking pain relief as anomalies, he said. When in reality, these patients are victims, and physicians sometimes fail to treat pain as a medical disorder.

"When symptoms are truly chronic, it isn’t surprising to observe illness behavior," Patt said.

He added that it’s not helpful when physicians don’t feel accountable toward patients who know when something is wrong with their bodies, and want to identify the pain source in order to get some relief. He said patients who have been studied and restudied become conditioned, and are stunned by all the "shuffling" – from primary care physicians to various other specialists, and often back again.

"This leaves patients feeling abandoned, hopeless, helpless, anxious, narcissistic, and viewed as hypochondriacs," Patt said.

At the same time, Patt said, there is a legacy of distrust. Patients often experience "white-coat hypertension," and fear the "Dr. Jekyll and Mr. Hyde" treatment. On the other hand, physicians treating pain have a fear of being fooled by patients, some of whom are addicts experiencing disproportionate suspension and rage.

This leads to what Patt calls the "Legacy of Just Plain Misery."

"How can we be expected to tend to others when we’re miserable ourselves?" he asked. "When there are other circumstances happening in our lives outside of work, we can’t expect that it won’t affect us on the job."

He said patients only accept what they see – longer waits, less time with the doctor, and increased fees. They don’t comprehend all that goes on behind the scenes.

From his 20-year perspective, Patt views good medical practice as an art. He said it is the ability of applying the analysis of benefits and risks. The "art" is viewed in broad, longitudinal context, within culturally appropriate constraints. Also that patients should be given all treatment alternatives, including no treatment.

"Physicians should not goad vulnerable patients into blindly accepting procedures," Patt said.

He said there has always been a legacy of questionable practice – undertreatment versus overtreatment. Because many physicians have prescription phobias, inadequate pain treatment has become normal.

"This is bad medicine," he said.

What Patt learned really works to treat patients with pain is common sense, good communications skills, attention to details, good self care, applying the Golden Rule, and remembering the task at hand.

"Life is messy, not a textbook," Patt said. "Every patient is different, and should be treated accordingly."

On another note, the "Living with Chronic Pain" conference will be held next March at the George R. Brown Convention Center. It has been confirmed that they keynote address will be given by "Patch" Adams, the physician who wears a red, rubber clown nose to entertain both pediatric and adult patients, and made famous in 1998 when Robin Williams brought his story to the big screen.

The last two meetings of the 2002 Pain and Palliative Care Grand Rounds will have a change of venue. They will be held Thursday, Sept. 26 and Thursday, Nov. 21 at the new John P. McGovern Texas Medical Center Commons building, located at 6550 Bertner Ave. Meeting times will be from noon to 1:30 p.m., and lunch will be provided. For more information about the Pain and Palliative Care Group, contact Lori Nelson in the Texas Medical Center Executive Offices at (713) 791-8800, or lnelson@texmedctr.tmc.edu.

---

©2006 Texas Medical Center

---

E-Mail: tmcinfo@texmedctr.tmc.edu
URL: http://www.tmc.edu/tmcnews/08_15_02/page_03.html