CAPE ELIZABETH — As a neurologist, I frequently get referrals from primary care physicians to consult and assist with the pain management of patients. Pain disorders are common in the field of neurology, mainly in the domain of headaches and neuralgias (nerve pain).
While neurologists are trained to localize and diagnose potential neurological conditions causing pain (and at the end of the day, solving the primary cause is the best way to control symptoms), most neurologists are not adequately trained, do not have the experience, and do not have the proper clinic setting to handle chronic pain management.
The specialists best trained to handle chronic pain are usually from the anesthesiology world, with experts completing fellowships and subspecialty training. Other fields of medicine that commonly deal with pain management are the spine specialists (neurosurgeons and physiatrists), orthopedic surgeons, internal medicine specialists, oncologists and specialists trained in the field of substance misuse. In the urgent care setting, surgeons and emergency medicine specialists handle acute pain management. But, at the end of the day, the providers who “own” chronic pain management in the state are the providers in the trenches: the primary care physicians.
Fully aware of the opioid epidemic and its particular impact in the state of Maine, I am impressed by efforts at the state level to curb the damage, enhancing education, supervising and monitoring provider prescribing activity, help opioid overdose reversal treatment be more available and providing patients and families with resources to get help.
One glaring void that is missing in the war on opioid abuse and misuse in Maine is boosting chronic pain management care, research and education to the highest level, leaving it to specialists and bringing in national pain experts. While dedicated local pain clinics (usually private practices or associated with hospitals) make admirable attempts to help the long list of referrals with amazing local talent and credentials, there are simply not enough pain clinics and pain specialists in Maine to cover the state needs. A typical referral to a pain clinic in the state could be a process that could take months.
Maine would benefit from a nationally acclaimed pain management medical center. Let’s call it the Maine Pain Institute. It would be an expensive endeavor, involving bringing in pain specialists at a national level, with a huge, supportive staff. The Maine Pain Institute should include a research arm involving clinical and basic scientists and the necessary labs to conduct research. I envision the institute being a center of education, including a multidisciplinary center for patient and family support and engagement. The institute would be based on conventional medical practices but also incorporate functional and naturopathic (alternative) approaches to pain management.
The Maine Pain Institute would have to be funded by the state, and it will be costly – but, in my opinion, worth it. Having a national-level pain institute in our home state, run by a multidisciplinary group incorporating all the specialties mentioned above, would be highly desirable by the dedicated primary care physicians in Maine. I am sure it would quickly be a magnet for referrals from all over the state. The educational value of a consultation in the Maine Pain Institute would not only be for patients and families but also for the referring providers – getting a list of guidelines and recommendations for day-to-day management advice.
Opioid dependence and overprescribing over the years, and its sequelae of overdoses, unnecessary deaths, destroyed homes and families, is an epidemic at a national level. But, as it is affecting different states at various levels of urgency, I see an opportunity for the state of Maine and its leaders to connect the dots, coordinate the health care systems, bring together conventional medicine and functional medicine resources, fundraise, invest in and market a state-sponsored pain center of excellence.
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