Bookpleasures.com welcomes as our guest Dr. Lynn R. Webster, author of The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us. Dr. Webster is an anesthesiologist specializing in pain medicine. He is vice president of scientific affairs for PRA Health Sciences, a leading international medical research organization. He was formerly the founder of Lifetree Clinic and Lifetree Clinical Research, both in Salt Lake City, Utah, and was president of the American Academy of Pain Medicine in 2013-14.
Norm: Good day, Dr. Webster, and thanks for participating in our interview.
How and why did you become interested in treating pain? As a follow-up, how do you define chronic pain?
Dr. Webster: The short answer is that I saw a huge need and thought I could make a difference.
In 1989 I started a post-op pain service in a local community hospital. The type of service I started was new in the country at the time. I developed a technique to deliver medications to the spinal area where the nerves exit the spine. As a result, patients who would have their chest cut open from their sternum to the spine could wake up from surgery without experiencing any pain. It was miraculous for the time. Even I was amazed at how effective the technique was.
Later I began to offer the same techniques to people in excruciating pain from terminal cancer.
It was clear to me at the time that medicine, and in particular the skills I had learned, could prevent an enormous amount of suffering. The gratitude I received from patients, families, and colleagues was overwhelming and thrust me into the field. I felt that a new frontier in medicine was emerging and I could be one of the pioneers. It was intoxicating. Once, every generation or two, it seems that such advances in medicine occur, and I was there to help make this one happen. Relieving pain became my religion. I eventually moved out of the hospital and began to treat people with chronic non-cancer pain in my private clinic.
Pain is often divided into acute, chronic, and cancer-related pain. The usual definition of chronic pain is that it is pain lasting for more than three months, although some definitions specify six months.
Norm: What is a pain clinic, and in view of the bad raps some of these clinics have received over the past few years, how would one go about choosing a reputable clinic?
Dr. Webster: There are many types of pain clinics. Some offer a limited set of therapies, while other clinics offer a broad range of intensive services. Clinics are staffed with providers who also have a broad range of expertise. Multi-disciplinary clinics with providers who offer multiple treatment options including interventional, pharmacological, and behavioral modalities are generally the best, though there are clinics that offer limited services that are still quite good. The most reputable clinics have clinicians board certified in pain medicine by the American Board of Pain Medicine or American Board of Anesthesiology. Eligibility to take boards by these two organizations requires board certification from anesthesiology, physical medicine and rehabilitation, psychiatry, or neurology. There are well-trained physicians in other disciplines as well, but they usually are limited in the type of treatment options they can provide.
In choosing a clinic, I would look at the credentials of the providers and what types of services they offer. Do they offer only drug treatment, or do they employ the full spectrum of services available in medicine?
It should be noted that primary care physicians provide most pain care in America. This is fine and a necessity because there are too many people in pain to be seen by only specialists. Many primary care physicians do an excellent job of treating most pain problems.
Norm: There has been reported in the media that doctors are using some very creative techniques to ease pain these days and some have been used for centuries. These include spider venom, electricity, bee venom, and others. Would you care to comment and how effective are these techniques?
Dr. Webster: There are many treatment options available. Some are more effective than others.
All treatments should be tailored to the needs of the person in pain. For example, transcranial stimulation is generally safe and can be effective in some people with certain types of pain. Acupuncture, music therapy, animal therapy, and other therapies can also be helpful for some people.
Yes, new drugs are being developed from animal poisons. The toxin from the puffer fish is currently being explored as a possible analgesic. Ziconotide is a protein derived from the paralyzing venom of the Conus Magus (sea snail). Ziconotide is one of the few new drugs for the treatment of pain that have been developed in the past 25 years. There are many opportunities to develop analgesics from other toxins that are usually considered lethal, but unfortunately, effectiveness and safety for most of these exotic drugs have not been proven.
Norm: Why is it that in the treatment of severe chronic pain that medicine comes up against substantial social and political forces?
Dr. Webster: Chronic pain has not been viewed as a serious medical problem. It has largely been considered a symptom rather than a disease. Many people think that pain, as a symptom, can be overcome if the person with pain just tries harder. This attitude demonstrates a deep misunderstanding about pain and is inherently discriminatory.
There are limited treatment options for chronic pain due to a lack of effectiveness and cost. There simply are not many good options. It is made worse by payers who do not cover most of the therapies that do exist. This leaves opioids as the default treatment. Opioids are not very effective and cause a huge abuse and addiction problem in the country.
Societal problems from opioids have been driving the public dialogue. Yet most of the harm from opioids is not occurring with patients but with people who have improperly obtained the medications for non-medical purposes. Nevertheless, the opioid crisis is preventing the country from appropriately addressing the needs of people in pain. We have duelling crises that compete for attention: pain and addiction. For the problem of opioid abuse to be solved without harming people in pain, we must find other ways to relieve pain.
Norm: In your experience, did you favor some types of therapies more than others? If so, which ones?
Dr. Webster: I had no favorite therapies. I favored what worked best for that patient. My approach was to try the safest and least aggressive therapy first. If that was not sufficient, then I would try more aggressive therapies. Of course, we were always limited by what the insurance would pay.
It is a provider’s responsibility to always weigh the risk against the benefit. We should always seek the most benefit with the least risk, paying attention to the individual’s desires as well.
Norm: Should patients and doctors be concerned about the use of narcotics to treat pain when addiction can become a good possibility?
Dr. Webster: Absolutely. Unfortunately, opioids can lead to many problems, including abuse and addiction. No one should use an opioid if there is a better, that is, safer and more effective, therapy available. If an opioid is used, it should be used for the shortest time possible. Patients and their families should understand the risk of harm before using them.
Norm: Is it true that women are more likely to suffer from chronic pain than men, that they are more likely to be prescribed higher doses and take painkillers for longer periods of time and more likely to seek out multiple prescribers?
Dr. Webster: The literature states that women do experience more pain than men. It is not clear why this is the case, but some researchers suggest that estrogen plays a role in enhancing pain with some women. Of course, if women experience more pain, then they are likely to be prescribed more analgesics.
It is also true that women are prescribed more sedatives for pain. I suspect this is due to a bias with some providers that emotions are the seed to much of the pain in women. This is generally viewed as cultural bias against women.
Norm: What purpose do you believe The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us serves, and what matters to you about your book?
Dr. Webster: Pain is far more prevalent than most people realize and has devastating consequences to millions of lives in America. Treatment options are almost non-existent, yet it represents the country’s most common healthcare problem. My hope is that the book will resonate with readers and that our society will refuse to tolerate the degree of suffering that exists. My hope is that the book will facilitate a social movement that will demand safer and more effective therapies so people with pain can live with dignity and not be stigmatized and ostracized from our communities.
Norm: What was the most difficult part of writing your book and did you learn anything from writing your book and what was it?
Dr. Webster: Choosing among the thousands of patient stories that I had available to me, each with its own unique experience, was a struggle. And transitioning from those stories to the larger community and national need for a cultural transformation to address the challenges described in Part 1 was daunting. Readers often expect a book from physicians to be about how to address the medical problem on which they are writing. I did not want to provide a self-help or didactic book but rather an experiential book that would inspire the reader to be engaged in a social movement that would make a difference for humankind’s primal enemy: pain.
Norm: What is next for Dr. Lynn R. Webster, and where can our readers find out more about you and your book?
Dr. Webster: I have spent my career trying to make life better for people who have pain and/or addiction. I will continue to direct my energy toward this purpose. In the fall of 2015, a documentary I have co-produced will air with the same title: The Painful Truth. The film will feature some of the real-life patients from the book. They are not actors. A trailer for the documentary can be found on my book website, www.ThePainfulTruthBook.com. I will continue to advocate for more funding and research for safer and more effective pain therapies. In my day job, I will continue to conduct research that I hope will eventually deliver safer and more effective therapies to the millions of Americans who are desperate for relief.
Norm: As this interview draws to a close what one question would you have liked me to ask you? Please share your answer.
Dr. Webster: How can we do a better job of relieving pain in America?
Policymakers must be made aware of the magnitude of the problem of pain suffering, and we must see that treating pain is a human right. Today, most payers deny payment for effective treatments, leaving many people to suffer needlessly. We must have a national commitment to change attitudes and beliefs about pain.
Pain begins as a symptom but often becomes a disease. Just as there are many different types of cancer, so there are many different types of pain, each with its own pathologic mechanisms. Sadly, pain can be as malignant as cancer and can destroy lives and lead to suicides. We need a “Manhattan Project” to discover cures for many of the diseases of pain. This will require a cultural transformation. For this to happen, old attitudes must die and new ones must emerge. Hopefully, the country is ready for this movement.
Norm: Thanks once again and good luck with all of your future endeavors.