In response to a very passionate Dr Alan Cato, who recently commented on the current exploitation of the pain epidemic, I think he brings up many truths, but no constructive input. His article, How pain as a vital sign contributed to prescription pill mills, is a direct attack at the Joint Commission’s “Pain: the Fifth Vital Sign” movement back in 2001. I agree, when a large governing body wants to guarantee that anyone in pain is receiving treatment, and that treatment is a vastly profitable industry, it will enable exploitation. However, it is only exploited if there are unclear indices and diagnoses, and that is the real discussion. Pain is perceptual, pain is qualitative, and the current tools like EMG and MRI are borderline ineffective at providing specific, quantitative information. The key is innovation, education and regulation.
Innovation means not settling for inadequate technology to diagnose pain. EMG is a strictly motor/muscle test, with no ability to test pain specific fibers; but it is the first prescription when a patient comes in with neck or back pain. MRI is anatomical, not physiological. As of right now, the only FDA approved device on the market to diagnose and pinpoint specific nerve pain is the Axon II. It is quick, painless and accurate, making it a standard piece of equipment needed in any medical office. The education is needed in medical schools and hospitals where new technology doesn’t permeate traditional, outdated tools. Lastly, regulation is put in to place when solid, helpful tools like the Axon II are introduced and proven.
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