Bridging the Gap: Pain Medicine and Palliative Care

Chronic, progressive diseases bring a host of difficult symptoms and causes of suffering. There are disease-mediated symptoms, such as pain, dyspnea, fatigue, and loss of mobility, and there are the typical accompanying negative emotional states, such as depression, anxiety, and a sense of uselessness ⇓. These symptoms and mood states intertwine and interact in a complex manner, and each one deserves attention. This complex interplay of the biomedical, social, and psychological is the basis of the interdisciplinary model of care endorsed by both the specialties of Hospice and Palliative Medicine and Pain Medicine. Of the many symptoms experienced by those with advanced illness, pain is one of the most common and most feared ⇓. High-quality pain control is equally important in order to prevent family stress, and prolonged and pathological grief in surviving loved ones ⇓.Nevertheless, pain continues to be underrecognized as a serious and significant problem, as evidenced by the prevalence data reported by the Institute of Medicine ⇓ and findings of a recent Research!America survey (in partnership with Zogby Analytics). In this poll, only 18% of respondents considered chronic pain a major public health problem, but 60% believed pain tends to be dismissed by the public and doctors ⇓. Perhaps it is this persistent dissonance between facts and perceptions that leads pain to be undertreated, even when prevalence rates and syndromes are well understood, and the means of relief are within clinicians' capabilities to provide directly or through consultation.With careful assessment and a comprehensive plan of care that addresses the various aspects of the patient's needs, incorporating the …