Why isn’ t Central Pain any better understood now than ten years ago?
On one occasion a neighbor took her sick child to the Pediatrician for an antibiotic. He told her the illness was viral and that not wanting to contribute to antibiotic resistant strains he would not give an antibiotic. He said to just keep her away from other children and the illness would have to run its course, since nothing helps viral colds. She was entirely outraged because the doctor charged the usual office fee for the visit, but did not do anything. She still had a sick child. Patients do not like to be charged for being told nothing can be done.
Is there anything like this in Central Pain? Absolutely. There is no satisfactory treatment, according to the National Institutes of Health. While treatments are alleged for peripheral nerve injury pain, no study has shown this to be the case for CENTRAL NEUROPATHIC PAIN. The doctor knows this but may send the patient home on successive visits with any number of drugs designed for peripheral nerve injury pain. A sedative may help a bit, but basically, the patient must learn to manage life to minimize pain because there is as yet no real treatment for the condition.
The doctor, knowing that no treatment is forthcoming if it is CP is not likely to press the patient to stop talking gibberish about Central Pain (what else can one do if there are no words for dysesthetic pain) and try to come up with something like an adequate verbal descriptor. The patient is in PAIN and wants the doctor to do something right NOW.What else would a compassionate doctor do?
Until patients are required to be more specific, the doctor will be poor at sorting out Central Pain from other pains. Until the doctor has something real to offer, the patient will not want to pay money just to expand the database of the doctor’s knowledge. Almost invariably, the patient wants to talk about pain severity and not pain quality, because they want relief. And so, no progress is made. Only when both patient and doctor determine to do it right and take the time for a real history and physical will any of this change. In the meantime, with limited time provided by managed care, things will stay the same, with ignorance for the doctor and disillusionment for the patient. A real workup must be thought of in terms of hours or days, not minutes. Third party payers will have to do their part if things are going to move forward.