Publications
APS Bulletin • Volume 10, Number 1, January/February 2000
President's Message
Shaping a New Century: Our Evolving Role
C. Richard Chapman, PhD
Common sense tells us that 2000 is just another year, but the zeitgeist confers an ineluctable sense of adventure and opportunity. For a short while, we realize that we build the future; we don’t ride passively into it. The transition to the 21st century makes us aware of history as a narrative that we all are writing through our actions.
When the new century ends, will uncontrolled pain still cause widespread suffering and ruin lives? Will there still be rampant ignorance among healthcare providers about the nature of pain and appropriate ways to control it? Will people still die in unbearable pain while healthcare professionals stand by in specious helplessness, claiming that there is nothing more they can do? We answer a resounding “No!” to these questions, because we are determined through our individual and collective efforts to conquer the nemesis of pain. We have it by the tail, and we will not let go.
The future understanding of pain
Other questions follow that are harder to answer. How will scientists construe pain 100 years from now? Pain is a broad domain of inquiry, and APS is a multidisciplinary society boasting a remarkable range of scientists within its ranks. At one extreme we have basic scientists who follow the reductionist pursuit of digging ever deeper into the molecular mechanisms of nociception and analgesia. At the other we have sociologists, epidemiologists, and anthropologists who frame pain in terms of societal, economic, and cultural issues. No single discipline “owns” the pain domain, and none can claim the right to serve as architect for a future theory of pain. We know that we cannot reduce pain to either nociception or behavior and that the study of subjective reports alone is insufficient. The future understanding of pain will have to emerge from an interaction of scientists working at many levels of inquiry, tempered by the experience of clinicians who deal with pain on a day-to-day basis.
Imagine creating an APS time capsule that future members will open as the new century ends. It contains written statements from members, each forecasting how science and medicine will construe pain in 2100. Is there a visionary among us who could provide even a roughly accurate forecast? Future research paradigms may produce comprehensive, integrated accounts of pain and pain control that we cannot imagine today.
Which of our scientific and clinical accomplishments will future professionals consider milestones in science and medicine? Conversely, which of our current pursuits and endeavors will prove to be dead ends? Building the future is a little like investing in the stock market. We should put our time and energy into things that are likely to pay off by endowing the future with what we want it to hold: a comprehensive, multidisciplinary understanding of pain together with clinical “know-how” that can prevent or relieve pain in every clinical setting. Moreover, we should give priority to long-term over short-term gains. The purpose of our research, our teaching, and our public policy work is not only to change the world in which we live but also to shape the future. If we do our jobs well, the term chronic pain will be an anachronism in 2100.
We have some choice about how and where we will leave our mark on the future. The impact we will have on the future depends heavily on how we prepare ourselves in the present. I suggest three things that we can do right now as an investment in our future: (a) build a membership rich in diversity that represents the professional domains we wish to influence; (b) pay attention to the care and feeding of our professional minorities; and (c) work toward a more complete integration of professions. Table 1 provides an overview of APS membership.
In a multidisciplinary society, members teach one another, share resources, and advance both science and practice by envisioning new, multidisciplinary approaches to long-standing problems. Such experience changes the society’s members, and these members transmit to their own professions the knowledge, skills, and values they have acquired. Consequently, such a society affects the fields from which it draws its members to a much greater extent than it affects other fields. It follows that if we see a need for improvement in pain management in one or another clinical domain, we should actively recruit new members from those domains. For example, we would all agree that pelvic pain is a major area of concern for APS, but the society has only a few gynecologists and no urologists in its ranks. Until we bring a significant number of these professionals into the fold, APS will exert little influence on the problem of pelvic pain.
The role of neuroscience
Table 1 indicates which professions are minorities within APS. Perhaps the most important and challenging of these is neuroscience. Early in the society’s history, neuroscientists enjoyed the role of high priest—the keeper of fundamental knowledge and sacred values. As time progressed, the pain domain became more complex. Economic and political issues, imbued with urgency, came to overshadow the once salient role of scientific progress at our meetings, and the prominent influence of the pharmaceutical industry at the APS Annual Scientific Meeting has further helped to push neuroscience toward the margin. It is time to enhance the role that these colleagues play in APS, for they are essential to the validity of the organization. Neuroscientists attend meetings not only to talk to one another and teach the rest of us, but also to learn from the observations of physicians, nurses, psychologists, and others. The absence of an integrating theme such as translational pain research is conspicuous, and we should address this.
Finally, we have to work toward a more complete integration of the professions. Clearly, various professions benefit from using APS as a forum in which to address common concerns about medical practice and public policy, but we can do much more. Enormous practice, social, and policy issues surround the question of when to prescribe opioids for chronic pain. Many physicians on the front lines feel overwhelmed by the psychosocial complexity of prescribing opioids. At the same time, many clinical psychologists feel that economic forces are steadily disengaging them from the chronic pain arena. Integrating clinical psychology with physician prescription of opioids would benefit everyone, including patients. Clinical psychologists have the skills to create screening tools that can identify suitable candidates for opioid trials. They can work with patients to define suitable goals and outcomes measures for opioid trials, track changes in functional capability, deal with side-effect issues, and develop contracts with patients. They can help educate families and alleviate erroneous concerns about addiction, and they can provide guidance on patients who have histories of substance abuse. Integrating psychology with the prescription of opioids might allow us to see opioids as tools for rehabilitation. In this, and in many other ways, we should be able to open new visions for multidisciplinary collaboration.
The transition to a new century helps us to see that we are not just living out our lives and fulfilling our careers; we are building a future that others will occupy—as healthcare providers, scientists, and patients. The quality of that future depends on the investments of time, energy, and priority that we make now. Active involvement in APS is a great way to contribute.