From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way

Dr. Steven Richeimer's 2010 editorial, "Are we lemmings going off a cliff? The case against the "interventional" pain medicine label", raised significant concerns regarding the trajectory of pain medicine at that juncture.1 Fourteen years later, we find ourselves in an even more disturbing place. The trend regarding which Dr. Richeimer attempted to warn us - labeling ourselves as "interventional pain specialists" - has spiraled into something even more damaging. He suggested that we strive toward the label of "comprehensive pain physicians", as "interventional pain physicians" relegated physicians who treat pain to mere "technician" status. Recently, we have witnessed trainees, and even some programs, viewing (and labeling) pain medicine as "pain surgery", with the emphasis on procedures at the expense of holistic, patient-centered care resulting in the potential devaluation of the profession. We strongly opine that the rise of social media and the overwhelming emphasis on posting advanced procedure photos from the operating room on social media have skewed perceptions of what actually constitutes "pain medicine". While interventional procedures certainly have their place, the oversaturation of devices, therapies, and industry-backed techniques has created overwhelming "noise". More troubling is the rise of unaccredited fellowships, which resemble interventional radiology training programs with an overarching focus on the "procedural fix". Some of these programs ignore the complexities of pain, including psychosocial and comorbid factors. Training has shifted, and many fellows believe that this unfortunate paradigmatic revision is in the best interest of their patients. This is not the future for which we should be aiming. Dr. Richeimer's point regarding the rise of interventional pain medicine driven by financial considerations and convenience is perhaps even more relevant today than was the case 14 years ago. Over the past two years, we have witnessed a significant decrease in applicants for accredited pain fellowships, with many drawn to high-paying anesthesia patients deserve. sionals place in us.