REASONS WHY CURRENT TREATMENTS MAY NOT RELIEVE PERSISTENT PAIN
The only inflammatory mediators that are addressed in the old ways of treatment are the prostaglandins and leukotrienes, which are produced by the cyclooxygenase and lipoxygenase pathways. Failure to address the other major inflammatory mediators such as interleukin-1 beta and tumor necrosis factor alpha will result in treatment failure in patients whose pain is derived from inflammatory mediators that are not being treated. Physicians who do not understand this new law of pain will continue to blame patients for chronic pain and recommend psychiatric help. Over-reliance on structural imaging studies such as MRI and CT-scans to explain chronic pain should stop. Structural imaging studies cannot provide any information on the biochemical mediators causing soft tissue pain. Presence of a structural defect cannot predict pain and neither can the absence do the same. A landmark study has shown that one-third of perfectly healthy persons who have no pain will have a herniated disk present on an MRI scan. Should any of these persons have a slip and fall injury and present in the Emergency Room, the disk will be blamed for the pain and they have a high probability of getting unneeded surgery. On the other hand, persons with severe pain such as Fibromyalgia who do not have any structural abnormalities will be labeled as malingerers and drug seekers and sent for urgent psychiatric counseling. There is an urgent need for doctors and patients to understand Sota Omoigui’s Law of Pain and for development of biochemical functional scans that will provide information on the biochemical mediators that are responsible for persistent pain in areas of injury as well as neighboring uninjured areas.