By David Nagel, M.D.
Dr. David Nagel has written a powerful book about chronic pain called Needless Suffering—How Society Fails Those with Chronic Pain. (order here from Amazon). Having read the book, the National Pain Report asked Dr. Nagel to share with us why he wrote the book.
As a specialist in Physical Medicine and Rehabilitation for the past 30 years, I have treated complex medical problems which we cannot cure. Our goal is to help those we work with adapt to the bio-psycho-social-spiritual challenges they face. One common denominator of many of these disabilities is pain. As my practice has evolved over the years, I have come to specialize solely in what some call chronic pain management. Early in my career, I was inspired by Marion Emerson, MD. Marion suffered from a number of medical problems she had no interest in telling us about. She felt that a barrier was merely a challenge to find a way around. She had found a way around the barriers she faced, and they were in the past. Her goal was to turn her attention to helping others. She also believed that medical care only began at the bedside. Our ministrations must find their way to the community through social advocacy. And so we followed this 65 yr old diminutive professor around Rochester, New York in a quest to help find a place for those who suffer from the problems created by chronic disability.
I was also inspired by my mother who suffered her entire adult life from the pain of a severely progressive form of Rheumatoid Arthritis. She neatly hid her pain behind an infectious smile, and I learned from her that most patients with chronic pain do suffer, often unnecessarily, in silence. Despite her pain, my Mom was always advocating for those in need and trying to correct social injustices. I would argue that the way we, as a society, treat those with chronic pain is a social injustice. We ostracize, stigmatize, and blame those who suffer for their infirmities because we don’t understand their pain, we don’t have a solution, and it is easier to walk away from them, to abandon than them, than it is to stay and comfort them.
As my pain practice evolved, I truly believed I was making a difference. Then, about 13 years ago, I was faced with a number of socio-economic challenges to my practice, ones many doctors are facing, and I had to make a choice; do I continue my pain management practice as I saw fit, or do I change to an interventional pain practice? To this date, I struggle with the decisions I made. In fact, when I introduced myself to the Pain Action Alliance to Implement a National Strategy (PAINS), I referred to myself as a hypocrite. I felt a need to write about my struggle, to share my dilemmas. I also sought to join several public and private organizations in making a change in the way chronic pain is perceived, judged, and treated. The result was Needless Suffering. As I mentioned earlier, Marion Emerson taught me that there are numerous social entities beyond medicine that have the ability to help or harm those who suffer. Together, we form a multi-disciplinary team. In my years of practice, I was struck by how it only took the actions of only one person or group to ruin the positive actions of everyone else. I found that many of those people who harm the process are totally oblivious to their actions, and others often put their needs above the needs of those they should be helping. I felt it was not enough to just identify the needs of those who suffer, but also identify those who have the potential to help or harm. There are a lot of heroes and villains in this process. In Needless Suffering, I identify who they are, what they do well, what they do poorly, the gap between, and, most importantly public and private policy solutions to bridge the gap in between. I begin and end the book with an assessment of the challenges I faced and how I responded. This book was a journey of personal discovery, and I leave it to the reader to judge my actions.