Medicine: Pain is a Pain

It's an obvious Noble Prize.  If someone out there can take the subjective idea of pain and make it objective and measurable, this will forever change the course of medicine.  How critical is it in our medical assessments?  Well, for starters, it's often a reason why a patient seeks medical care.  Only rarely does a patient seek care for euphoria (you can make arguments for manic episodes and use of recreational drugs).  Second, pain is often part of the patient's objective assessment.  Think about it.  Temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation are all objective measures.  Even the physical exam is an objective measure: it's there or it isn't.  And if it's there, we'll describe it in excruciating detail and even rate it on scales.  And though pain is subjective it's considered a vital sign.  

Most physicians will give patients the benefit of the doubt.  When we take care of patients, one  of our goals is to minimize pain and subsequently suffering.  But if you ask any one of us, we are to some degree jaded.  There are those bad apples who are trying to scheme the system and obtain drugs for their own personal high or monetary gain.  In just my few years of practicing medicine, it's amazing how many people have had their medications stolen or left their bag of medications on some form of public transportation.  Maybe some of these people did, but really, did all of them?  We've devised ways around these issues: frequent visits, pain contracts, and even urine drug screening.  A careful eye on pharmacy and doctor visits can reveal polypharmacy and doctor shopping.  We can assume someone has pain, but how do we really know?  Ultimately, you're trusting someone's own perception.  It's a loss for the physician who trusts a patient who isn't being honest.  It's a loss for the patient who isn't trusted by the physician despite being honest.  Another reason why physicians become frustrated is the tremendous variability in not only pain's presentation but a patient's ability to tolerate pain.   How can patients who writhe in pain after major surgery decline pain medication, yet other patients who lie comfortably in bed request very specific pain medications, like Vicodin or Percocet or Dilaudid or Demerol?    

Now imagine there is a test, say, a blood test that could measure pain objectively.  A simple blood test.  A huge step would be a test that yields positive or negative results.  The ideal test would not only differentiate between true pain and false pain, but would stratify true pain, and be cheap to administer.  This would separate the true patients from the pain-seekers and malingerers.  There might be criteria for patients to meet before they could even get pain medication.  To be able to confidently address pain would also aid in monitoring pain control over time and even minimize side effects of pain medications, which range from liver and kidney toxicity to respiratory depression and coma.  It would save valuable resources and time.  So will anyone devise such a test?  I certainly hope so.  I'm currently reading a book about the discovery of insulin and how it changed the course of diabetes.  Just a century ago, we thought finding a cure for diabetes was impossible.  But insulin was discovered.  Medicine and science are forever changing fields and I hope the future holds an answer to this mystery. One day.