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A physician’s personal odyssey with chronic pain

Philip Pizzo, MD, former dean of Stanford's medical school was preparing to head to Washington, D.C. to meet with top federal health officials when he leaned down in his office and felt the sharp sting of pain. It would be the beginning of a long odyssey into the world of chronic pain – the very subject he had planned to go to Washington to discuss.

The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.

My hope is that by sharing my personal story, it will generalize the discussion and create more dialogue about the realities that 100 million people face...

“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing," he said in an interview. "I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive."

In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, "While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual."

As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”

“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression... It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”

A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated - albeit with a major surgical procedure - that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.

After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.

Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.

“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”

Previously: The high cost of pain: Medical school dean testifies on problem to U.S. SenateA call to fight chronic-pain epidemic, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine and Researching ways to “heal the hurt”

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