I Thought So

Years ago, I attended a physician's conference on musculoskeletal pain. I know, I'm not a doctor, but the conference looked fascinating and they accepted my registration. When participants asked me how my practice was going, I replied "Pretty good!" 

One of the most interesting moments of the conference happened during a panel discussion. While not the intended focus of the panel, they got completely sidetracked in a rather heated debate about mechanisms of action for referred pain. As is commonplace at conferences, microphones were set up in the aisles, so that participants can weigh in on the discussion. This debate as to possible mechanisms of referred pain seemed to go on endlessly, getting more heated as time went on. Musculoskeletal pain often follows very predictable pathways, but how? 

At one point, when the debate was bordering on insufferable, another person stepped up to the microphone. This distinguished gentleman addressed not the panel, but the audience. 

"Can anyone in the room tell me the mechanism of action of anesthesia?"  Complete silence. 

"I thought so," was his parting remark as he took his seat. 

With that, the panel discussion ended. Game over. 

"What just happened here?" I asked the physician next to me.

"Don't you know who that is?" he asked, incredulously. 

I shook my head, feeling slightly embarrassed. 

"That doctor wrote the definitive textbook on anesthesia. If he doesn't know, no one on the planet knows."


Would it be great to understand the mechanism of an intervention? Of course. There is, however, a long history of using a treatment without such knowledge. From aspirin to massage therapy, we use treatments that aren't fully understood. Why do we still use them? Because these treatments, in general, produce results that can be replicated. Clinicians don't have the luxury of waiting for full understanding. When someone in pain is sitting across from you, they need you to do something. Make no mistake, a deeper understanding of the mechanism will help make the treatment more effective. These research efforts are essential. In the meantime, we need to pay attention to the accuracy and success of our approach, continually refining and tweaking to improve our clinical outcomes. Our clients deserve nothing less.