Clint Cole, III – PAINS Research Intern

by Clint Cole, III, PAINS Research Intern

I have to admit that the first time I sat down to meet with Myra Christopher, I was terrified. After graduating with my biology degree from Truman State University, I decided to take a gap year to apply to medical school and gain some new experiences and learn some new things before completely diving head first into a new life in medicine. Before sitting down to meet Myra over lunch, I had done a search to find all of the information on her and the Center for Practical Bioethics I could find. Quickly, I found out how influential both had been in the field of bioethics. Bioethics—what did that even mean? I had no classes, lectures, or anything on the subject, but for some reason I thought it was a good idea to go ahead and see if there would be any opportunities to intern at the Center. Oh, right—I said I wanted to learn “some new things.” Our lunch must have gone well because Myra offered me an opportunity to intern with the PAINS Project at the Center and within a couple of weeks I was going into the office.

My first week—or my first several months really—would best be described as a whirlwind. I was nearly overwhelmed with learning about the amount of work PAINS had done and was doing, in addition to the stack of reading materials that kept piling up on my desk. Although my classes in undergrad were heavily centered on science, I guess I really was going to use the liberal arts education that Truman State continuously championed. However, I was still seriously lacking in any knowledge of public policy or the policies behind what I viewed medicine to be. I quickly learned that there is much more to medicine than seeing patients and the “famed” saving lives.

After surviving the first several months in this new environment, I started to become more comfortable and I have now spent about a year and a half thinking about chronic pain (which is about a year and a half more that I ever have before). During these months, I have been fortunate to have many different experiences, meet many different people, and accomplish a goal I had—to learn new things.

Some of the most eye-opening of which would be:

  • taking care of my grandmother at the end of her life and experiencing the issue of chronic pain head-on,
  • listening and learning from a group of Citizen Leaders who either live with or are impacted by chronic pain in some way,
  • hearing of the difficulties and frustrations doctors have in treating chronic pain patients, and
  • coming to understand the frustrations that patients have with their doctors.

These frustrations of both physicians and patients, in addition to the concurrent issues of opioid addiction and chronic pain allowed me to figure out just how tricky the pain management space is, especially in a time where the media is much more focused on addiction than chronic pain. When it comes to the healthcare providers, the frustration arises because it seems like it is nearly impossible to adequately care for chronic pain patients. There is no quick and easy fix—it takes a lot of time and energy to care for these patients, and with an average of only 7 hours devoted to learning about pain care in medical school, there is an extensive lack of understanding. This contributes to the frustrations of patients because they feel their doctors don’t care about their pain; they feel they often write them off as addicts, drug-seekers, and “problem patients.” On the national level, the complexities of connections between opioid addiction and chronic pain provides for a level of difficulty not easily compared with in medicine today.

And all of this, somehow, was my first foray into medical policy.

Even through learning about all of these issues in this space, one unmistakable thing I’ve learned about in this internship is chronic pain—all of the articles and policies that I’ve read and all of the caring physicians and strong patients that I’ve met have made sure of this. Included in the things I’ve come to understand are that:

  • Chronic pain is itself a disease, and not a symptom.
  • It involves a very wide range of conditions and experiences. It’s highly individualistic.
  • It has biological, psychological, and social components. It is a biopsychosocial disease.
  • It can be difficult and time-consuming to manage.
  • Comprehensive pain treatment involves things that are not easily (or at all) covered by insurance. These include yoga, acupuncture, cognitive behavioral therapy (CBT), physical therapy (PT), diet, and exercise.
  • Opioid medications are an important part of a treatment toolkit, but often shouldn’t be used as a first-line treatment—they have their own inherent risks.
  • Chronic pain doesn’t discriminate. Any age, gender, social status, etc., can be affected, and often it’s impossible to physically see. Many people in pain look completely normal.
  • Chronic pain is stigmatizing. Legitimate patients are seen as weak, blamed for their pain, and labeled as drug addicts, when they are actually some of the strongest people I’ve met.
  • “Comprehensive pain care will improve the lives of millions of Americans, save billions of dollars and reduce opioid prescribing.”

As I am preparing to transition yet again, from this internship to medical school, I feel I am bringing with me a perspective on medicine that I would never have begun to imagine before meeting Myra for lunch. The lessons I’ve learned from being here with PAINS and the Center, and from people living with chronic pain, will be carried with me the rest of my career and can be easily transferred to any aspect of medicine. I have learned through these lessons that a good physician must:

  • respect all persons,
  • advocate for those without a voice,
  • understand what goes into medical policymaking,
  • work harder everyday to continue to improve health for everyone, and maybe most importantly,
  • take time to listen—to really listen and hear what a patient is telling them.

Although I don’t know where I’ll end up in the big world of medicine, I will always hear Myra’s voice in the back of my mind telling me to speak up and speak out.