1/11/2018 The future of pain research | Science

0 0
 
Advertisement

Institution: WATSON LIBRARY IBM CORP | Log in | My account | Contact Us

Become a member Renew my subscription | Sign up for newsletters

INTRODUCTION TO SPECIAL ISSUE

The future of pain research

Peter Stern, Leslie Roberts
+ See all authors and a liations

Science  04 Nov 2016:

Vol. 354, Issue 6312, pp. 564-565
DOI: 10.1126/science.354.6312.564

Article Info & Metrics eLetters  PDF

eLetters is an online forum for ongoing peer review. Submission of eLetters are open to all. eLetters are not edited, proofread, or
indexed.  Please read our Terms of Service before submitting your own eLetter.

Submit a Response to This Article

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 1/8
1/11/2018 The future of pain research | Science

RE:0 Is it Possible
0 to Better Manage Pain in Spontaneous Pneumothorax?

Uri Kartoun, Research Staff Member,

IBM

(24 March 2017)

Undesirably and at a relatively young age, I had the opportunity to be admitted in the Division of Thoracic Surgery and go through a
video-assisted thoracoscopic lung surgery (VATS). In this letter, I describe my patient experience and propose a minor modi cation to
  
the treatment guideline for management of spontaneous pneumothorax [1]. I believe that my patient experience may be of an interest
for patients and clinicians.

Imagine it is a regular Thursday, the beginning of another day. You wake up, brush your teeth, have a cup of coffee, and prepare for a
day full of adventure. Your life is intense and lled with activities, and you have great ambition and plans. But suddenly, all of that
changes.

On a Thursday evening in March 2008, I found myself, with no warning, being driven to the emergency room. The trip felt endless and
painful, and I felt every bump the car passed over. No words could describe the direness of the situation. When I arrived at the ER, I
was immediately connected to oxygen and had an X-ray and other tests. I was told that I had developed a condition called
spontaneous pneumothorax (an accumulation of air in the space between the lungs and the chest cavity that can result in a partially
or completely collapsed lung). The doctors were going to drill a hole in my chest, and they were going to do it immediately. The ER
staff said I would need to be hospitalized for several days. I realized then that my life would never be the same.

During the rst night of my admission, I lay connected to a chest tube and could not fall asleep. It was di cult to move, given my new
reality that combined physical pain with loud moans from patients suffering in nearby beds. I had been a smoker, as many other
students were at that time, and I felt intense withdrawal effects. But I also was encouraged by the thought of becoming a former
smoker, thanks to my situation.

Before I was discharged, the chief physician told me he believed I would need surgery to x the damaged lung. He was right, of course,
and I found myself readmitted a few weeks after discharge to go through a 3-hour, video-assisted thoracoscopic lung surgery.

The surgery was not a big deal from a physician’s perspective—“only 5 percent die,” according to my surgeon—so, because I had
dedicated almost a decade of my life to working with different sensors in robotics labs, I tried to nd the positive aspects of having

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 2/8
1/11/2018 The future of pain research | Science

such
0
a surgery. It 0sounded adventurous to have a camera penetrate my ribs within millimeters of my heart and have a surgeon x me
by stapling and titanium staples to my left lung.

The surgery began—and I awoke after seemingly a few seconds—I did not sense anything under the 3-hour anesthesia. When it was
over, I was carried on a stretcher back to a hospital room for several days of recovery. During the rst hours, I experienced no
signi cant pain because strong anesthetics were still in effect, but I felt lightheaded, and it was di cult for me to move or eat.

The pain gradually increased as midnight approached, and if the pain initially was like hearing the faint sounds of an army of soldiers,
horses, and drummers, all of them were now in my room and all over me, louder than anything I had ever heard. And this intensive pain
lasted for days.

When a patient is admitted for spontaneous pneumothorax, the clinical staff usually mounts two types of devices on the patient: 1) an
intravenous (IV) rehydration infusion set and 2) a chest tube. When those two devices are mounted, each on a different side of the
body (i.e., the IV is attached to the patient’s right hand, and the tube attached to the left side of the patient’s chest), the patient’s
mobility becomes limited, pain intensity may increase, and it becomes more di cult to get out of bed and walk. Before I was
discharged I mentioned to the clinical staff that a future spontaneous pneumothorax patient would feel more comfortable if both
devices were mounted on the same side of the body. The clinical staff was surprised but realized the validity of my simple suggestion.
I believe that such a minor change in clinical practice could make a difference for many patients, and I hope that the guideline for
management of spontaneous pneumothorax [1] will be updated accordingly.

As I suffered pain, I realized that pain treatments were scheduled at prede ned time intervals and predetermined doses. For instance,
oxycodone was administered every 4 hours; metamizole, twice a day; and pethidine, once a day. This scheduling is unfortunate
because humans react differently to pain intensity and treatments, given varying subjective characteristics such BMI, gender, and
comorbidities. If there were a technology that could accurately measure a patient’s real-time pain intensity, the clinical staff would
have a better idea about the most effective dosage and when to provide a pain treatment. Further, if there were a way to measure an
increasing level of pain (e.g., the pain level is 5 at 10:00 a.m., and 6 at 10:05 a.m.), the clinical staff could provide the treatment at
10:05 a.m., not 15 minutes later when the patient’s pain level has become more intense. These abilities are not yet available in
hospitals, but prediction models combined with wearable and near-bed sensing technologies are gradually becoming more accurate
as a result of software and hardware advances over the past decades. Such technologies may lead to accurate pain assessments for
personalized and more e cient pain management for patients.

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 3/8
1/11/2018 The future of pain research | Science

Now,
0
almost a decade
0
after my two admissions, I am extremely grateful. Not only did I ultimately quit smoking, but my life-threatening
experience as a patient in the Division of Thoracic Surgery also inspired me to entirely shift my career. I have conducted research
focused primarily on health care at Microsoft and Massachusetts General Hospital and now at IBM Research.

My personality was reshaped by my experience as a patient. I recall the patient in a nearby bed who had a conversation with his wife
about me one night—and who died the next day. Another patient lost his mind and was forcibly taken to the Psychiatry Department.

When I am conducting research and reporting on a clinical discovery, developing a novel readmission model, or proposing a new
prediction risk score, I often recall my own hospital admissions. In a way, I hope that my work in the medical domain may delay or
even prevent future admissions and may reduce pain intensity for many individuals, including me.

REFERENCES
[1] MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline
2010. Thorax 2010;65 Suppl 2:ii18-31.

Show Less
Competing Interests: None declared.

View Full Text

Science
Vol 354, Issue 6312
04 November 2016

Table of Contents
Print Table of Contents
Advertising (PDF)
Classi ed (PDF)
Masthead (PDF)

ARTICLE TOOLS
 Email  Print  Save to my folders  Alerts
 Request Permissions  Citation tools  Share

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 4/8
1/11/2018 The future of pain research | Science
Advertisement
0 0

RELATED CONTENT
News
Pot and pain

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 5/8
1/11/2018 The future of pain research | Science

News0 0
Primed for pain

Review
Pain regulation by non-neuronal cells and in ammation

Review
Neural circuits for pain: Recent advances and current views

Review
Deconstructing the sensation of pain: The in uence of cognitive processes on pain perception

Review
Exploring pain pathophysiology in patients

Editorial
Forecasting the opioid epidemic

RELATED INFORMATION
VIDEO We don't know: Pain
Podcast: The impact of legal pot on opioid abuse, and a very early look at a fetus?s genome

SIMILAR ARTICLES IN:

PubMed
Google Scholar

CITING ARTICLES IN:

Scopus (1)

Advertisement

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 6/8
1/11/2018 The future of pain research | Science

0 0

Related Jobs

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 7/8
1/11/2018 The future of pain research | Science

0 0
Senior Specialist, Regulatory Affairs-
CMC
Madison, NJ, US

Requisition ID: REG003526Merck & Co., Inc. Kenilworth,

N.J., U.S.A. known as Merck in the United States and
Canada, is a global health care leader with a diversified
portfolio of prescription medicines, vaccines and animal
health products. The differ

Employer: Merck

DIRECTOR, GRAHAM SUSTAINABILITY

INSTITUTE
Ann Arbor, Michigan TBD

The University of Michigan, one of the world’s premier

research universities with tremendous breadth and depth of
academic excellence, invites nomi...

Employer: University of Michigan

Director, Endeavor Center for Faculty

Development
Winter Park, Florida DOE

Rollins College seeks an experienced, collaborative Director

for the Endeavor Center for Faculty Development, endowed
by the Endeavor Foundation.

Employer: Rollins College

MORE JOBS ▶
NAVIGATE THIS ARTICLE
Article
Info & Metrics
eLetters
 PDF

Science

http://science.sciencemag.org/content/354/6312/564/tab-e-letters 8/8