Written by Dr. Russell Raath; Chronic Pain Clinic
Article originally published in the November issue of JOY! Magazine
Forty years ago, when I became a specialist anaesthesiologist, most of the pain we dealt with was acute pain. Today, acute pain is, by comparison, well understood and generally well managed. This is also the type of pain we are taught about at medical school. The principles are relatively straightforward. The patient has pain, so we identify and treat the cause: fix the broken bone, operate on the diseased organ, repair the injury. Then, while the underlying problem heals, we treat the pain with medication. Eventually the underlying problem heals, the pain disappears, the medication is stopped, and that is the end of the story.
The ‘acute pain model’
The problem is that we have made the mistake of applying this same ‘acute pain model’ to chronic pain. We continue to rely heavily on pain medication, sometimes failing to identify and treat the underlying cause of persistent pain. I became increasingly convinced that there had to be a better way. Finding that better way became the guiding principle of my practice – and remains so today. We have very few medications that are genuinely satisfactory for long-term chronic pain. Many have significant side effects; some carry risks of tolerance, dependence or addiction; and, in many patients, their effectiveness diminishes over time. If medication could not provide the answer, then our entire approach to chronic pain had to change. I began to explore approaches that went beyond simply suppressing pain, focusing instead on identifying and addressing the mechanisms responsible for persistent pain. So, instead of asking only, “What can I give this patient to reduce or manage the pain?”, I began asking: “Why does this patient still have pain – what is maintaining the pain, and what can I do about the reason?”
The analogy of a fire
I often explain chronic pain using the analogy of a fire. Imagine walking into a room filled with smoke. The smoke is unpleasant and it is making you cough and struggle to breathe. You can open the doors and windows, switch on fans, and do everything possible to clear the smoke. You may make the room more comfortable, but if the fire is still burning, the smoke will keep returning. I believe chronic pain is much the same. The pain – and many of the symptoms that accompany it – can be thought of as the smoke. We can try to reduce that smoke with medication, injections, procedures, and other treatments. Sometimes that is necessary and enormously helpful. But if we only keep treating the pain without asking what is generating and maintaining it, the underlying problem remains. There is a fire burning somewhere.
Why is this patient still in pain?
So the fundamental question we ask in our pain clinic is not simply, “How can I reduce this patient’s pain?” It is: “Why is this patient still in pain?” What is maintaining it? What mechanism is continuing to drive the pain? What has been missed? And, most importantly, can we identify and treat that underlying driver? Our aim is therefore not simply to turn down the volume of the pain. It is to find the fire, understand why it is burning, and, wherever possible, put it out. When the fire is extinguished, the smoke has a reason to disappear. This changed the way I practice medicine and gradually I changed from only being a doctor to being (or trying to be) a healer.
This article appears in the November 2026 issue of JOY! Magazine. Read the digital version of this magazine here: joygifts.co.za
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Date published: 22/10/2026
Feature image: Sourced from article originally published in the November issue of JOY! Magazine
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