Writing in the January 2019 issue of Health Affairs, Professor of Geography and Epidemiology Jonathan Mayer describes his "haunting experience with untreated pain" following damage to a major nerve during surgery and the drive that propelled him "to demand better education about and treatment for pain." Titled "'Pain Behavior': What My Pain Treatment Got Wrong," the article has been rippling out through the media and Professor Mayer, who also holds appointments in the Schools of Public Health and Medicine, hopes it may one day affect the neglect of pain and pain treatment. On the occasion of the article's publication as well as Professor Mayer's coming retirement from the University of Washington, he expands here on how his personal experience of pain has influenced his career and what's next. Professor Mayer may also be heard in an interview that aired on WTOP-FM out of Washington, D.C., by clicking here.
On myriad pain related projects: "I’ve worked on, and am working on, a number of pain related projects. In my earliest, because there was and is little clinical consensus about when to do back surgery, we expected to see significant geographic variation in rates of back surgery in Washington State. This is because “schools of thought” that develop around invasive procedures are frequently less a matter of scientific proof than social consensus, and this consensus is frequently localized to individual institutions, or areas at a variety of scales. This is exactly what we found: a 15-fold variation in back surgery rates that could not be explained by any demographic or epidemiologic variables that predict the the prevalence of serious back pain. This was published in the journal Spine, which is the major journal for spine surgeons and spine care in general. In another study, we were interested in assessing the degree of geographic variation in availability of prescribed opioids for serious pain in Washington. Earlier work had shown that in New York City, pain medications were virtually unavailable in poorer neighborhoods, such as Harlem and the South Bronx. But what about in a state such as Washington? We found little variation in availability. Opioids were equally available in pharmacies everywhere, even after adjusting for demographic variables. This was published in the Clinical Journal of Pain. A project that I am developing with colleagues (a lawyer-ethicist and a human rights lawyer) in Colorado is about the stigma of chronic pain. We know that it exists and is widespread, but how prevalent is stigma? How may we study this epidemiologically, philosophically, socially and psychologically?
Right now, colleague Suzanne Davies Withers and I are working on three related projects concerning opioids. The first is an exploration of the drivers of opioid overdoses leading to death, and we are doing this with several other investigators, under funding from the UW Department of Psychiatry and Behavioral Sciences. We will also identify hotspots of opioid mortality at a much finer scale than has been done previously. The second is more of a national study examining spatial variation in opioid prescribing rates, and the third is testing the hypothesis that patients who have had severe injuries in rural areas are more likely to develop chronic pain issues. Yet another is to examine the degree to which “mid-level practitioners” – physician assistants and nurse practitioners – contribute to overall opioid prescribing. Our preliminary evidence is that they are almost as important in prescribing as are physicians. We have been promised a grant to do this verbally. These projects are in cooperation with various departments in the School of Medicine, in which I hold an appointment, and the Harborview Injury Prevention Center."
On the connection between geography and pain medicine: "Little in health care is distributed equally. There is always geographic variation in the prevalence of diseases, and also in the provision of medical care. The main drivers of health care are political and economic, and not epidemiologic. Much of my career documents this; Suzanne and I are extending some of this into treatment for pain, and the geographic epidemiology of pain."
On opportunities available in retirement: "I’m not retiring at all from my research—things will continue as they are now. We will also continue the UW Honors pain seminar. I teach this with a retired Professor of Neurosurgery who was one of the leaders in the establishment of pain medicine as a practice specialty and a scientific specialty – and my mentor in pain as a biological, social, and psychological phenomenon. This continues to be exciting. I’ll also be doing advocacy work at a number of levels surrounding pain and its treatment. It’s interesting that a number of news services ... have already requested interviews on my experiences and perspectives. I realize that I’m speaking from a privileged position, and I think that it’s very important to use that privilege to help others who may not have that advantage. So 'retirement' will be interesting – especially as I get deeper into acting (I'm in a movie and another is coming up, but I can’t talk about them because of nondisclosure agreements)! So much powerful material comes out of narrative, and I am working on a screenplay dealing with chronic pain. So, we’ll have to see. I can tell you one thing: life is never boring, and the coming years will not be boring in any way!
I’ve [also] been writing a series of more creative pieces on my encounters in and around medicine, as a patient, as an academic in Schools of Medicine and Public Health, and as somebody who has served in several clinical roles, including as a staff member on the UW’s Infectious Disease clinic, and as former Chief of the Clinical Ethics Consult Service at one of Seattle’s hospitals for over a decade. One thing that remains so vivid is that each patient is a story and has a story. Some are so deeply embedded that I just have to write about them (or had to for those that I have written). The time that I had to tell a family that their loved one had died in surgery because nobody else thought to or was available to do so; my first encounter with death in the ER and the middle aged woman who had died, even as I was doing CPR and hearing her ribs creak; and patients who had positive outcomes. I’ve written about my mother’s dramatic death as were flying her to Seattle from Wisconsin in a medical evacuation jet after a stroke, and my decision to honor her very last wishes to discontinue life support – and the clinical detachment that that required in order to do so. Untreated pain, suffering, and cure. There are always stories in medicine. I’m going to continue writing about these encounters, and submit them for publication as short vignettes, or as a book. Something like 'Views from the Edges of Medicine.' The impulse is strong, I think I have something to say, and since my first playwriting experiences 20 years ago, realize that I seem to have talent in creative writing. So that, too, is part of my retirement plan. Pain – its treatment, its lack of treatment, its ebb and flow, of others and in myself, make it impossible for me not to write these sorts of pieces."
UW undergraduate students have just a few opportunities to catch a class with Professor Mayer this year before he transitions to Emeritus status: GEOG 280 Geography of Health & Healthcare is available in winter quarter and in spring quarter we will offer GEOG 380 Geographical Patterns of Health and Disease as well as the "Honors Pain Seminar," HONORS 222.