We interviewed Dr. Narita, a consulting physician for our association. What is his vision as a leading expert in the field of chronic pain and a physician certified by the Japanese Association of Rehabilitation Medicine? This is a very interesting interview that we were able to obtain only from a doctor well versed in the field of rehabilitation.

Profile

He is a leading expert in the field of chronic pain, both clinically and academically. He supervises health management support for companies, holds around 50 training sessions for doctors a year, and is actively involved in promoting the science of chronic pain by collaborating with pharmaceutical companies on a number of materials promoting the importance of chronic pain and exercise.

[Education and work experience

2001 Graduated from National Defense Medical College
2001 The National Defense Medical College Hospital
2003 Medical Staff, Orthopedic Surgery, JSDF Hanshin Hospital
2005 2005 Medical Officer, Support Group for Humanitarian Reconstruction Assistance, 6th Iraqi Reconstruction Assistance Group
2010 Medical Officer, Japan Disaster Relief Team (JDR), Haiti
2013 Chief, Department of Rehabilitation Medicine, JSDF Hanshin Hospital
25 years Director of Orthopedic Surgery Department and Director of Rehabilitation Department, JSDF Hanshin Hospital
2014 Director of Orthopedic Surgery Department, Neyagawa Hikari Hospital
May, 2009 Vice President, Neyagawa Hikari Hospital
April 2020 Vice President, Kobe Mariners Welfare Association Port Island Hospital

Qualifications

  • Japanese Orthopaedic Association Certified Specialist
  • Board Certification in Rehabilitation Medicine, Japanese Society of Rehabilitation Medicine
  • Japanese Orthopaedic Association Certified Sports Physician
  • Certified Sports Doctor, Japan Sports Association
  • Japanese Orthopaedic Association Certified Rheumatologist
  • Japanese Orthopaedic Association Certified Exercise Physiotherapist
  • The Japanese Society for Osteoporosis
  • The Japanese Society of Bone Metabolism

What is the relationship between chronic pain, rehabilitation, and emotion?

Interviewer Morimoto: Thank you very much for assuming this position, Dr. Morimoto, as IAIR has many things we would like to do, and it is very significant for us to have the participation of an advisor and doctor. May I ask for your view on the role of rehabilitation in the medical industry?

Advisor Dr. Narita (Dr. Narita): Thank you very much. In particular, I have been involved in chronic pain for a long time, and I have been expecting something effective in chronic pain. In other words, we (physicians) think that immediate effect itself is a necessary part of the treatment, whether it is drug therapy, injection therapy, or surgical therapy. There were many cases where patients asked, "Doctor, I'm in pain, is there any treatment that can take away the pain right away?" I think there were many cases where patients asked, "Doctor, I'm in pain, so is there any treatment that can take away the pain right away? However, I realized through many years of clinical practice that chronic pain is not an area in which immediate relief can be expected or desired. I finally came to believe that chronic pain can only be improved by restoring lost functions through physical exercise, and that rehabilitation is by far the most important factor in this process. Conversely, as a physician, I began to think about what kind of treatment is really necessary to promote rehabilitation efficiently. Simply put, my way of thinking has changed 180 degrees.

Morimoto: Another point of concern for us so-called "rehabilitation professionals" is that while the perspective of exercise therapy is very important, as rehabilitation professionals, we at IAIR also place great importance on the perspective of "looking at people. In terms of the future of rehabilitation, in addition to exercise therapy, including from a preventive perspective, the biopsychosocial aspects of chronic pain, such as the emotional aspects, will also become very important. In this respect, rehabilitation has the advantage of being able to involve the patient on an hourly basis up to the point where it takes 40 minutes or 60 minutes to complete. In this respect, rehabilitation has the advantage of being able to be involved on an hourly basis up to the point where it takes 40 minutes or 60 minutes to complete a task.

Dr. Narita: You are absolutely right. What I find most attractive about the field of rehabilitation is that we spend a lot of time in contact with patients. We doctors have only a point of contact. If pain is caused only by physical sensory stimulation, and if the revised definition of chronic pain has not changed, then it is justifiable to think that there is no need to spend a lot of time with the patient. However, there is the emotional component. However, we now know that emotion is a major component of pain in the pathophysiology of chronic pain. In this case, the fact that the point of contact with the patient as a medical professional is the point of contact with the patient is a very negative point, and this is an area that doctors cannot make up for. Therefore, I believe that rehabilitation professionals should be able to understand, gather information about, and approach the emotional aspects of patients by spending time with them as they recover their functions. Therefore, I am certain that this will be the most important aspect of the rehabilitation profession, and that it will change the way it is perceived.

Morimoto: Chronic pain and multidisciplinary cooperation are not only important in the rehabilitation field, but also across occupational fields, isn't that right?

Dr. Narita: You are right. In particular, I believe that emotion will become an important theme in the future. In other words, when emotion comes into close focus, the focus will not be on conventional drug therapy, injection therapy, or surgical treatment, which are all designed to provide immediate relief of pain and slow pain, but rather on what types of professionals are involved and to what extent they are involved in approaching the emotional state. However, in this area, there is no advantage or disadvantage, but all professions are suited or not suited to the job, so what are the emotional aspects that can be captured by physical therapy or rehabilitation professionals? It is necessary to identify what kind of job is best suited for the person in physical therapy or rehabilitation, or what kind of job is best suited for the person who will be involved in a multidisciplinary collaboration in terms of emotions. I think it will be important to promote discussion of the fact that not one profession can understand all information.

THE ROLE OF THE IPRS (INSTITUTE FOR THE STUDY OF PAIN AND MULTIDISCIPLINARY COLLABORATION) IN THE HEALTHCARE INDUSTRY

Morimoto: IPRS is exactly where we are going with this.

What is IPRS? → https://iprs.site/

Dr. Narita: Yes, the word "pain" is included in the IPRS, but a major component of this pain is emotion. If we can expand the understanding of emotion among multiple professions, this is the step that will bring us closest to understanding chronic pain, and I think it will be a new approach to treatment that has not been taken until now. In other words, until now, when it came to solving pain through multidisciplinary cooperation, the theme of solving pain through multidisciplinary cooperation was to discuss how to reduce pain from 8 to 6 on the VAS scale of 10, for example, but in my opinion, the guidelines will be changed in 2020, and lowering the VAS is a new approach to solving pain. I think that the most important thing that is required in multidisciplinary cooperation is not only sensory stimulation but also pain input to the emotional part of the patient, our interpretation of pain, and how to provide appropriate treatment according to each of these factors. In this context, I think that IPRS is an important organization in terms of considering the emotional aspect of pain in particular.

Morimoto: Thank you very much. On the other hand, what is the current level of understanding of pain in the medical industry?

Dr. Narita: Pain in the medical industry still tends to be interpreted as an objective numerical value. Another is that pain is only interpreted as an electrical signal that is converted into a sensory stimulus, so the current situation neglects the emotional aspect of pain.

Morimoto: I see. So it seems that learning at IPRS will play a very important role in the medical industry after all.

THE ROLE OF IAIR IN SOCIETY

Morimoto: This is a bit of a change of subject, but do you think that doctors and rehabilitation professionals will play an increasingly active role in the area of health promotion, which IAIR is involved in?

Dr. Narita: Thank you very much. In this regard, we are not only targeting those who are currently ill, but also those who have been ill or injured, and until now, we may have only targeted such people. However, by rewriting the concept of chronic pain, we will be able to approach people with emotional problems before they become more serious, or at the first stage of pain, and our targets will now include people with pre-symptomatic or preventative diseases. I think the scope of your activities will expand to an even greater extent than before (laughs).

Morimoto: (laughs) Thank you! Now, finally, as a teacher, do you have any expectations for IAIR, or anything you would like to do as IAIR, including IPRS?

Dr. Narita: I believe that IAIR itself is a group of professionals. Therefore, it is important for each individual within IAIR to dig deeper into his or her own expertise. However, I would like to differentiate IAIR from other associations in the future. However, it is important to expand horizontally, isn't it? I think there are still very few organizations or associations that can establish horizontal connections. What I would like to say to each member of IAIR is to always dig deeper, but also to share a horizontal perspective and develop horizontally, and what I mean by horizontal development is to use the theme of emotion, to use the current keyword, as a common language, and to use multiple professions to measure the degree of improvement of patients with respect to that common language. If we can develop into an organization that can measure the degree of improvement of patients in response to this common language, I think we can clearly differentiate ourselves from other organizations.

Morimoto: Thank you very much. I would also like to explore what we can do well as IAIR.

Dr. Narita: In order to add value and leverage your expertise, of course, you are working on deepening the depth of your expertise, but I hope that we can further develop a group of professionals who are capable of developing horizontal emotions while doing so. I hope that we can further develop a group of professionals who are capable of horizontal development of emotions while doing so. For example, emotion is not just about the mind, but also about the content of our thinking, and of course we need to dig a little deeper. That is why we have to do it in a multidisciplinary way, and I would like to send out the message that we are doing it in a multidisciplinary way. If we do that, there will be many people who will participate in the project. The larger the group, the more we can get out of it, and the bigger the group, the more we can get out of it. I think that is necessary. That is the direction I would like to see the group take.

Morimoto: As society becomes more inclusive, we would like to participate in such a world.

Dr. Narita: Yes, that's right. If pain is pain, and pain has been lumped together in the past, then we need to be inclusive and diverse, and we need to be able to include a wide variety of people, and we need to be able to connect to the improvement of chronic pain and rehabilitation with the opinions of many different people. If we can send out a message that we want to improve chronic pain and rehabilitation with input from a variety of people, it will lead to much-needed medical care, won't it?

Morimoto: We look forward to working with you in the future.

Dr. Narita: I think one good message is that we are an organization that is breaking away from being lumped together with only the same group of specialists.

Morimoto: That could be said more.

Dr. Narita: I think that by increasing the number of initiatives, the activities will become even more active. At that time, I think that by emphasizing the SDGs and other aspects of the SDGs, for example, we will be able to further change our image both externally and from the perspective of the companies.

Morimoto: Yes, indeed. I would like to expand my contribution to society and my path. I look forward to working with you.

Dr. Narita: Thank you very much. Thank you very much.

After the interview

From the interview with Dr. Narita, I was able to gain various insights into new forms of medical care, the diversity of professions, and the possibilities. I also realized that I still have much to learn, including the understanding of "emotion," which will be common to all of us in this field. As medical professionals, it is important for us to continue to update our knowledge and contribute to society without forgetting.