Thank You, John Satterthwaite!

Ann Quinlan-Colwell, PhD, APN

Developing this president column is no small task. It is written to pay tribute to our friend and mentor Dr. John Satterthwaite who recently stepped down from serving as the treasurer of the Southern Pain Society during the last 34 years.  John nurtured and guided SPS while significantly impacting many SPS members in ways that can never be repaid. As Dr. Mordi Potash said so well: “it is an absolute truism that there would not be a Southern Pain Society in existence in 2020 if not for John Satterthwaite.” This was echoed by Lori Postal who recently wrote John Satterthwaite has served the Southern Pain Society as a “trusted mentor, historian, voice of reason and steward of our finances.” Not only is John a man of many talents who has contributed greatly to the world of pain management but he has paradoxical qualities as well.  Although he is often a wise sage when on the stage, he is equally comfortable and meaningful being the guide on the side.  He is often a man of few words yet a great storyteller. John has always reminded Dr. Geralyn Datz of “a firm but fair patriarch, if you are under his wing, he is protective and compassionate.”  Several people make the analogy of John steering and guiding the SPS ship. Dr. Harry Gould appreciated John’s welcoming spirit and guidance for the “kids in the candy shop” (the SPS Board of Directors) “to get the most with what we had” (financially). John’s devotion and perspective on the history and the mission of SPS have been priceless.  As I recount these observations and impressions I am nodding my head in agreement. John is an expert physician, teacher, patriarch, sage, guide, shepherd, steward, mentor, storyteller,  navigator, voice of reason, friend and so much more.

Dr. Eric Pearson particularly loves John’s “wisdom and amazing dry sense of humor” which was reflected in preparing for this column.  After sending John some questions about his life, he sent me the “answers to the essay test.”  He was the son of a Station Manager for Capital Airlines born in Clarksburg, W.V. but moving frequently during his childhood and teens.  He had several early occupational goals including being “a trash collector because you could ride on the outside of the truck,” an Air Force pilot and “several other questionable thoughts.” His focus changed while working summers as an orderly and surgical tech in the OR in Georgia, where the anesthesiologists encouraged him to consider anesthesiology instead of surgery which as a fan of the TV show Ben Casey, he found interesting.  In fact, he initially “thought of going into Thoracic Surgery, but the residency was too long, and “ultimately chose anesthesiology because you work in a climate-controlled area and can wear pajamas all day (ha-ha)… It is immediate treatment response medicine and sleeping patients don’t complain.”

John noted that his  “involvement with pain was accidental.”  After practicing for 2-3 years, a neurosurgeon from Memphis, TN moved to the area and asked John to do epidural steroid injections.  As a result, other ortho and neuro doctors followed with similar request, and he became the first person in Greenville, S.C. to be “practicing pain.” Subsequently other surgeons asked if there were injections that could administered for “patients with an unusual pain with discoloration and extremity swelling.”  John’s interest was sparked in what was then RSD (reflex sympathetic dystrophy) which he began treating.  He was told by a local orthopedist that “we never had RSD in Greenville until you came to town.” 

John joined SPS in March of 1987 which qualified him as a Charter Member.  He clarifies: “at least that is what my certificate says.”  His intertest in RSD led him to  attend his first SPS meeting in 1989 because they had a day long program on “RSD” at the SPS regional section meeting, held in conjunction with APS.  Wearing his historian hat, John wrote: “attendance at the regional meetings tended to be greater than the APS meetings and we were subsequently uninvited to hold our meetings with APS.  The first independent SPS meeting was in 1991 in Chattanooga, TN.  I have been to each meeting since then except one.” 

“In 1989, the President of SPS Dan Hamaty, whom I knew because of his involvement with Pain Therapy Centers (PTC), asked me to become Treasurer which I accepted.”  Because of the involve tax and registration paperwork necessary to transfer the office, John continued to act in that capacity until 12/31/2019.  “If not for my current health issues, I would continue as I get to interact with some of the giants in the field and it is fun. I was asked to run for SPS President by Renee Rosomoff 1996, but declined because of this” (responsibility to the role of treasurer).

Because of his interest in pain, John developed a relationship with Dr. C. David Tollison who was a Clinical Psychologist specializing in pain.  Dr. Tollison set up a multidisciplinary pain treatment program in hospital system where John was located. This was the start of PTC of which John became Medical Director with Dave as Program Director.  “Due to the financial success of PTC, other hospitals in the region became interested.  We started a program in Charlotte with Dr. Hamaty as Medical Director, and at one time there were several programs in four states.  Unfortunately, with changing reimbursement, these programs ultimately died out.”

John noted that he has “been surrounded by some of the greats in the field of pain, but the person who has had the greatest influence was Dave Tollison.  We have practiced together for 30 years.  We have edited several books and spoken at many events.  One of my prized possessions is a copy of the 3rd edition of our “Practical Pain Management” which was translated into Chinese.  This was the third bestselling pain text behind Bonica and Raj.”  “Others especially Hu and Renee Rosomoff had a tremendous influence on my life in pain management as well.”

John felt fortunate to meet or work with Hu and Renee Rosomoff, Marty Grabois, Bert Ray, Stan Chapman, Peter Staats, Jeannie Koestler, Ben Johnson, Dan Doleys, Todd Sitzmann, and many other leaders and pioneers in the field of pain management during the last 30 years. He has many SPS related reminiscences.  His most “memorable SPS event was at a Board of Directors meeting in Charlotte in 1996.  President Renee Rosomoff was notorious for micromanaging and long meetings, but this one started at 11:00 am and was finally over at about 1:30 the next morning when someone (not one of us although I wish it had been) set off the fire alarm at the hotel.  Although we were still not finished, nobody went back to the meeting room following the “all clear”.  Even Renee’s husband Hu, who came to all Board meetings because of his love for the organization, had left much earlier.  (FYI, Hu Rosomoff was founding President of SPS, and subsequently served as APS President, AAPM President, and was a giant in the field of pain.  I was privileged to call him a friend.)”  Another favorite memory was that Hu and Renee “attended every Annual Meeting together.  They sat on the front row, in front of the speaker, so you knew they were listening.  After every speaker Hu would stand and provide commentary.  All of it useful, but sometimes critical.  I presented a talk on “Epidural and other steroid injections” at one of our meetings.  I knew Hu was a multidisciplinary treatment advocate.  Despite his being a neurosurgeon, he was very critical of procedures or medications for pain treatment.  His clinic in Miami was one of the leading multidisciplinary pain treatment facilities in the world.  When he stood up, I held my breath until he said my presentation was the most objective and comprehensive discussion on injections he had ever heard.  Quite a relief.”

A memory lane of pain management for John reflects significant change.  It also reflects the “honesty, genuineness, firm opinions rooted in his experience and desire for others to succeed” that Dr. Geralyn Datz described. He relays that today “it has become almost impossible to treat patients appropriately.  In the early years, we treated patients based on our understanding of the pain mechanisms and pathophysiology.  We experimented with injections, infusions, anticonvulsants, antidepressants, calcium channel blockers, anti-inflammatory, and other medications.  This laid the groundwork for much of what we use now or try to.  Now every pharmacist, insurer, lawyer, and government/insurance bean counter are practicing medicine and preventing, or impeding, treatment of patients.  Malpractice suits and regulatory agency threats are constant threats.  Cost effective has become the mantra instead of patient effective.  I agree with evidence-based medicine, but we had no evidence in the early years.  In fact, many of the studies now quoted began with a ‘what if we try this?’  That was our work.  It’s hard to formulate a treatment program with a bureaucrat or insurer standing in the way.  Yes, PT, complementary treatments, behavior modification are excellent alternatives to opioids, but no insurer will cover them.  Private practice is handcuffed by payors.”

When asked about the current opioid abuse/misuse crisis, John replied: “I think back to Russell Portenoy who basically asked, ‘what is the difference in pain from a vertebral fracture from metastatic cancer and from osteoporosis?’  Answer, there is none except the cancer patient will probably die sooner than the osteoporosis patient.  This was the beginning of the use of opioids for non-malignant pain.  Unfortunately, practitioners were unable or unwilling to appropriately screen and evaluate patients and prescribing went out of control.  It has become extremely difficult in this day of volume practice to appropriately evaluate who is a candidate for opioid use and who is not.  Evaluating who is and is not a candidate for chronic opioid use is not easy and is quite time consuming, and you must be able to say no.  Opioids are also being inappropriately prescribed for acute pain.  A postop hernia repair does not need 30 mg of  Oxycontin for pain management.  Back strain does not require initial treatment with opioids when other modalities have not been tried.  It is just quicker and easier to write a script than do a more complete evaluation and get other  treatments declined.  Finally, there are people who misuse or abuse opioids, and many practitioners do not take the time to weed them out.  Unfortunately, there is not a lab test for pain, and a history and physical have become relics of the past while lab studies, computers, and x-ray have taken over.”

If John could wave a magic wand to achieve a program/practice of perfect pain management, he would have two wishes.  “First, patients would be honest and not lie or manipulate, but this will never happen.  Second, there would be complete coverage for interdisciplinary treatment to include behavior modification, psychological evaluation, physical therapy, aquatic and other therapy, medications as indicated, injections as indicated, necessary evaluations and procedures, rehab and work hardening, and last but not least, any opioid prescriptions for longer than two weeks needs to be approved by a specialist. In fact, as many clinics do, no one should be placed on opioid therapy without a psychological evaluation from a qualified pain psychologist and undergo ongoing eval and treatment.”

In conclusion to reflect the wonderful Satterthwaite wisdom that Eric Pearson noted, John offered a few pearls and words of wisdom for pain management clinicians.  He stressed that “the key word is clinician.  Remember you are a professional.  If you are a one trick pony, one trick is all you have.  If the only thing you have is a hammer, you will be useless for anything but a nail.”  “Pain has been defined by the IASP as An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. The proposed new 2019 definition is: An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.  In those definitions notice three factors: actual or potential tissue injury, sensory experience, emotional experience.  Each of these aspects needs to be addressed.  Injections, pills, or counselling only deal with one issue.  Pain is a complex issue so there is no simple answer or treatment.  So, stop trying to hammer that bolt through the steel plate with your hammer.”