Pain Management With Therapy

What to expect from your pain management specialist

A pain management specialist is a doctor who evaluates your pain and treats a wide range of pain problems. A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain. Patients are seen in a pain clinic and can go home the same day. Pain management doctors offer a mix of medication-based treatments and procedures, that can stop the pain at its source.

A pain specialist is a doctor who is an authority on managing pain in his or her own field, whether it’s neurology, anesthesiology, or even psychiatry. Find out which type of specialist you should consider seeking and how you could benefit.

When pain control seems beyond reach, it may be time to turn to a pain specialist, an expert within his or her own field: A pain specialist in neurology knows how to treat stubborn migraines, a pain specialist in anesthesiology can handle delicate lung cancer operations, and a pain specialist in orthopedic surgery can address issues that arise around joint replacements, just to name a few examples.

As with any ailment, the first stop for patients looking for pain treatment should be their primary care physician. However, if you can’t find a satisfactory pain management program within an appropriate length of time or if your pain is getting worse, referral to a pain specialist may be the next step.

What Does a Pain Specialist Do?

Unlike acute pain, which is generally caused by a sensation in the nervous system designed to alert a person to a possible injury or ailment and the need to get it treated, chronic pain lasts much longer. Sometimes it may start as acute pain in the form of a sprained back or serious illness that continues much longer than it should. In other cases it might be due to an ongoing condition. Still other patients have pain despite no evidence of an injury.

Common types of chronic pain include:

  • Back and neck pain
  • Arthritis
  • Migraines
  • Shingles
  • Cancer pain
  • Nerve pain

Pain Control by Specialty

While acute pain usually improves with time, chronic pain can linger and may even require intervention. How a pain specialist chooses to proceed with pain control depends greatly on his background and expertise. Pain specialists can come from a wide variety of specialties:

  • Anesthesiologists. Anesthesiologists can offer nerve blocks, trigger point injections, and oral medications. They may also be able to implant devices like stimulators and pumps.
  • Neurosurgeons. These specialists can often do spine or nerve surgery, procedures related to the spinal cord or brain, and disk replacement or spine fusion surgeries, among other pain treatment techniques. They may also provide nerve blocks, implantable devices, and oral medications.
  • Physiatrists. Physiatrists are rehabilitation physicians who use various kinds of therapy including physical, recreational, and occupational therapy, and focus on exercise and movement. Some may also do nerve blocks, implant stimulators, and possibly medication pumps.
  • Psychiatrists. In addition to prescribing oral medications, psychiatrists may offer cognitive behavioral therapies, family counseling and group therapy, hypnosis, and biofeedback, among other therapies. Many psychiatrists focus on how the patient reacts to pain and issues related to how the pain is affecting the quality of life.

Introduction to pain management

Pain management can be simple or complex, depending on the cause of the pain. An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:

  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Acupuncture and other alternative therapies; and
  • Referral to other medical specialists
  • All of these skills and services are necessary because pain can involve many aspects of a person’s daily life.

Role of the Pain Management Specialist

Diagnose the Cause of Back Pain

Before the physician can treat the patient’s pain, he must understand the cause of the pain. In some pain cases the cause may be obvious, such as a spinal fracture. In cases of chronic pain, the cause(s) may be elusive and make diagnosis difficult. The physician relies on the patient’s medical history, physical and neurological examinations. Additional diagnostic tools help to support or rule out a suspected diagnosis.

In-depth Patient Evaluation

The physician and patient talk in-depth about the patient’s current problem and medical history. The physician may ask when and how the pain started, for a description of the pain, about activities that increase or reduce pain, and current or past treatments.

Physical and Neurological Examination

A physical examination assesses the patient’s vital signs; pulse, respiration, heart beat, blood pressure, and so on. A neurological exam evaluates the patient’s sensory (feel) and motor (function) capabilities including reflexes, balance, ability to walk, muscle strength and muscle tone.

  • X-Ray or Radiograph is a common test performed to reveal the condition of the body’s bony structures. Results may suggest more testing is necessary.
  • CT scan (Computed Tomography) is a 3-dimensional imaging study also used to evaluate bone and soft tissue. Each detailed anatomical picture resembles slices or cross-sections of the specific area of the body.
  • MRI (Magnetic Resonance Imaging) is a powerful imaging tool. MRI is commonly used for musculoskeletal evaluation as it provides great detail about bones and soft tissues.
  • PET scan (Positron Emission Tomography) uses small amounts of radionuclides (radioactive isotopes) to measure tissue changes at the cellular level. This test is performed when cancer is suspected.
  • Discography allows the physician to evaluate the intervertebral discs (one or more) as a possible pain source. The test evaluates the structural integrity of the discs and may be used to replicate back or leg pain. The procedure involves the use of a contrast dye injected into each suspect disc to be examined by x-ray or CT scan.

Some Facts About Pain

  • Most people don’t have to live with pain. There are pain treatments. While not all pain can be cured, most pain can be managed. If your doctor has not been able to help you, ask to see a pain specialist.
  • The side effects from pain medicine are often manageable. Side effects from pain medicine like constipation, dry mouth, and drowsiness may be a problem when you first begin taking the medicine. These problems can often be treated and may go away as your body gets used to the medicine.
  • Your doctor will not think you’re a sissy if you talk about your pain. If you’re in pain, tell your doctor so you can get help.
  • If you use pain medicine now, it will still work when you need it later. Using medicine at the first sign of pain may help control your pain later.
  • Pain is not “all in your head.” No one but you knows how your pain feels. If you’re in pain, talk with your doctor.