Pain is an essential natural sense. It helps us identify sources of danger and avoid injury. But there’s pain as a warning system, and then there’s pain as a primary or secondary symptom of illness. Whether it’s a minor tweak in your back that won’t go away or post-operative pain plaguing you for months, a professional must address some types of pain that are unlikely to go away. Finding the source of a chronic pain issue is sadly more complex than just asking where it hurts.
Pain management physicians utilize years of medical training and expertise and collaborate with specialists from different medical disciplines to identify and diagnose sources of chronic pain and establish a personalized plan of action. Pain management physicians can mean the difference between living the rest of your life with a nagging injury and taking the first step towards a pain-free existence.
Role of Pain Management Physicians
Pain management physicians are medical professionals who specialize in diagnosing and treating conditions with pain as a primary or secondary symptom, also known as pain doctors. Pain isn’t a specialization you choose in medical school – pain management physicians often have years of experience as trained residents in other fields of medicine, such as anesthesiology, orthopedics, neurology, or oncology. Upon completing board certification in a primary specialty and fellowship accreditation, physicians become eligible for subspecialty board certification in pain medicine.
Furthermore, state-specific requirements and recognized credentials are needed to become a pain specialist. As such, pain management physicians are often experienced medical doctors with a unique background in one or more fields of medicine. Pain clinics tend to employ pain management physicians with different medical backgrounds to pool together as much accumulated knowledge as possible, helping patients get better and more accurate diagnoses and develop treatment plans that consider a patient’s history and biopsychosocial health. The day-to-day of pain management physicians may include (but not limited to):
- Follow-up appointments.
- Reviewing patient progress.
- Formulating treatment plans.
- Running and studying diagnostic tests.
- Interviews and consulting appointments with patients.
- And consulting with colleagues and other medical professionals.
What to Expect at a Pain Clinic
There are at least two different kinds of pain clinics that focus entirely on one or two types of pain (such as neck injuries or pain and spinal conditions or pain) and those that focus on pain treatment in general. The former will focus on patients within their specialization, such as whiplash or slip-and-fall victims, injured workers, or patients with spinal conditions such as stenosis or spondylolisthesis. The latter will usually have a more extensive, interdisciplinary:
- Rehab doctors
- Physical therapists
- Occupational therapists
- And various doctors on board
In many cases, patients with certain conditions who are likely to seek pain management will have been advised to do so through their primary care physician. Seek pain management services from the get-go. You may find a pain clinic through the recommendation of your doctor. You might have a better idea of what you’re looking for – such as a clinic or doctor specializing in post-operative pain, neuropathy, spinal conditions, or sports injuries.
Depending on who you go to and what for, you may expect different types of service. In many cases, pain management begins with diagnostic treatments. Doctors may utilize imaging tools, nerve blocks, and physical exams to determine the causes of pain. Afterward, treatments will range from medications and non-invasive interventions to physical and mental therapy, pain pumps, or surgery.
A Holistic, Integrated, Multimodal, Interdisciplinary Approach to Pain Management
Some people misunderstand pain management as a profession mostly revolving around opioid prescriptions. While opioid medication can have an immediate effect on severe pain and help deal with cases of intractable pain, opioids are far from the only tool in pain management physicians’ repertoire. Non-opioid medication, over-the-counter drugs, muscle relaxants or anti-convulsant drugs, and anti-depressants all play a role in treating pain. Aside from medication, pain treatments can include:
- Talk therapy
- Nerve blocks
- Physical rehab
- Nerve stimulation
- Pain pump implants
- Radiofrequency ablation
- Regenerative treatments
Nerve Blocks and Stimulation
A nerve block injects certain medicines (such as an anti-inflammatory corticosteroid or an anesthetic) to reduce swelling surrounding a nerve and/or reduce pain signals. Nerve blocks can last hours, days, or even longer – some nerve blocks are used purely for diagnostic purposes to eliminate potential sources of pain. In contrast, other nerve blocks destroy a portion of the nerve to eliminate pain until the nerve regrows.
On the other hand, nerve stimulation uses electrical impulses to combat pain. A small lead wire is inserted into the body near the target nerve, and low-level electricity is used to disrupt pain signals and bring pain relief to patients who have not responded to medication. Radiofrequency ablation is another common pain management intervention, where a specialized needle is used to ablate or cut a nerve using heat. This allows the nerve to heal better while temporarily blocking pain signals to the brain.
Mental Health and Physical Therapy
Pain management physicians focus not just on treating immediate pain symptoms but also on improving a patient’s chances of avoiding or minimizing recurring pain and improving pain resilience. Physical and mental therapy can improve a pain patient’s quality of life, reduce the likelihood of recurring pain and dull chronic pain, and help combat mental health issues that actively contribute to the spread and exacerbation of pain symptoms, such as depression.
Interventional Pain Procedures, Treatments, and Surgeries
Surgical interventions may become necessary when first-line treatments are no longer effective and when a patient does not exhibit any counterindications that would otherwise rule out surgery. Surgical interventions could help stabilize a fractured spine to avoid or treat back and leg/arm pain, remove scar tissue forming around a shoulder injury, or remove inflamed tissue around an arthritic knee.
Most surgeries performed on chronic pain patients are minimally invasive, utilizing imaging technology, small flexible cameras, and specialized tools for pinpoint incision accuracy. While surgery might be necessary to treat complex injuries, it is often the last resort. More conservative methods are often preferred by doctors and patients alike, with many treatments, interventions, and alternatives to consider.