DO I NEED A PAIN MANAGEMENT DOCTOR?
DeWayne Lockhart, Jr. MD
BASED ON ABA AND ASRA RECOMMENDATIONS
1. What does a pain management specialist do?
A pain management specialist is a physician with special training in evaluation, diagnosis, and treatment of all different types of pain.
Pain is actually a physical or an emotional experience. This very definition creates its complexity and need for someone specialized enough to understand how to diagnose and appropriately treat it.
Pain is a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of many of the above. Pain can also arise for many different reasons such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Occasionally, pain can even be the problem all by itself, without any obvious cause at all.
2. Why do I need to see a pain doctor?
We here at Associates in Medicine & Surgery understand that as the field of medicine learns more about the complexities of pain, it has become more important to have physicians with specialized knowledge and skills to treat these conditions. We offer an in-depth knowledge of the physiology of pain, the ability to evaluate patients with complicated pain problems, understanding of specialized tests for diagnosing painful conditions, appropriate prescribing of medications to varying pain problems, and skills to perform procedures (such as nerve blocks, spinal injections and other interventional techniques) are all part of what a pain management specialist uses to treat pain. In addition, the broad variety of treatments available to treat pain is growing rapidly and with increasing complexity. With an increasing number of new and complex drugs, techniques, and technologies becoming available every year for the treatment of pain, the pain management physician is uniquely trained to use this new knowledge safely and effectively to help his or her patients. Finally, the pain management specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with a multidisciplinary approach to the treatment of their pain.
- What should I look for in a pain management specialist?
The most important consideration in looking for a pain management specialist is to find someone who has the training and experience to help you with your particular pain problem and with whom you feel a comfortable rapport. Many types of chronic pain may require a complex treatment plan as well as specialized interventional techniques, so pain specialists today must have more training than in the past.
The widely accepted standard for pain management education today is a fellowship (additional training beyond residency which occurs after graduating from medical school) in pain management. Most fellowship programs are associated with anesthesiology residency training programs. There are also fellowship programs associated with neurology and physical medicine and rehabilitation residency programs. The fellowship consists of at least one year of training in all aspects of pain management after completion residency training.
In addition you also should ask whether they have experience with your specific pain condition and what types of treatments they offer. Do they only perform procedures or do they use a multidisciplinary approach to pain management? Who do they refer to for other treatment options such as surgery, psychological support or alternative therapies? How can they be reached if questions or problems arise? What is their overall philosophy of pain management?
- How can I be referred to a pain management specialist?
This all depends on your particular insurance provider and their requirements. The best way to be referred to a pain management specialist is through your primary care physician. Most pain physicians prefer to work closely with your primary care physician to insure good communication, which in turn helps provide the optimum treatment for you as a patient. Patients are also often referred by specialists who deal with different types of pain problems. Back surgeons, podiatrists, neurologists, cancer doctors, as well as other specialists usually work regularly with a pain physician and can refer you to one.
- What should I expect during my first visit to a pain management specialist?
On your first visit to a pain management specialist, he or she will get to know you and begin to evaluate your particular pain problem. This will usually involve a detailed history, a physical exam and review of tests that you have had performed. The questions you are asked and the physical examination will typically focus on your particular problem, but your pain physician will want to know about past and current medical history as well. Providing all of your relevant medical records is important for review prior to this visit in order to obtain the most out of your visit.
Often you will be given a questionnaire before your first visit that will ask detailed questions about your pain problem, and you will probably be asked to bring any imaging studies (such as X-rays, computed tomography [CAT/CT] scans, or magnetic resonance imaging [MRI] scans) or other tests that have already been done. You should know before your first visit whether or not a procedure is anticipated. If so, you may need a driver to take you home.
Most importantly, this visit is an opportunity for your pain physician to begin to analyze all of this new information and discuss with you an initial assessment of your pain problem. He or she may know exactly what is causing your pain, or perhaps further diagnostic procedures will be needed. But no matter what type of problem you have, you should leave this first visit with a clearer understanding of your pain and the course of further evaluation and treatment that is planned.
