Pain Management: Specialist Or Not?

Pain management doctors are specialists in the evaluation, diagnosis, and treatment of pain. They are qualified physicians who have undergone advanced training and are often board-certified in a particular specialty, such as sports injuries or cancer pain. These doctors address both acute and chronic pain resulting from various conditions, illnesses, or injuries. While they are experts in their field, the recognition of pain management doctors as specialists by insurance providers can vary and depends on factors such as state regulations and insurance company policies.

Pain management doctors' qualifications and training

Pain management doctors, also known as pain physicians, are specialists who assess, evaluate, classify, grade, and treat pain. They have detailed knowledge of the pathophysiology of pain and the pharmacology of pain medications and are skilled in interventional procedures to relieve pain.

Qualifications and Training

To become a pain management doctor, one must first obtain a bachelor's degree in pre-med or science, followed by a doctorate in medicine (MD or DO). During medical school, it is recommended to graduate with a science-based degree such as biology, chemistry, or physics. After obtaining a medical degree, physicians must complete a medical residency, choosing a specialty such as anesthesiology, physiatry, or neurology, which aligns with pain management. In some countries, a license to practice medicine in the state or region may be required.

Following the residency, physicians can pursue fellowships, which may be mandatory for those wishing to enter highly specialized fields. Board certification is another optional step, depending on career goals. To become a certified pain management specialist, one must pass a certification exam offered by the American Board of Anesthesiology (ABA) under the authority of the American Board of Medical Specialties (ABMS). The entire process of becoming a pain management physician can take about eight to nine years.

In the UK, pain medicine is recognised as a subspecialty of anaesthesia. To become a consultant in anaesthesia and pain medicine, one must complete a three-stage anaesthetic training programme, with the final stage focusing on the special interest area of pain medicine. This comprehensive training programme covers acute and chronic pain management, providing the necessary skills to manage complex clinical and operational issues.

In India, there are various fellowship and certificate courses in pain medicine offered by universities and medical institutes. Additionally, the National Board of Examinations (NBE) has approved a dedicated two-year Fellowship National Board (FNB) in Pain Medicine, which is a structured course specifically designed for this specialty.

Skills and Traits

In addition to the extensive educational and training requirements, pain management doctors need strong interpersonal skills, excellent bedside manners, and empathy to build successful careers. Working with individuals in pain requires compassion and the ability to support patients' perseverance, hope, and trust.

The types of treatments they offer

Pain management doctors are specialists in the evaluation, diagnosis, and treatment of pain. They are qualified to treat any type of pain resulting from illness, injury, or surgery. These doctors are trained to diagnose the specific cause of pain and the underlying conditions that lead to it. They then devise a treatment plan to relieve, reduce, or manage pain.

Pain management doctors offer a range of treatments, including medication, procedures, and complementary therapies. Here are the types of treatments they offer:

Medication

Pain management doctors may prescribe medications to reduce or relieve pain. This can include over-the-counter medicines and prescription drugs. Common examples include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or celecoxib
• Acetaminophen (Tylenol)
• Topical creams, gels, lotions, or patches containing capsaicin or lidocaine
• Muscle relaxants such as baclofen or cyclobenzaprine
• Antidepressants, including SSRIs, SNRIs, and tricyclic antidepressants (TCAs)
• Anticonvulsants like gabapentin or pregabalin, which are often used for nerve pain
• Anesthetics or numbing medications, such as lidocaine
• Anti-anxiety medications, including benzodiazepines or antidepressants
• Corticosteroids for short-term use, like prednisone or methyprednisolone
• Opioids (narcotics) for severe acute pain, although these are typically prescribed for short-term use due to the risk of addiction and side effects

Procedures and Interventions

Pain management doctors also employ various procedures and interventions to alleviate pain. These include:

• Nerve blocks or spinal injections to numb pain
• Transcutaneous electrical nerve stimulation (TENS), which uses low-voltage electrical currents delivered through skin pads to painful areas
• Radiofrequency ablation (RFA), where heat or chemical agents are applied to nerves to stop pain signals, often used for chronic pain conditions like arthritis of the spine
• Viscosupplementation, which involves injecting lubricating fluid into joints to treat arthritis pain
• Implantation of a pain pump or spinal cord stimulator to relieve pain at the level of the spinal cord, the body's control center for sensing pain
• Regenerative treatments, such as stem cell therapy
• Epidural steroid injections
• Joint injections
• Neuromodulation

Complementary and Holistic Therapies

In addition to medication and procedures, pain management doctors may recommend complementary and holistic approaches. These can include:

• Physical therapy and exercise, such as yoga, swimming, or walking
• Massage therapy
• Acupuncture
• Chiropractic care
• Dietary changes and weight loss regimens
• Mind-body therapies like meditation, relaxation techniques, guided imagery, or tai chi
• Cognitive behavioral therapy (CBT) to change how the mind reacts to physical discomfort
• Biofeedback

Lifestyle Changes

Pain management doctors may also advise patients to make certain lifestyle changes to help manage their pain. This can include recommendations for:

• Losing weight if overweight or obese
• Adopting a balanced diet
• Getting adequate sleep
• Managing stress levels
• Using the RICE method (rest, ice, compression, and elevation) for injuries to bones, muscles, and soft tissues

Pain management doctors tailor their treatment plans to each patient's specific needs, combining various approaches to achieve the best outcomes. They work closely with patients to monitor their progress and adjust the treatment plan as needed.

When to see a pain management doctor

Pain management doctors are physicians who have undergone specialised training in the evaluation, diagnosis, treatment, and prevention of pain. They are qualified to treat pain resulting from illness, injury, or medical conditions. These doctors are also known as "pain doctors" or "pain specialists".

Pain management doctors can help with:

• Diagnosing the specific cause of your pain and the underlying conditions that lead to it.
• Prescribing the best therapy for you based on their specialised training and the latest research.
• Coordinating treatment between multiple doctors and healthcare professionals.
• Ongoing care for any physical or mental concerns.

You should consider seeing a pain management doctor if:

• The pain has not subsided within a week or is persisting with a specific motion.
• You are experiencing other symptoms along with your pain, such as fever or tingling in the affected area or your extremities, which could indicate nerve damage or a systemic issue.
• The pain is sharp, persistent, or otherwise causing you to suffer.
• Your pain is impacting your mobility and making it difficult to go about your day, work, or enjoy your favourite activities.
• The pain is affecting your quality of life, including your emotional health, ability to sleep, perform daily activities, or social interactions.
• You are struggling to perform day-to-day movements or activities without pain.
• You are experiencing radiating pain or strange sensations, such as numbness and tingling, which could indicate a pinched nerve or herniated disc.
• You have developed a dependency on medication to manage your pain.
• You are experiencing breakthrough pain between medication doses or serious side effects from the medication that are not responding to initial treatments.
• You are unable to get a good night's sleep due to the pain.
• You are experiencing pain that is not controlled with prescribed doses of medicine.
• You need help in learning to take an active role in managing your pain and improving your coping mechanisms.
• You would benefit from a team of specialised healthcare providers to manage your pain.

If you are experiencing any of the above, it is advisable to consult your primary care physician, who can refer you to a pain management doctor or specialist in your area.

How to get referred to a pain management doctor

If you are experiencing chronic pain, your primary care doctor may refer you to a pain management doctor. This is a medical doctor (MD) or doctor of osteopathy (DO) who has received specialised training in pain medicine. They will evaluate, diagnose, treat and prevent many different types of pain.

Pain management doctors treat both sudden and chronic pain, including headaches, back pain, arthritis, nerve pain, and pain after surgery. They can also help with pain that is affecting your mental health, or stopping you from participating in certain activities.

If you are experiencing chronic pain, the first step is to talk to your primary care doctor. They will be able to refer you to a pain management doctor, who will work closely with them to ensure good communication and the best treatment for you. You may also be referred by specialists such as surgeons, neurologists, or cancer doctors.

Before your first appointment, it's a good idea to start monitoring your symptoms and writing them down. Take any scans or medical letters you have to your appointment, as well as a list of any medications you are taking.

The goals of pain management

Pain management doctors are physicians who have undergone advanced training in the evaluation, diagnosis, and treatment of pain. They are considered specialists and are often consulted when primary care doctors are unable to treat a patient's pain.

Pain management is a complex and highly individualized field, and a pain management doctor's goals may vary depending on the patient's specific needs. However, here are some common goals of pain management:

Improve Quality of Life:

The primary goal of pain management is to improve a patient's overall quality of life. This includes reducing the impact of pain on their daily activities, relationships, emotional health, and ability to enjoy life. The focus is on helping patients regain control over their lives and return to the activities they enjoyed before pain became a part of their lives.

Reduce Pain Intensity:

While completely eliminating pain may not always be possible, pain management aims to reduce pain intensity to a more manageable and livable level. This may involve a combination of treatments, including medications, physical therapy, behavioural counselling, and complementary therapies.

Enhance Physical Functioning:

Pain management specialists encourage patients to participate in regular exercise, including stretching, cardiovascular conditioning, and weight training, under supervision. The goal is to gradually increase physical activity and improve strength and endurance without exceeding the patient's pain limits.

Improve Mental Wellbeing:

Chronic pain often leads to mental health issues such as depression, anxiety, guilt, and feelings of loss. Pain management aims to address these issues by providing emotional support and coping strategies. This may involve working with a clinical psychologist or psychiatrist as part of a comprehensive, interdisciplinary approach.

Appropriate Use of Medications:

Pain management specialists are cautious about prescribing medications, especially narcotics and opioids, due to their potential for addiction and side effects. The goal is to use medications responsibly and only when absolutely necessary, exploring alternative treatments whenever possible.

Coordination of Care:

Pain management doctors often work as part of a multidisciplinary team, coordinating treatment with surgical specialists, occupational therapists, physical therapists, and other healthcare professionals to meet all the patient's needs.

Overall, the goals of pain management are to reduce pain, improve function, enhance quality of life, and provide patients with the tools and support they need to manage their pain effectively.

Frequently asked questions