Pain Management Specialists: What They Do, How to Find One
Doctors who specialize in pain management recognize the complex nature of pain, and a pain doctor "approaches the problem from all directions," Yonan said. Ideally, treatment at a pain clinic is patient-centric, but in reality this may depend on the available resources of the institution. Currently, there are no established standards for the types of disciplines that must be included, and this is another reason why treatment offerings will vary from clinic to clinic.
But at the very least, experts say that a facility should offer to patients three types of physicians: a coordinating physician, who provides consultation to specialists on your behalf, a physical rehabilitation specialist, and a psychiatrist, to help you deal with any accompanying depression or anxiety, especially if you have chronic pain.
Other medical specialties represented in pain management are anesthesiology, neurosurgery and internal medicine. Your coordinating physician may also refer you for services from occupational medicine specialists, social workers and/or alternative and complementary medicine practitioners.
To qualify as a pain management specialist in the eyes of the American Board of Medical Specialties, a health care provider should be an MD with board certification in at least one of the following specialties:
- Physical rehabilitation
- Psychiatry and neurology.
Dr. James Dillard, an assistant professor of medicine at Columbia University College of Physicians and Surgeons, says that the pain management physician should also have her or his practice limited to that specialty in which they hold the certification. You can check to see if the doctors at the pain management clinic you are considering are board certified by going to the American Board of Medical Specialties web site.
Goals of Pain Management
While some types of pain come from primary sources such as headaches, and others from secondary sources such as from surgery, the field of pain management treats all of it as a disease. This allows for the application of science, and the latest advances in medicine to relieve your pain. And while many patients, especially those in chronic pain, see a psychiatrist or therapist as part of the experience, learning to cope with pain is less and less the focus of treatment.
"We now have many modalities, including medication, interventional pain management techniques (nerve blocks, spinal cord stimulators and similar treatments), along with physical therapy and alternative medicine to help reduce the pain," says Yonan.
The goal of pain management is to minimize pain, rather than eliminate it. This is because quite often it is not possible to completely do away with it. Two other goals are to improve function and increase quality of life. These three goals go hand-in-hand.
As a first-time patient in a pain management clinic, you might experience the following:
- Diagnostic tests, if necessary, as determined in the evaluation.
- Referral to surgeon, if indicated by the tests and evaluation.
- Interventional treatment, such as injections or spinal cord stimulation.
- Physical therapy to increase range-of-motion and strength, and to prepare you to go back to work.
- Psychiatry to deal with depression, anxiety and/or other issues that may accompany your chronic pain.
- Alternative medicine to provide a complement to your other treatments.
Back and neck pain sufferers who do best with a pain management program, says Yonan, are those who have had multiple back surgeries, including failed surgeries, and are still in pain, those with neuropathy, and those for whom it has been determined that surgery would not benefit their condition.
"People who have become addicted to pain medication actually need more sophisticated help than what a pain management program can offer them. A chronic pain rehab program is a better choice for these people," he says.
According to Pain Physician, results from research studies on pain management are not always applicable to the problems patients come in with to the clinics on a day-to-day basis. Unfortunately, this has a negative effect on insurance reimbursement and other payment arrangements, as well as standardization of this medical specialty.
"Better understanding of pain syndromes by communities and insurance companies and more studies on pain will help increase insurance coverage for pain management treatments. In the future, the use of technology will help improve the outcomes of interventional pain management techniques," Yonan says.
Manchikanti, L. MD, Mark V. Boswell, M. MD, PhD., James Giordano, J. PhD Evidenced Based Interventional Pain Management: Principles, Problems, Potential and Applications Pain Physician 2007; 10:329-356
Personal Interview. Dr. Sameh Yonan, MD, Pain Management Specialist at Hillcrest, Willoughby and South Pointe Pain Centers at Cleveland Clinic Health System
James N. Dillard, MD., DC. CAc. The Chronic Pain Solution: Your Personal Path to Pain Relief Bantam Dell a division of Random House New York 2003