People often erroneously think of treatment by a pain management specialist as consisting of only narcotic “pain killers.”
However, the practice of pain medicine or pain management is diagnosis driven just like other medical specialties. Just as one goes to a cardiologist for an evaluation of heart disease and receives treatment based on a unique diagnosis, a visit to a pain management specialist results in unique treatment because every patient with pain is also different. The discipline of pain medicine is concerned with the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders.
Pain affects more Americans than diabetes, heart disease and cancer combined. There are approximately 116 million Americans with chronic pain, defined as pain that has lasted more than three months and 25 million people with acute pain.
Like other doctors, the pain management specialist must examine each patient and create a treatment plan based on the patient’s symptoms, examination and other findings. For example, the cardiologist must first examine you and make several determinations. These include deciding whether your heart disease will respond to weight loss and exercise, whether you have high blood pressure and need medication to lower your blood pressure or whether your cholesterol is elevated or whether you have a blockage and need an interventional procedure or as a last resort, whether you might need to be referred to a cardiac surgeon for coronary bypass surgery.
All patients with heart disease do not take the same medications. It depends upon the cause of the problem. Just as there are different treatment options available for heart disease, there are a vast number of treatment options available for spinal or orthopedic pain.
While patients may go to a pain management physician because they “hurt,” just as they go to a cardiologist because they all have heart problems, all pain does not respond to narcotics. It is an unfortunate and common misconception that if patients go to the pain management doctor, they will be treated with narcotics.
Treatments for spinal or orthopedic pain vary just like treatments for heart disease vary. It depends on what is the cause of your problem.
First of all, it is important to understand that there are different types of spinal or orthopedic pain. One might have muscular pain, ligamentous pain, joint pain, bone pain, pain due to a herniated disks, pain from a fracture, or pain from a pinched nerve or a nerve injury. Pain medicines are prescribed based upon the source of the pain.
Some patients who come to pain management never need pain medications. They may respond to an injection, other intervention, bracing, or to physical therapy. Our knowledge has increased to where we understand more on how poor posture and walking improperly all perpetuate musculoskeletal pain. With sophisticated use of exercises, tailored to a patient’s specifics needs, physical therapy may be helpful.
An evaluation in physical therapy may reveal that the patient’s pain is a result of poor movement, tight muscles, stiff muscles, weak musculature, or postural problems. For example, we know that patients who have degenerative disk disease, where the disk between two bones has started to wear and tear, can decrease the pressure on the disk by doing exercises to increase your core musculature and eliminate or reduce back pain.
Like the cardiologist who performs interventional procedures such as cardiac catheterizations, pain management physicians perform interventional procedures to eliminate or reduce pain, and surgery as in other areas of medicine should always be the last resort.
When you initially go to your cardiologist because of a minor problem, I am sure that most of you would not ask “do I need surgery?” One usually wants to explore other options before surgical interventions are explored.
From experience, I have learned that patients do best with treatment by a pain management specialist when they come with the same open mind and attitude where they are willing to explore numerous options and not become focused primarily on getting narcotics or thinking that surgery is their only option.
I used the example of the cardiologist because I know that most of us would prefer that the cardiologist explore all options before referring us to a cardiac surgeon. This is the same approach that one should use when they have an orthopedic or spinal problem. Always ask about non-surgical options for your orthopedic or spinal pain.
The pain management physician, like the cardiologist, does not perform surgery. The cardiologist does interventional techniques, prescribes medications, and oversees your cardiac rehab program. Likewise, a pain management physician manages and directs your physical therapy or rehabilitation program, prescribes medications, and performs interventional procedures. Both the cardiologist and pain specialist will refer you to a surgeon when needed.
Timing is key to the success of your treatment. You should not delay an evaluation for heart disease, nor should you continue to ignore spinal or orthopedic pain, and wait too long before seeking an evaluation with a pain specialist. I have seen far too many patients wait too late in their treatment before seeking care with a pain specialist. Like other specialties, early intervention might lead to a better outcome.
Pain management is a process. It consists of many treatment options and more importantly, the treatment for your pain may not be the same as it is for your neighbor. Just like a pacemaker may be the treatment of choice for your spouse but not the treatment of choice for you when you see a cardiologist.
With advances in pain management there are a number of treatment options and narcotics are not the treatment of choice for everyone who sees a pain management specialist.