What is Pain Management?
By Dr. Arthur Schurgin • Copyright 1997
I started to answer this question in a copyrighted piece entitled “Top Ten Questions” that I wrote in 1997. When I look back, I am surprised how much of this still applies to my patients today. While technological advances in medical therapeutics change the field of Interventional Pain Management on an almost daily basis, the way we relate to our patients doesn’t change.
To my way of thinking, the term Pain Management can be a bit misleading. The term “management” sort of implies that you are always going to have significant pain and that the pain specialist is there to simply help you live with it. More often than not, that is simply not the case.
While it is true that some patients may always have pain from a chronic condition, at Comprehensive Pain Management, we believe in minimizing pain and optimizing your potential. Therefore, our emphasis is on helping you to recover as much function as possible with the minimum invasiveness.
What is Pain Management? Pain Management is the medical subspecialty dedicated to the treatment of patients with serious chronic and acute pain problems. Treatments may range from prescribing medications and physical therapy to manual medicine (manipulation) to nerve blocks and other injections for specific types of pain problems.
What is a Pain Management Specialist? A Pain Management Specialist is a physician who devotes himself/herself primarily to the treatment of patients with acute and chronic pain. Most often, the Pain Management Specialist is an Anesthesiologist or Physical Medicine and Rehabilitation Specialist by training. However, many other types of Physicians are actively involved in the treatment of pain.
How do I know if I need a Pain Management Specialist? Usually your Family Physician or other treating Physician will help you to determine this. When your pain problem does not respond to conservative treatments such as medications, manipulation, and physical therapy, you may want to ask your Doctor about the services of a Pain Specialist. If your pain problem is significantly affecting your daily life, a Pain Specialist may be able to help you.
Does my insurance cover the cost of a Pain Management Specialist? Generally, yes. Please check with our office regarding your insurance coverage. We participate in most major health plans and accept Worker’s Compensation and Motor Vehicle Liens. For the most part, these services can be covered.
What can I expect when I see a Pain Management Specialist? First of all, the Pain Specialist will get to know you, both personally and medically. He or She will discuss your pain problem, in detail, as well as your medical history. The Pain Specialist will also discuss your pain problem as it affects the rest of your life. A physical examination will also be a part of your first visit to a Pain Specialist. Any X-rays, MRI’s or other available studies can be evaluated at the same visit. In this way a diagnosis and a plan of action can be determined. In other words, a strategy for managing your pain problem will be developed.
What’s next? Depending on your particular type of pain problem, a variety of treatments may be prescribed. First of all, a physical therapy and exercise program may be prescribed if physical conditioning needs to be improved. Medications may be prescribed, when appropriate. These medications may include specific pain medications known as analgesics. Since sleep is frequently disrupted with serious pain problems, improving the sleep pattern can actually reduce pain significantly. If manual medicine (manipulation) has not been tried, the Pain Specialist may prescribe it. Finally, injection therapy, such as Nerve Blocks may be recommended.
What are nerve blocks? Nerve blocks are injections in specific areas of the body directed at specific types of pain problems. Examples are epidural injections for disc problems in the back or neck, facet injections for arthritic pain in the spine, and trigger point injections for severe muscle pain. Medication injected via nerve blocks often includes a local anesthetic such as xylocaine and medications similar to cortisone.
Nerve blocks can dramatically reduce the level of pain promptly in many conditions. Nerve blocks, however, are only one piece of the Pain Management puzzle. Nerve blocks frequently need to be combined with other treatments such as Manipulation and Physical Therapy to have a long-term positive impact.
What can I expect from a nerve block procedure? Most patients are a little apprehensive if they have never had a nerve block. Your Pain Management Specialist will clearly explain the procedure to you before beginning and will answer all of your questions. In skilled hands, nerve blocks are extremely safe. However, your Doctor will discuss potential risks and benefits ahead of time. In this way, you will understand what to expect from the procedure. Most patients find nerve blocks to be surprisingly easy and comfortable.
What are the long term goals of a Pain Management Specialist? Simply put, the long-term goals of the Pain Management Specialist are reduction of pain and improvement of function. This may not be as simple as it sounds. Many factors are involved in making the long-term changes necessary to overcome chronic pain. Some of these factors are discussed below.
What about prevention of chronic problems in the future? Your Pain Management Specialist will work with you to develop a plan to prevent or reduce chronic pain problems in the future. The plan may include: improving physical conditioning, reducing tobacco, alcohol and caffeine use, and attention to emotional issues, which may impact on your pain problem. Together, you and your Pain Management Specialist can agree on a strategy that suits your needs and will serve you well in the future.