Pain Management

Pain management combines techniques that help patients reduce or better tolerate pain. Today, expert physicians known as pain specialists have many options to help patients ease pain.

Pain results from the interaction between three components of the nervous system: the peripheral nerves, spinal cord and brain. Nociceptive pain occurs when nerve receptors that sense tissue damage are stimulated by an unpleasant sensation. Neuropathic pain is caused by damage to the peripheral nervous system or central nervous system.

There are two major types of pain:

People who develop significant pain often find that it overwhelms many aspects of their lives. Their personal relationships and work productivity may suffer, and their appetite may be reduced. Pain limits the mobility of some patients and prevents them from performing daily tasks. In many cases, pain also takes an emotional and psychological toll, fostering irritability, depression and feelings of hopelessness or even suicide. Experts in pain management refer to the presence of three symptoms related to pain – suffering, sleeplessness and sadness – as the “terrible triad.”

Untreated or undertreated pain can create an extreme rise in pain levels and patient anxiety. Pain management is best achieved by regular administration of pain medicine, or other treatments, to control the pain. When pain is under control, the patient’s quality of life is greater and the vicious cycle of ever-increasing pain can be alleviated. Patients whose pain is under control find they are less stressed physically and emotionally and are better able to sleep, focus on work and enjoy social activities and relationships with loved ones.

The best way to treat painful symptoms is to seek medical care to help alleviate the pain and diagnose the cause. Patients usually will see their primary care physician first to get a diagnosis and receive initial treatment. Some disorders will require consultation with a specialist to determine a cause. However, severe acute pain and chronic pain are often best treated by a pain specialist. These physicians are experts in all aspects of pain, including its causes, how the body reacts to pain signals and how medications or other treatments can dull or eliminate pain.

Many physicians who specialize in treating pain are anesthesiologists. These are the medical professionals who make sure that patients do not experience pain during and after surgery or other procedures, such as childbirth. In addition, many neurologists are skilled in pain management, especially for neuropathy, neuralgia and migraines and other headaches.

Physicians specializing in pain management usually have advanced training in the field of pain medicine (e.g., pain fellowship training), as well as certifications from a variety of boards, such as the American Board of Anesthesiology or the American Board of Pain Medicine.

In some cases, the anesthesiologist will lead a team of medical professionals dedicated to managing a patient’s pain. These may include physicians such as neurologists, orthopedists, oncologists and psychiatrists. It may also include other medical personnel such as nurses, physical therapists, occupational therapists and psychologists. This kind of treatment is known as multi-disciplinary approach to pain and has been seen to be most effective for various chronic pain conditions.

Other specialists who treat pain conditions include:

• Rheumatologists, who specialize in rheumatic conditions such as arthritis and lupus
• Physiatrists and sports medicine physicians, who specialize in musculoskeletal conditions such as tennis elbow and shin splints

In diagnosing the cause of pain, the physician will review the patient’s medical history and should perform a physical examination. Patients will be asked to describe their pain in detail – location, duration, aggravating or relieving factors. Patients may also be asked to fill out a pain assessment questionnaire that helps the physician to determine how pain is affecting their life.

Diagnosis may be a lengthy process for some disorders, such as fibromyalgia. A wide range of diagnostic tests may be used, such as blood tests, urine tests, x-rays, radionuclide imaging or CAT scan (computed axial tomography).

Many treatments are available to alleviate pain. In many cases, they will be combined as part of a treatment plan to treat the underlying condition and the pain that results.

Injection therapy may be an option. Local anesthetics and/or corticosteroids can be injected around nerve roots or into muscles and joints. Such injections can reduce swelling, irritation, muscle spasms and abnormal nerve activity. For example, local anesthetics and corticosteroids can be injected in epidural space (the area between the protective covering of the spinal cord and vertebrae) for back pain. With nerve blocks, local anesthetics and/or corticosteroids can be injected to block a group of nerves (known as a plexus or ganglion) from causing pain in a specific organ or body region. For instance, a nerve block may be injected around the sciatic nerves for sciatica pain.

Many modalities (physical therapeutic agents) are used in pain management. Some, such as heating pads or cold packs, can be used at home. Others, such as ultrasound therapy, require the expertise of a professional such as a physical therapist or occupational therapist.

Some patients find relief from complementary and alternative techniques such as acupuncture, acupressure, biofeedback or hypnotherapy. Patients are advised to consult their physician before trying alternative methods, including nutritional supplements.
Surgery is usually a last resort for patients who do not respond to other therapies.

Patients who wish to see an expert in pain management can ask their physician to recommend a pain specialist. In some cases, patients may find these experts at a local pain treatment center. These may be referred to by several names, including pain clinic, pain management center, pain unit or pain service. In some cases, these facilities are attached to a hospital or medical center. In other cases, they are stand-alone facilities.
Services offered vary, so it is important for patients to find a facility that has the right expertise for treating their condition. A patient’s primary physician is usually the best resource for finding the appropriate pain experts.

Before receiving any care, patients should be sure the prospective pain specialist has the proper accreditation, preferably from a national organization such as the American Board of Anesthesiology or the American Board of Pain Management. Patients should also contact their health insurance company to see which costs will be covered.

The goal of therapy is usually to improve the quality of life and to reduce pain if possible. Before treatment begins, clients should be allowed to state their desired outcome.

Medical and technological advances have made pain more manageable today than ever before. However, in many instances pain goes untreated, undertreated or mistreated. Some patients believe that they must live with their pain. Others are afraid to request pain medications for fear of becoming addicted to them, even though this rarely occurs when medications are used properly.

In addition, many physicians have had little training in pain care and may be unaware or not fully informed of treatments that can help to relieve pain. When used properly under the close supervision of a physician, medications such as opioids can be used to treat pain without causing dependency and addiction.

It is important for patients to seek advice from a pain physician earlier in the course of the pain. Patients should not be embarrassed about their pain or afraid to voice their concerns out of fear of appearing weak or complaining. Pain that goes untreated may worsen other health problems, delay recovery and interfere with the healing process. Untreated pain worsens not only overall pain control but also the patient’s qualify of life. It is important that patients seek out proper care and not give up until they find an effective method of pain relief.