What Is a Pain Medicine Specialist?
A pain medicine specialist or a pain management specialist is a physician who is trained in the specific discipline within the field of medicine that is involved in the evaluation, the treatment, and the rehabilitation of people who are in pain. Pain has a wide spectrum that includes acute pain and chronic pain. Post-operative pain and pain in connection with a malignancy or cancer are symptoms related to another condition or disease. There are also other cases where pain is the primary problem. This is true for neuropathic pain and headaches.
A pain medicine specialist may act as a consultant to other doctors or serve as a patient’s principal physician. They are expected to have the ability to evaluate patients who are suffering from complex pain problems and an in-depth knowledge of the physiology of pain. This is necessary so that they can prescribe the appropriate medication and perform procedures skillfully. As the number of new and complex techniques, drugs, and technologies increase, pain medicine specialists must use their knowledge to help their patients safely and effectively. They use a multidisciplinary approach to develop a comprehensive treatment plan for their patients.
In order to become a pain medicine specialist, a doctor must acquire additional training after medical school and residency. This comes in the form of a fellowship program. Depending on the physician, his fellowship training may be associated with neurology, anesthesiology, physical medicine or rehabilitation. This typically lasts one year and through that time period, the physical is trained in various aspects of pain management.
The program’s completion is marked with board certification in pain management. The American College of Graduate Medical Education recognizes three board certifications in pain management. These three are from the American Board of Psychiatry, the American Board of Anesthesiology, and the American Board of Physical Medicine and Rehabilitation.
Aside from education and training, certain things should also be looked at in choosing a pain management specialist to determine if he would work well with a certain patient or a certain condition. Check if a physician has experience in treating your specific condition and if you are interested in specific treatments, ask what types of treatments they offer. It may also be a consideration to find out whether they use a multidisciplinary approach or they only perform procedures. Certain factors also come into consideration, like a patient’s cultural background and the special needs of pediatric and geriatric patients.
Pain management specialists are responsible for the treatment of a wide ranges of conditions, including lower back pain, knee pain, fibromyalgia, arthritis, head pain and migraines, hip pain, neck pain, sciatica, nerve pain, and complex regional pain syndrome (CRPS).
Patients often meet their pain medicine specialists through a referral from their primary care physician, neurologist, cancer doctor or surgeon. On the first consultation, the pain medicine specialist’s primary purpose is to understand the symptoms or the pain that the patient is experiencing. In order to do this, they will provide a questionnaire or do an interview to find out a patient’s detailed history and symptoms. In conjunction with that, they will also conduct a physical exam and request for appropriate tests, like x-rays, CT scans, and MRIs, among others.
In developing a treatment plan, a pain medicine specialist has several options. These include:
Together with these options, a pain medicine specialist also offers counseling to the patient and his family, directing a multidisciplinary team to put the treatment plan into effect, and coordinating with other physicians or healthcare providers for additional care like rehabilitation programs, physical therapy, and psychological therapy.
Pain Relieving Procedures
In other cases, the pain management doctor may also recommend complementary therapies like massage, acupuncture, physical therapy, chiropractic care, exercise, yoga and meditation, as well as diet changes and weight loss.
The quest to tame pain has been ongoing since the ancient times. It was almost vital for survival as people realized that the experience of pain hampers the body’s ability to heal. Similarly, the numbing of pain was also important in performing surgeries, especially the crude procedures of the past. The techniques adopted by the ancient peoples range from enlightened to horrific.
Ice was a common pain killer used to numb body parts by many cultures, but then some believed that bleeding a person up to the point of unconsciousness was the way to relieve pain. Some Native American cultures thought that a person’s pain and illness can be extracted by holding pain pipes against the patient’s skin and sucking out the undesirables. Inca shamans chewed coca leaves, a natural and mild version of cocaine, while drilling holes in the patients’ heads. This practice was believed to release evil spirit and relieve pain. They would periodically spit into the wounds and the coca-resin spittle would make the gash sufficiently numbed until the procedure ends.
The Chinese turned to the use of needles and developed the practice of acupuncture while Egyptians capture electric eels from the Nile to be lain on wounds. Heeding the advice of Socrates, the Ancient Greeks used the willow’s bark and leaves to help women during childbirth. Today, we know that the willow contains a form of salicylic acid which is the active ingredient of the common painkiller we know today, aspirin.
Other plant by-products had been discovered to provide relief to pain. Some of which are marijuana, belladonna, jimson weed and mandrake. Finally, opium, a derivative of the poppy plant, made surgery an option with its anesthetic properties. Soldiers began carrying small sacks of opium into battle. Letheon was a word popularized by Virgil, to refer to poppy-induced sleep.
During the Middle Ages, the most popular method of inducing narcosis was through the soporific sponge. Its ingredients include opium, lettuce seed, mandrake, mulberry juice, ivy and hemlock. To use it, it is dipped in water and then squeezed into the mouth. Not only was it an effective medicine, there was also a countermeasure to it. Its effects could be reverse by intake of juice made from fennel root or by drinking vinegar.
In the 16th Century, chemists crafted laudanum, which is opium prepared in an alcoholic solution. Then in the 19th Century, morphine, the active substance in opium poppy, was extracted in its pure form. Because of its highly addictive nature, this eventually led to the First Opium War.
In 1830, Jean-Pierre Robiquet first isolated codeine, a naturally occuring methylated morphine. It was used to replace raw opium and was primarily used as a cough remedy.
It was American medical science that birthed and introduced surgical anesthesia to the world. In early 1840s, Crawford W. Long became the first physician to use modern chemical anesthetic during a major surgical procedure. He discovered the potency of ether through one of the vapor parties done with his fellow physicians.
One of Long’s patients, James Venable, had been putting off and evading a surgery to remove two large cysts on the back of his neck due to his fear of pain. Long suggested the use of ether and the patient agreed. Long placed an ether-soaked towel over Venable’s face and once the patient was asleep, proceeded with the operation as normal. However, this medical breakthrough is not credited to Long as he did not publish his results until 1849. In 1846, William Morton had published about his work in using ether to induce deep sleep. Despite this, Long continued to think only of his patients and he was also the first to use ether for a relatively pain-free childbirth.
In 1844, American dentist Horace Wells used nitrous oxide, more popularly known as the laughing gas, in a dental operation. This idea came about in a similar fashion as ether did to Dr. Long. Wells participated in laughing gas socials with his colleagues and was deemed perfect for minor dental surgery because it wore off quickly and did not put the patients into deep sleeps.
In 1847, James Simpson used chloroform but due to its strength, waking up after its use took unusually long and its use never became popular. In 1910, it was finally banned following fatal incidences in a number of surgical cases.
In 1880, cocaine was used for local anesthesia and was highly touted by Sigmund Freud. Liquid cocaine drops were dripped into his eyes in 1884, and he had a successful and painless eye surgery. Through the early to mid-20th century, local anesthetics became more effective as more drugs were developed. THese were mainly derivatives of cocaine, namely: eucaine, novocaine, and lidocaine.
Although some form of aspirin has been in use prior, it was not until 1895 that Frederick Bayer and Felix Hoffman properly formulated
After local anesthetics, regional drugs or nerve blocks were developed. A particular procedure of great significance was the epidural in the 1950s which numbed a woman’s body from the waist down to relieve pain during childbirth.
Finally, the most powerful of pain medications became known as general anesthesia which induce sleep and immobilize the body for major surgery. It is administered today through gas or an intravenous line.
The development of new and more effective painkillers continue to advance medical science and improve patient care. Hyptiva is such a drug. It is safe for people who have kidney and blood diseases, and it is also well-tolerated by geriatric patients. It also allows the patient to wake up within minutes of stopping its flow into the body.
Baker, R. (2009). Epidural steroid injections. KnowYourBack.org. Retrieved from https://www.knowyourback.org/KnowYourBack/Treatments/InjectionTreatmentsforSpinalPain/EpiduralSteroidInjections
Baker, R. (2013). Radiofrequency neurotomy for facet and sacroiliac joint pain. Spine-health. Retrieved from https://www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain
Bone, Muscle and Joint Team. (2018). 4 injections that can banish joint pain for months. Retrieved from https://health.clevelandclinic.org/4-injections-that-can-banish-joint-pain-for-months/
Cherney, K. (2016). Osteoarthritic medications list. Healthline. Retrieved from https://www.healthline.com/health/osteoarthritis/medications-list
de Falla, K. (2016). Muscle relaxants. Spine-health. Retrieved from https://www.spine-health.com/treatment/pain-medication/muscle-relaxants
de Falla, K. (2016). Non-steroidal anti-inflammatory drugs. Spine-health. Retreieved from https://www.spine-health.com/treatment/pain-medication/nsaids-non-steroidal-anti-inflammatory-drugs
Dvorksy, G. (2013). A brief history of painkillers (and why they work). Retrieved from https://io9.gizmodo.com/how-drugs-work-to-help-you-ease-the-pain-1452216695
Griffin, R. M. (n.d.). Pain relief: How NSAIDs work. WebMD. Retrieved from https://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work#2
Mayo Clinic Staff. (n.d.) Antidepressants: another weapon against chronic pain. Mayo Clinic. Retrieved from https://www.mayoclinic.org/pain-medications/art-20045647
Opioids and chronic pain. (2011). NIH Medline Plus. Vol. 6, No. 9, Page 9. Retrieved from https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg9.html
Opioid (narcotic) pain medications. (n.d.). WebMD. Retrieved from https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1
Neuromodulation. (n.d.). Weill Cornell Medicine. Retrieved from https://painmanagement.weillcornell.org/health-library/neuromodulation
Poppy, B. (2016). How nerve blocks work to relieve pain. Retrieved from http://www.painphysicians.com/blog/how-nerve-blocks-work-to-relieve-pain
Semiatin, S. (2013). The history of pain relief and anaesthesia. Issues. Retrieved from http://www.issuesmagazine.com.au/article/issue-march-2013/history-pain-relief-and-anaesthesia.html
Spinal cord stimulation. (n.d.). Australian Pain Management Association. Retrieved from https://www.painmanagement.org.au/2014-09-11-13-35-53/2014-09-11-13-36-47/180-spinal-cord-stimulation.html
The specialty of chronic pain management. (n.d.). American Society of Regional Anesthesia and Pain Medicine. Retrieved from https://www.asra.com/page/44/the-specialty-of-chronic-pain-management
What does a pain management doctor do. (n.d.). Pain Doctor. Retrieved from https://paindoctor.com/what-does-a-pain-management-doctor-do/
What is pain medicine. (n.d.). American Board of Pain Medicine. Retrieved from http://www.abpm.org/what