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.
Education & Training
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.
Roles & Responsibilities
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:
the prescription of medication
the prescription of rehabilitation treatments
the performance of procedures for pain relief
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.
Medications Prescribed
These are considered as narcotics and they are effective in relieving moderate to severe types of pain. These drugs bind to opioid receptors in the spinal cord, the brain and other areas of the body. By doing so, the drug reduces the amount of pain messages that are received by the brain, thereby reducing feelings of pain.
Morphine is used to alleviate severe pain after surgery or in people with advanced cancer. Other opioid drugs are methadone, buprenorphine, oxycodone and hydrocodone.
However, this particular type of drug can be dangerous when abused. So it should be taken as directed when used for a short time. On the other hand, people who are in long-term use of opioids need monitoring and screening to prevent addiction disorder. Others develop a physical dependence to the drug and when its use is ceased, withdrawal symptoms appear. These may include muscle and bone pain, diarrhea, vomiting, restlessness and insomnia.
Despite its name, antidepressants are used to treat many chronic pain conditions even if depression is not recognized as a factor in the disease. How this type of drug works on the body to manage pain is not fully understood, especially since pain relief is not its intended purpose. A possible explanation is that it increases the amount of neurotransmitters found in the spinal cord and this reduces the pain signals.
Antidepressant drugs are used for the treatment of pain due to arthritis; migraine and tension headache; fibromyalgia, nerve damage to due shingles or diabetes; nerve pain like peripheral neuropathy, stroke, radiculopathy and spinal cord injury; as well as facial, lower back and pelvin pain.
However, the drug’s effect in pain relief is not felt immediately. The pain may be lessened after a week of taking the medication, but its full effect or the maximum relief from the drug may not be felt until after several weeks. Tricyclic antidepressant drugs are the typical choice for pain management and examples of these drugs are amitriptyline, imipramine, clomipramine, doxepin, desipramine and nortriptyline.
Muscle relaxers. Muscle relaxants are not a class of drugs. Instead, these are different drugs that have an overall sedative effect, musculoskeletal relaxant properties and central nervous system depressant characteristics. Muscle relaxants are effective for short-term treatment of acute and painful musculoskeletal conditions by reducing skeletal muscle spasms, relieving pain and increasing the mobility of the affected muscles.
Muscle relaxants are typically prescribed for back pain and fibromyalgia. It is commonly used for treatment in conjuction with physical therapy, rest, stretching, exercise and other therapies. Examples of muscle relaxants are baclofen, chlorzoxazone, carisoprodol, cyclobenzaprine, dantrolene, diazepam, metaxalone, methocarbamol and tizanidine.
Non-steroidal anti-inflammatory drugs. NSAIDs is a large class of drug that relieve pain by hampering body substances that trigger feelings of pain called prostaglandins. NSAIDs are able to lower fevers, reduce inflammation and relieve pain.
These drugs are used to treat acute and chronic muscle, back, neck and osteoarthritic joint pain. It is also effective for rheumatoid arthritis and ankylosing spondylitis. Non-steroidal anti-inflammatory medications are versatile in that they are available as over-the-counter as well as prescription drugs. Examples of non-prescription NSAIDs are aspirin, naproxen, ibuprofen, and ketoprofen. To name a few prescription NSAIDs, they are celecoxib, piroxicam, indomethacin, ketoprofen, sulindac, nabumetone, and diflunisal.
There are also variations of NSAIDs that do not require intake through the mouth. This is helpful for patients who are unable to eat. Examples of such drugs are ketorolac, which is given intravenous, intramuscular or intranasal, and diclofenac, which is available as a gel, a patch or a solution.
Pain Relieving Procedures
Epidural steroid injections is a common mode of treatments used for neck-related arm pain and lower-back-related leg pain. The epidural space is filled with fat and surrounds the spinal sad, providing cushion for the nerves and spinal cord. When steroids are injected into this space, it has a potent anti-inflammatory effect that reduces pain and improves function.
This treatment does not treat the actual condition that results to pain, but it allows the body to cope with the condition and restores a person to normal everyday function. Within three days of the injection, the patient may feel pain relief already but in others, the medication takes up to a week to produce the maximum effect. The pain relief and improved function can last a number of months and then the injection can be safely administered periodically for its benefits to continue.
Epidural steroid injections are also usually done in conjunction with other treatments to prolong or enhance its beneficial effects. Other treatments may include oral medication and physical therapy.
The side effects of this procedure are generally mild and they will also pass within a few days. These side effects are anxiety, difficulty sleeping, temporary water retention, and changes in the menstrual cycle. Some people also experience a steroid flush which is the flushing of the face and the chest, accompanied by a feeling of warmth. Like other side effects, this may last up to several days. However, steroids are generally very well-tolerated by the body and a person may not experience any side effect at all.
Nerve blocks, as implied by its name, is a procedure that blocks that pain messages that are traveling along a nerve or a group of nerves, such that they do not get to the brain. This procedure may be done for two different purposes.
The first is diagnostic, where the results may last for as little as a few hours or up to a few days. This is done to determine if a particular nerve or nerves are the source of the pain or the problem. The patient will be asked to monitor his level of pain and through this, it can be determined whether the treatment was successful or not. If it is successful, another block may be done, or the doctor may recommend a radiofrequency neuroablation, which is a more lasting option.
The other nerve block is therapeutic. Unlike the diagnostic nerve block, the therapeutic one provides longer-lasting relief. This is possible because of the type of drug injected around the nerves. The injection would involve an anesthetic medication for short-term pain relief and an anti-inflammatory drug for long-term benefits. After each injection, the relief experienced by the patient may last longer as well.
This procedure may be done in order to reduce opioid usage or increase the patient’s ability to perform physical therapy.
Joint injections involve corticosteroids injected into the joints to ease osteoarthritis pain as well as pain in the knees, hips and shoulders. Aside from the drug, newer options are also available, like orthobiologic injections such as placental tissue matrix (PTM) and platelet-rich plasma (PRP).
Corticosteroid injections is the go-to treatment for osteoarthritis pain and other joint pains. It can offer pain relief lasting for two to three months. At the same time, it reduces inflammation in the joint.
When corticosteroid doesn’t work, hyaluronic acid injections are the alternative. This option is also better if the patient has or has a high risk for diabetes since corticosteroids can raise blood sugar levels. In persons with osteoarthritis, the joint fluid becomes watery. HA injections are chemically similar to the natural joint fluid so it helps restore the natural properties of the joint fluid. It also acts as a lubricant and a shock absorber. The relief from pain can last from four months up to one year, in HA injections.
Platelet-rich plasma injections use the patient’s own blood to promote healing. How? Platelets contain proteins and growth factors that aid soft tissues in healing. It can also improve the body’s immune response which then reduces inflammation. However, for this procedure, the patient must stop taking any oral anti-inflammatory medications for a short period of time.
Placental tissue matrix injections are similar to platelet-rich plasma injections in terms of mechanism. They make use of the placental tissue obtained after a baby is delivered, which has a large number of growth factors that promote healing. In addition to that, the placental tissue would not cause an adverse reaction in the patient’s body. However, this is the most expensive option among the four.
Radiofrequency ablation or radiofrequency neurotomy is a type of injection procedure where a heat lesion is created on certain nerves to interrupt the pain signals’ path to the brain. It is done to treat facet joint pain or sacroiliac joint pain caused by degenerative diseases or injuries. If the procedure is effective, it will provide pain relief that lasts for 9 to 14 months, sometimes even longer.
Spinal cord stimulation is an option that is typically offered to patients who have chronic pain conditions. This is a surgical procedure where a spinal cord stimulator is positioned near the spine. The spinal cord stimulator is an electronic device that delivers a pulsed current which interrupts the pain signals that are being sent to the brain. This current is felt as a tingling sensation and is controlled through a handheld controller that allows the patient to change the intensity. However, this has to be within the limits decided by the pain medicine specialist. This procedure is said to reduce the pain experienced by the patient by up to 50%.
Before the actual procedure, the patient will be given an external spinal cord stimulator as a trial. The experimental period would last up to two weeks so that the pain medicine specialist can assess whether the procedure would be truly effective and beneficial to the patient.
Although it is a surgical procedure, it is less invasive and has long-term benefits. The battery of the spinal cord stimulator would need to be changed but not until after several years. However, another consideration that must be made before proceeding with this option is that the device can activate airport security and MRIs would be difficult to perform once the device is implanted.
Deep brain and cortical stimulation delivers electrical current to stimulate the deep nuclei of the brain. This is commonly used for the treatment of Parkinson’s disease and epilepsy, but also for neuropathic neck pain.
Intrathecal drug delivery is performed with an implanted pump that store and deliver medication into the intrathecal space around the spinal cord by means of a catheter. This way, increased pain relief can be achieved despite a lower dosage. The medication contained within the pump is sufficient for two to three months, and is then easily refillable in a pain clinic.
This procedure is used to help patients with chronic pain from failed back surgery syndrome, cancer pain, complex regional pain syndrome, and peripheral neuropathy.
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.
History
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.
Your FindaTopDoc account is completely free. Find doctors & request online appointments. Participate in Health Journeys in over 100 specialty communities. Easy & secure access! Simple Facebook login.
FindATopDoc is a trusted resource for patients to find the top doctors in their area. Be visible and accessible with your up to date contact information, certified patients reviews and online appointment booking functionality.
