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12/19/19

What is pain management anyway?

Let’s assume, for the sake of this presentation, that you are one of the millions of Americans who had a first episode of low back pain this year. At first, your back locks up, you are completely incapacitated, you can’t move. You panic. Something is really wrong, isn’t it?

When you finally pick yourself off the floor, you go to either the Emergency Room or your primary care physician. You are given some medication, told that everything will be fine, and sent home.

Your pain slowly gets better, but you are not well. You fear that any movement will bring your pain back. You decrease your activity. Several weeks pass by. Exasperated, you go to your primary care physician again, and you are told “I’m going to send you to a pain management doctor”.

That’s great, you think, but then you realize: “what is a pain management doctor?” You may be thinking “I don’t really want to take pain medication for the rest of my life now!” You get anxious. The pain gets worse.

Well, let’s talk a little bit about pain management. Pain management doctors are experts in the diagnosis and treatment of painful conditions, either spinal or peripheral (shoulder, hip, knee, etc). Most of us have a primary specialty, which can be Physical Medicine and Rehabilitation, like mine, or Anesthesiology, Neurology, sometimes even Radiology or Surgery. Most of the pain management doctors have had additional training, which is called a fellowship, and are also Board Certified in the sub-specialty of Pain Medicine.

Usually, acute pain, either coming from the spine or from peripheral musculoskeletal structures, is treated by primary care physicians. For the most part, rest, anti-inflammatories, physical therapy, are sufficient for the pain to subside and for the patient to return to normal function.

When these treatments are not sufficient, and the pain persists, patients should probably be referred to a pain management specialist, unless of course they have certain red flags that would require surgical evaluation.

Appropriate and timely referral to a pain management doctor can help diagnose the problem accurately. This, in turn, will avoid lingering chronic pain and also facilitate an appropriate treatment, either surgical or non-surgical.

Pain doctors combine physical examination with radiology testing (X-rays, CTs, MRIs, etc) and also diagnostic injection techniques to find out where the pain source is. They may then use additional injection, or interventional, techniques to treat the painful source. If that is not possible or is not successful, then a surgical referral may be made.

I would like to take this opportunity to also say a few things about medication pain management, particularly as this relates to opioids, or narcotics. Chronic use of narcotics has reached epidemic proportions and has become a large problem.

Pain management doctors are in the best position to manage judicious use of narcotic medication. We routinely use drug screens, monitor pharmacy reports, perform pill counts, etc. However, good pain specialists should strive to offer alternative options to chronic opioid therapy.

My personal goal with each patient is to diagnose their condition accurately, offer them non-surgical options of treatment, and, if those are not available or fail, refer them for the appropriate next step in treatment. I also aim to eliminate opioid use as much as possible.

I hope I shed some light on the question: what is pain management? Pain management is diagnosis and treatment of painful conditions, whether spinal or peripheral musculoskeletal, but also pertaining to cancer or post-operative pain. Pain management doctors work with either primary care doctors or other specialists, although some patients come to us directly.

I look forward to discussing your problems with you. To schedule an appointment, please refer to the information below.

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