What to expect from your pain management specialist

A pain management specialist is a doctor who evaluates your pain and treats a wide range of pain problems. A pain management doctor treats sudden pain problems such as headaches and many types of long-lasting, chronic, pain such as low back pain. Patients are seen in a pain clinic and can go home the same day. Pain management doctors offer a mix of medication-based treatments and procedures, that can stop the pain at its source.

Types of pain treated by a pain management doctor

The types of pain treated by a pain management doctor fall into three main groups. The first is pain due to direct tissue injury, such as arthritis. The second type of pain is due to nerve injury or a nervous system disease, such as a stroke. The third type of pain is a mix of tissue and nerve injury, such as back pain.

Disorders that cause pain due to tissue injury

• Osteoarthritis (wear and tear arthritis in the large joints: knees, hips)
• Rheumatoid arthritis (arthritis due to an autoimmune reaction – felt in small joints like fingers, wrists)

Nerve or nervous system disorders that cause pain

• Stroke (post-stroke pain)
• Multiple sclerosis
• Spinal cord injury
• Neuropathy (nerve pain due to shingles, HIV, diabetes)

Mixed pain disorders

• Neck pain
• Back pain
• Cancer

A pain management doctors’ background

Pain management doctors have over nine years of medical training. First, they gain a broad education in medical school. Then, they get another four years of hands-on training in a field like anesthesiology, physical medicine and rehabilitation, or neurology. Finally, they complete another year of training, that focuses solely on treating pain. This leads to a certificate from the American Board of Pain Medicine.

A diverse treatment approach

Pain treatment may start with a primary care doctor, with basic pain medications and physical therapy. However, for advanced pain treatment, you will be sent to a pain management doctor. Pain management doctors are trained to treat you in a step-wise manner.

1. First line treatment involves medications (anti-inflammatories, muscle relaxants, anti-depressants) and injections that numb pain (nerve blocks or spinal injections). TENS (Transcutaneous electrical nerve stimulators – units that use skin pads to deliver low-voltage electrical current to painful areas) may also be used.
2. Second line treatment involves advanced procedures such as radiofrequency ablation (RFA) or viscosupplementation. During RFA, heat or chemical agents are applied to a nerve in order to stop pain signals. It is used for chronic pain problems such as arthritis of the spine. Viscosupplementation is the injection of lubricating fluid into joints, used for arthritis pain. At this stage, the doctor may also prescribe stronger medications.
3. Third line treatment involves an implant with a pain pump or a spinal cord stimulator. These treatments act to relieve pain at the level of the spinal cord, which is the body’s control center for sensing pain. Regenerative (stem cell) treatment is another option at this stage

For more information on treatments offered by pain management doctors, click here.

Your pain management doctor

Communication lies at the heart of a good doctor-patient relationship. Medical experience and compassion are other qualities to look for in a pain management doctor.

Desirable qualities in a pain doctor/pain clinic:

• In-depth knowledge of pain disorders
• Ability to evaluate patients with difficult pain disorders
• Appropriate prescribing of medications for pain problems
• An ability to use different diagnostic tests to pinpoint the cause of pain
• Skill with procedures (nerve blocks, spinal injections, pain pumps)
• A good network of outside providers where the patient can be sent for physical therapy, psychological support or surgical evaluation
• Treatment that is in line with a patient’s wishes and belief system
• Up-to-date equipment
• Helpful office staff

The pain management clinic

Pain patients are seen in an outpatient pain clinic that has procedure rooms, with ultrasound and X-ray imaging. Sometimes, the pain doctor performs the procedures in a nearby hospital. Some pain doctors may offer you sedation during the treatments. However, this is not needed in many cases. In a hospital, “Twilight” anesthesia may be given to a patient, as needed.

First visit to a pain management doctor

On the first visit, a pain management doctor will ask you questions about your pain symptoms. He or she may also look at your past records, your medication list, and prior diagnostic studies (X-ray, MRI, CT). It helps if you bring any prior, available studies (X-rays, CT scans, MRIs). The doctor will perform a thorough physical exam. At the first visit, It helps to have a pain journal or at least, to be aware of your pain patterns.

Common things your doctor may ask on the first visit:

1. Where is your pain? (what body part)
2. What does your pain feel like? (dull, aching, tingling)
3. How often do you feel pain? (how often during the day or night)
4. When do you feel the pain? (with exercise or at rest)
5. Setting for the pain? (is it worse standing, sitting, laying down)
6. What makes your pain better? (does a certain medication help)
7. Have you noticed any other symptom when you have your pain? (like loss of bowel or bladder control)

Start a pain journal

A pain journal helps keep track of how much pain you have on a given day. It also helps you communicate better with your doctor. You can note how often you have pain and how your pain prevents daily activities like sleep, work and hobbies. The journal will help you notice some things that may improve your pain: meditation or prayer, light stretches, massage. It will also help you note what makes your pain worse (stress, lack of sleep, diet).

You can rate your pain on a 0-10 scale, in the pain journal. This rating scale is a common tool, used by many doctors to measure pain.

0 you are pain-free

1-3 you have nagging pain

4-6 you have moderate pain that interferes with daily activity: work, hobbies

7-10 you have severe pain that stops you from your daily activities

A journal helps you record your mood and if you are feeling depressed, anxious or have trouble with sleep. Pain might trigger these states, and your doctor can suggest some coping skills or medications to help you. A pain journal helps you gain control over your pain and empowers you in ways you might not have thought possible.