In science, as more and more information about a specific topic is learned, it often leads to subspecialties. Consider the field of physics. There are astrophysicists, nuclear physicists, molecular physicists, and so on.
The same is true in medicine. Within the field of cardiology, there are general cardiologists, cardiac surgeons, electrophysiologists, etc. And within the fields of anesthesiology and physical medicine and rehabilitation, there is the subspecialty of pain management.
A pain management specialist is a doctor who has additional education and training in the physiology of pain, how it develops and how pain signals are transmitted throughout the body. Most pain management specialists have completed at least one year of training in all aspects of pain management after their residency training. This is known as a fellowship. When a physician has become board certified in their primary specialty and has completed an accredited fellowship, they become eligible for subspecialty board certification in pain management by the American Board of Anesthesiology, the American Board of Psychiatry and Neurology or the American Board of Physical Medicine and Rehabilitation.[i]
Due to their advanced training, pain management specialists understand how to diagnose and treat different kinds of pain, including:
Acute Pain: This is sharp pain that generally comes on suddenly and is caused by something specific. It usually subsides within six months.[ii]
Chronic Pain: This pain usually lasts longer than six months, often times even after the initial injury or illness has resolved itself.[iii]
Cancer Pain: This can be caused by cancer tumors that grow and press on nerves, bones or organs. But sometimes, cancer treatments themselves, such as radiation and chemotherapy, can cause pain.[iv]
Whether the pain originates from an injury, surgery or a disease such as cancer or diabetes, the pain management specialist has the training to treat the specific complexities of each type of pain. He or she understands what therapies will best address both the source of the pain and its symptoms.
Pain management specialists take a multidisciplinary approach to treating pain. That means they may rely on a combination of therapies to help their patients, including:
Medications: Pain management specialists have been at the forefront of fighting our nation’s opioid epidemic. That is because they understand that although medications may be part of a treatment plan, they must be carefully monitored and the use of narcotic medications must include documented plans for tapered discontinuation. Moreover, because pain specialists know how to treat the source of a patient’s pain, many of their patients never need pain killers to alleviate the symptoms of pain.
Injections: Steroidal injections to treat pain have been in use for nearly 70 years. They are a safe and effective way to address the inflammation that is a common cause of pain in areas such as the knees, shoulders and back.
Interventional Procedures: Advances in technology, such as improved x-ray and ultrasound imaging capabilities and innovative medical devices such as vertebral spacers and spinal cord stimulators, are offering long-term pain relief to patients with conditions such as spinal stenosis, diabetic neuropathy, post-laminectomy syndrome, complex regional pain syndrome (CRPS) and chronic migraines.
Supplementary Therapies: These include physical therapy to regain strength and mobility in injured areas of the body; cognitive therapy to develop coping strategies and mindfulness techniques for dealing with chronic pain; and alternative therapies such as acupuncture and chiropractic manipulation.
Most patients initially seek pain relief from their primary care physicians. But if the pain remains unresolved even after following their doctor’s treatment plan, they should ask for a referral to a pain management specialist.
Early diagnosis and intervention produce the best outcomes for treating pain. Delays in effective treatment may result in further damage to body tissues and nerves and may make the pain more difficult to treat.
Dr. Ioannis Skaribas is fellowship-trained and double board certified in Anesthesiology and Pain Medicine. He specializes in advanced interventional pain therapies. Dr. Skaribas is a clinical assistant professor in pain medicine at The University of Texas Health Science Center at Houston and has contributed his expertise to several textbooks and professional journals.
[i] ASRA: The Specialty of Chronic Pain Management
[ii] Cleveland Clinic: Acute vs. Chronic Pain
[iv] Mayo Clinic: Cancer Pain