A pain specialist is a medical doctor who has selected the sub-specialty of pain medicine. Most pain specialists are already specialists in another field. In my case, I am an anesthesiologist with a sub-specialty in pain. We are physicians who have dedicated ourselves to helping people manage chronic pain and other types of painful conditions.
Who should visit a pain specialist?
Most pain specialists see patients by referral, that is, another doctor will recommend that you visit a pain specialist. You may also seek out a pain specialist on your own if you feel that you have poorly controlled pain.
What does a pain specialist do that is different from other doctors?
Although pain is by far the most common reason for which people get medical help, medical schools do not emphasize pain. Many physicians actually feel that they are not well equipped to deal with the more difficult cases of pain.
Is there more than one kind of pain?
Absolutely. First of all, doctors differentiate between acute pain—which is what you experience when you stub your toe or right after surgery—and chronic pain, which is pain that lasts for a long time. There is a lot of medical evidence that says that acute pain is different than chronic pain. For instance, chronic pain “hurts more” because it often involves central sensitization which tends to amplify pain signals.
There are also different types of pain in terms of their mechanism. Some pain is neuropathic, which means it comes from damaged or abnormal nerves. That type of pain is different from the pain of stubbing your toe, which doctors would call nociceptive pain. Different types of pain may require different types of treatments.
How is pain treated?
Many people think that drugs are the only way to treat pain, but that is a myth. There are patients who need pain-relieving drugs, but not every patient will benefit from them. There are non-drug ways to manage pain, including lifestyle modifications, exercise, and complementary therapies. There are also many drugs that can help relieve pain.
Many patients with complex pain conditions require what I call a “multimodal” approach. We use multiple modes of treatment. In a way, it is playing the percentages.
What do you mean by “playing the percentages”?
Let’s take an example of a patient who is about 50 years old and has osteoarthritis which has caused moderate to severe pain for the past year. Now let’s say this patient tries some aquatic exercises at the local recreation center. She finds out that this reduces her pain by about 10 percent.
Now some people would think this is not much, but it is important. Water exercise is easy, fun, and has no side effects (except messing up your hair). So I would encourage her to keep doing that—and let’s count it as 10 percent.
Now let’s say that we make some lifestyle modifications. She had a very erratic sleep and wake schedule, so we move her to going to bed and getting up at approximately the same time every day and making sure she got 7 or 8 hours of sleep a night. She was surprised, but this eliminated about 15 percentof her pain. So now 25 percent of her pain is taken care of as long as she keeps this up. The patient was overweight—but by losing just 15 pounds, she said her pain decreased about 20 percent. This patient now has cut her pain almost in half by doing nothing other than making some lifestyle changes!
I would encourage her to keep doing those things. I would then get her to try a topical treatment on the affected joints. She found it cut pain by nearly 50 percent. Put that together with her other experiences, and she has reduced her pain by 95 percent—without drugs.
I think what is important is that pain patients do not look for the “magic pill” that will take away all of their pain. It’s a percentage game.
Do pain specialists ever prescribe drugs?
Of course. As a matter of fact, most physicians prescribe pain relievers from time to time. They can be very effective, particularly for severe pain or in cases where nothing else works. My attitude is to prescribe the lowest possible dose for the shortest possible time.
What do I do if I want to see a pain specialist?
The ideal method is for you to tell your primary care physician and get a referral. But you can also look online and find pain specialists near you. Pain specialists are going to want to work with you to get your pain under control—we can be very “demanding doctors” because we sometimes expect patients to make lifestyle changes. On the other hand, if you have felt that nobody up to now took your pain seriously, you ought to see a pain specialist. We do understand how difficult pain syndromes can be.
Now it's your turn: Have you visited a pain specialist?