Experiencing persistent pain can significantly impact your quality of life, hindering your ability to work, enjoy hobbies, and even perform daily tasks. If you’re struggling with chronic pain, you might be wondering, “What kind of doctor should I see?” The answer could be a pain management doctor. These specialized physicians are experts in diagnosing and treating a wide spectrum of pain conditions, helping patients regain function and find lasting relief.
Understanding Pain Management Doctors
A pain management doctor is a physician who specializes in the evaluation, diagnosis, treatment, and overall management of various pain conditions. They possess a deep understanding of pain physiology and are equipped with a diverse skillset to address complex pain disorders. Key skills of Pain Management Doctors include:
- Extensive Knowledge of Pain Physiology: They have a thorough understanding of how pain signals are transmitted and processed in the body, allowing them to pinpoint the source of pain accurately.
- Expert Evaluation of Complex Pain: Pain management doctors are adept at evaluating patients with intricate pain presentations, considering various factors contributing to their discomfort.
- Diagnostic Testing Expertise: They know which specialized tests, such as nerve conduction studies or imaging scans, are necessary to diagnose the underlying cause of pain.
- Medication Management for Pain: They are skilled in prescribing and managing medications, including non-opioid and opioid analgesics, to effectively control pain while minimizing side effects.
- Interventional Pain Procedures: Many pain management doctors are proficient in performing interventional procedures like nerve blocks, epidural injections, spinal cord stimulation, and radiofrequency ablation to provide targeted pain relief.
To become a pain management doctor, physicians must first complete residency in a primary specialty such as anesthesiology, neurology, physical medicine and rehabilitation (physiatry), psychiatry, or internal medicine. Following residency, they undertake a minimum of one year of fellowship training in pain management accredited by the Accreditation Council for Graduate Medical Education (ACGME). Board certification in pain management signifies a pain management doctor’s expertise and commitment to the field. Ideally, your pain management specialist should be double board-certified in their primary specialty and pain management.
What Treatments Do Pain Management Doctors Offer?
Pain management doctors are dedicated to providing non-surgical solutions for painful medical conditions. They focus on accurately diagnosing the source of pain to develop a targeted treatment plan. Often referred to as “interventional pain doctors,” many specialize in minimally invasive procedures designed to alleviate orthopedic and musculoskeletal pain. Common interventional procedures performed by pain management doctors include:
- Epidural Steroid Injections: Used to treat conditions like sciatica and spinal stenosis by reducing inflammation around the spinal nerves.
- Spinal Cord Stimulation: A therapy for chronic pain conditions like complex regional pain syndrome, delivering mild electrical impulses to interrupt pain signals.
- Radiofrequency Ablation: Utilizing heat to disable nerves transmitting pain signals, often used for neck and back pain related to facet joint arthritis.
- Cortisone Injections: Injections into joints to reduce inflammation and pain associated with conditions like arthritis and bursitis.
- Nerve Blocks: Injections of local anesthetic to block pain signals from specific nerves, aiding in both diagnosis and pain relief.
Beyond procedures, pain management doctors play a crucial role in coordinating comprehensive treatment plans. This often involves collaborating with other healthcare professionals to integrate physical therapy, psychological therapy, and rehabilitation programs. They also work closely with surgeons when surgery becomes a necessary part of a patient’s overall care.
Interventional Pain Management vs. Traditional Pain Management
The core difference between interventional pain management and other pain management approaches lies in the emphasis on precise diagnosis and immediate treatment. While some pain management practices might primarily rely on medication or physical therapy, interventional pain management doctors utilize a broader spectrum of treatments to achieve faster and more effective pain relief.
Interventional treatments offered by pain management doctors can serve dual purposes: they may directly resolve the pain issue, or they can provide valuable diagnostic information for other specialists, such as surgeons, to guide further treatment.
Many interventional pain management specialists have backgrounds in anesthesiology or neurology, specialties that already involve performing nerve blocks and similar procedures during residency. Their subsequent fellowship training in pain management allows them to refine these procedural skills and apply them specifically to diagnosing and treating common orthopedic, neurologic, and spine-related pain conditions.
Are You a Suitable Candidate for a Pain Management Doctor?
Individuals who may benefit most from seeing an interventional pain management doctor are often those with painful conditions that have the potential to be resolved through less invasive procedures than surgery. Ideal patients include those who:
- Have not yet undergone a thorough evaluation for their pain.
- Are unsure if surgery is the right option for them.
- Prefer to avoid or do not require surgery for their condition.
- Are still experiencing pain despite conservative treatments but are not surgical candidates.
- Have had spinal surgery but continue to experience residual pain after a reasonable recovery period. (This pain may arise from scar tissue, nerve damage from before surgery, new pain generators, recurrence of the original problem, or, in rare cases, unsuccessful surgery).
Common conditions effectively managed by interventional pain management doctors include back pain, joint pain, and nerve pain. Procedures like epidural steroid injections, cortisone shots, radiofrequency ablation, trigger point injections, sacroiliac joint injections, and spinal cord stimulation are frequently employed.
The most effective way to be referred to a pain management doctor is usually through your primary care physician. Spine surgeons, orthopedic surgeons, neurologists, rheumatologists, and other specialists who frequently manage pain conditions also commonly refer patients to pain management doctors. These physicians often maintain close communication with referring doctors to ensure coordinated and optimal patient care. You can also often book an appointment directly with a pain management doctor without a referral, depending on your insurance and the clinic’s policies.
Pain Management Doctors vs. Other Specialties
Pain management is a field that intersects with many medical specialties due to the diverse nature of pain-causing conditions. Compared to other specialties offering interventional treatments for orthopedic pain, pain management doctors provide a more comprehensive approach to clinical care coordination, particularly in medication management. Furthermore, many interventional pain management specialists are anesthesiologists who have undergone specialized training and possess extensive experience in performing pain-relieving interventions, including targeted nerve blocks and epidurals. They also have specialized expertise in advanced techniques like spinal cord and dorsal root ganglion stimulation.
Types of Pain Treated by Pain Management Doctors
Pain management physicians treat a vast range of pain conditions, from acute injuries like sports-related pain to chronic conditions such as arthritis, spinal disorders, nerve pain, muscle pain, soft tissue pathologies, and even migraines. The breadth of their expertise allows them to address almost any type of pain that impacts a patient’s function and quality of life.
When to Seek Help from a Pain Management Specialist
Everyone experiences pain at some point. Common issues like neck and back pain often stem from simple causes like overuse and typically resolve within a week with rest, activity modification, and over-the-counter pain relievers. However, if pain persists beyond 4 to 7 days, further medical evaluation may be necessary.
If pain remains a problem after 2 to 3 weeks of conservative treatments like physical therapy or medications, your doctor might recommend a referral to an interventional pain management specialist.
In cases of severe pain that hinders participation in home exercises or physical therapy, interventional pain management procedures might be considered earlier than 2 to 3 weeks to enable patients to engage in rehabilitation.
What to Expect During Your First Appointment
Your initial appointment with a pain management doctor will involve a comprehensive physical exam and a detailed review of your medical history. This typically includes:
- A thorough discussion of your pain history, including onset, location, intensity, and aggravating/relieving factors.
- A physical examination to assess your musculoskeletal and neurological systems.
- A neurological examination to evaluate nerve function.
- A careful review of your medical records, including prior pain management treatments, surgical notes, imaging scans, and reports.
To help your pain management doctor effectively assess your condition, bring all relevant medical records, including imaging results and reports, to your appointment. After a thorough evaluation, your doctor will provide specific recommendations for your personalized treatment plan.
How Pain Management Doctors Diagnose Pain
Diagnosing pain involves a systematic approach. The initial steps usually consist of obtaining a detailed patient history and conducting a physical examination. If needed, further diagnostic and imaging studies, such as X-rays, CT scans, or MRI scans, may be ordered. In some cases, nerve conduction studies or other specialized tests outside of radiology might be necessary. Interventional procedures can then be utilized to both treat the pain and help pinpoint its source.
Beyond pain relief, interventional procedures often offer valuable diagnostic insights. For instance, if a hip surgeon is uncertain whether pain originates from the hip joint, a pain management specialist can use ultrasound guidance to inject local anesthetic into the joint. If the patient experiences pain relief, it suggests the hip joint as the likely pain source.
Similarly, spine surgeons may request pain management doctors to identify pain sources by targeting specific spinal nerve roots with fluoroscopically guided injections. The patient’s response and pain relief level after the injection provide surgeons with crucial information to guide surgical planning.
Medications and Treatments Offered
Pain management doctors prescribe a range of pain-relieving medications, including:
- Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs) and oral corticosteroids to reduce inflammation.
- Nerve-stabilizing medications like gabapentin and duloxetine to manage nerve pain.
- Muscle relaxants to alleviate muscle spasms and pain.
While opioid medications can be beneficial for short-term management of acute pain, particularly after surgery, their long-term effectiveness for chronic pain is not well-supported by research. Furthermore, long-term opioid use carries significant risks, including increased risk of motor vehicle accidents, overdose, immune system suppression, and hormonal imbalances. Therefore, pain management doctors prioritize conservative opioid prescribing practices, typically avoiding long-acting opioids and limiting short-acting opioid prescriptions to short courses only.
Common interventional pain-relieving procedures performed by pain management specialists include:
- Spine procedures targeting herniated discs, pinched spinal nerves, or facet joint pain.
- Joint injections for pain in knees, shoulders, hips, and other joints.
- Injections for tendon and ligament pain (tendinopathy, ligament sprains).
- Muscle injections for trigger points and muscle pain.
- Targeted nerve blocks to interrupt pain signals along specific nerve pathways.
Injected medications often include corticosteroids (like cortisone), local anesthetics, and sometimes other specialized agents depending on the specific condition and procedure.
Pain conditions often respond best to a multimodal approach, combining various pain relief strategies. A pain management doctor may integrate multiple treatments into a comprehensive plan, such as:
- Rehabilitation and physical therapy to improve function and strength.
- Pain psychology to teach coping mechanisms and pain management techniques.
- Non-opioid medication therapy to manage pain and inflammation.
- Interventional pain-relieving procedures for targeted pain relief.
The field of pain management is continually evolving with new and complex drugs, techniques, and technologies emerging regularly. Pain management doctors are uniquely trained to stay at the forefront of these advancements and utilize this expanding knowledge to provide safe and effective pain relief for their patients.
Advantages of Interventional Pain Management
As medical understanding of pain complexity grows, the need for specialized physicians with in-depth knowledge and skills in pain management becomes increasingly crucial. Millions of Americans experience persistent pain that significantly impacts their lives. Consulting a pain management doctor can be a transformative step towards regaining vitality and improving overall quality of life.
As mentioned earlier, interventional pain management offers both diagnostic and therapeutic benefits. A patient’s response to a localized pain intervention can provide valuable information about the source of their pain. Furthermore, the treatments offered by interventional pain management doctors can provide effective and lasting pain relief for many individuals, allowing them to return to their active lives, often without needing more invasive surgical interventions.
If you are struggling with persistent pain, seeking help from a pain management doctor can be a crucial step towards finding relief and improving your overall well-being. Don’t let pain control your life – explore the options available with a pain management specialist.
To find relief from your painful condition, book an appointment with a pain management doctor today.
Why Choose HSS for Pain Management?
Hospital for Special Surgery (HSS) is consistently ranked as a top orthopedic hospital nationally, and our pain management doctors are recognized as among the best in New York City. Our physicians are not only board-certified in primary specialties but also hold board certification in pain management and have completed ACGME-accredited fellowships. If pain is holding you back, our experienced team can provide cutting-edge care. Utilizing minimally invasive interventions, including precise image-guided injections with ultrasound or X-ray technology, our doctors effectively relieve pain and restore function quickly. Many patients experience significant pain reduction and return to their normal activities within days or weeks. Take control of your life and break free from pain.
Begin your recovery journey. Find a pain management doctor at HSS.
Authors
Joseph C. Hung, MD
Attending Physician, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College
Semih Gungor, MD
Director, Pain Medicine Research, Hospital for Special Surgery
Attending Anesthesiologist, Hospital for Special Surgery
Seth A. Waldman, MD
Attending Anesthesiologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College
