Pain management

From Wikipedia, the free encyclopedia

Pain management (also called pain medicine) is the discipline concerned with the relief of pain. Pain has been described as, "An unpleasant sensory and emotional experience associated with either actual or potential tissue damage. It is a very personal and individual experience - defined as whatever the patient says it is, and it exists wherever he or she says it does."^[1]

Acute pain, such as occurs with trauma, often has a reversible cause and may require only transient measures and correction of the underlying problem. In contrast, chronic pain often results from conditions that are difficult to diagnose and treat, and that may take a long time to reverse. Some examples include cancer, neuropathy, and referred pain. Often, pain pathways are set up the continue to transmit the sensation of pain even though the underlying condition or injury that originally caused pain has been healed. In such situations, the pain itself is frequently managed separately from the underlying condition of which it is a symptom, or goal of treatment is to manage the pain with no treatment of any underlying condition (e.g. if the underlying condition has resolved or if no identifiable source of the pain can be found).

Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and pain modifiers such as tricyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy).

Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures - typically used for chronic back pain - include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators and intrathecal drug delivery system implants, etc. Over the last several years the number of interventional procedures done for pain has grown to a very large number. While widely performed across US, evidence supporting their efficacy is often lacking. However despite lack of scientific evidence, most patients do report significant improvements and relief of their symptoms after the procedures.

When making an appointment with a Pain Management Physician be mindful of certain caveats. While a lot of physicians refer to themselves as 'pain doctors,' many may not have proper training and often learned a number of the procedures on a 'weekend workshop' as opposed to a more formal residency training. While most of the procedures are safe and harmless certain ones such as epidural injections and spinal cord stimulators may have grave consequences if performed by an inexperienced physician. Ask your doctor about his/her training and credentials. Only two specialties formally incorporate Pain Management in their training: Anesthesiology and Physical Medicine and Rehabilitation. All others must often complete additional training to be certified, but even the former two often do an additional year of training to gain expertise.