A pain management doctor, also called a pain management specialist, is a physician who specializes in the management of pain as a primary pain disorder or as a symptom of the disease. They manage pain associated with a certain disease or condition or related to a specific cause (e.g. cancer pain, post-surgical pain, injury) or pain as a primary condition (e.g. headaches).
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Few pain management physicians restrict their practices to a specific pain problem or syndrome, e.g., back pain, headache, sports injury, and employ other physicians to provide in-depth evaluation and many treatment modalities to manage the condition and provide good coverage within their area of expertise. Patients with complex pain problems, such as fibromyalgia, complex regional pain syndrome, post-laminectomy back pain, post-traumatic stress disorder, however, should consider visiting a comprehensive pain center that offers the personnel and facilities to be able to perform a complete physical and psychological assessment of the pain problem and the resources to provide a broad spectrum of treatment options that can be tailored to the individual.
When you visit any pain management clinic, a specialist will evaluate your pain condition. This will usually involve a detailed history, a physical exam, and review of tests that you have had performed. You will also be evaluated on your past and current medical history. You will probably be asked by your pain physician to bring any imaging studies (such as X-rays, computed tomography [CAT] scans, or magnetic resonance imaging [MRI] scans) or other tests that have already been done.
Your treatment plan will be tailored to your specific medical condition or circumstances. There are a broad variety of methods available to manage your pain. Treatment modalities for pain include the following
- Medications
- Physical therapy (also known as occupational therapy and recreational therapy)
- Surgeries
In some cases, pain management doctors use alternative methods such as relaxation, meditation, acupuncture, cognitive behavioral therapy, heat and cold therapy, transcutaneous electrical nerve stimulation (TENS), biofeedback and hypnosis to help patients manage their pain symptoms.
Medications
Medications play a crucial role in pain management. There are various groups of drugs available to manage your pain.
Opioids
Opioids are prescribed for a patient with extreme pain cases such as cancer pain or postoperative pain. Opioids (also called narcotics) are potent painkillers. They provide instant relief to severe pain by altering your brain’s perception of the pain signal. However, opioids are typically prescribed only if other medication options aren’t successful, but are often discouraged because of extreme concerns about overdoses, drug abuse, physical dependence, and the effects of long-term use. High doses of opioids typically are needed to provide significant pain relief for neuropathic conditions.
You may experience some side effects while on opioids such as drowsiness, nausea, constipation, and vomiting. Opioids should not be combined with alcohol or drugs with sedating effects as it may lead to fatal consequences like respiratory arrest and death. Opioids are not advised for pregnant women.
Opioids such as oxycodone (Oxaydo, OxyContin), morphine (brand names MS Contin, Kadian, and others), and Tramadol (Ultra, Conzip, and others) treat diabetic peripheral neuropathy, post-herpetic neuropathy, polyneuropathy, and phantom limb pain.
Anti-seizure Drugs
Also knows as neuroleptic medications, anti-epileptic medications or anticonvulsant. They are often the first-line treatment for neuropathic pains such as trigeminal neuralgia, diabetic neuropathy or fibromyalgia. Anti-epileptic medications include:
- Pregabalin (Lyrica)
- Gabapentin (Neurontin)
- Carbamazepine (Tegretol)
- Topiramate (Topamax, Qudexy XR, Trokendi XR)
- Oxcarbazepine
Adverse effects of anti-epileptic medications include, but are not limited to, chest pain, constipation, confusion, drowsiness, nausea, heart problems, and serious allergic reactions. Anticonvulsant medications are highly contraindicated in pregnant
Muscle Relaxants
They are not typically prescribed for treating chronic debilitating pain but are used to treat pains associated with muscle strains, sprains or spasms. Muscle relaxants can provide instant relief for muscles aches by promoting blood flow o affected joints, ligaments or bones.
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Examples of muscle relaxants are carisoprodol (Soma) and baclofen (Lioresal).
Antidepressants
Anti-depressants can treat chronic pain associated with diabetic neuropathy, fibromyalgia, neck pain, and low back pain. The following classes of antidepressants are often prescribed for neuropathic pains
- Tricyclic antidepressants (TCA): They are used to treat diabetic neuropathy, central post-stroke pain and post-herpetic neuralgia (shingles). Examples of TCAs are amitriptyline hydrochloride (Elavil, Amitril), nortriptyline (Pamelor, Aventyl) and desipramine (Norpramin).
- Selective Serotonin Reuptake Inhibitors (SSRIs): Examples of SSRIs are fluoxetine hydrochloride (Prozac, Sarafem) and sertraline paroxetine (Zoloft, Paxil).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): Examples of SNRIs are duloxetine (Cymbalta) and venlafaxine (Effexor). Venlafaxine extended-release is also useful in easing the pain of polyneuropathies.
Steroids
Are extremely potent anti-inflammatory drugs that are effective for treating lower back pain. Oral steroids are not intended for long-term use. Oral steroids come in many forms but are usually ordered as a Medrol Dose Pack in which patients starts with a high dose for initial low back pain relief and then taper down to a lower dose over five or six days.
Therapy
Physical therapy is a very important part of any pain management and is tailored to meet each patients’ conditions and need.
Cognitive behavioral therapy: Allows patients to have a better understanding and control of their self-defeating thoughts and behaviors, thereby, enabling them to be more positive, productive and healthy.
Relaxation techniques: Activities like meditation, breathing exercises and visual images have proven to be useful in helping patients cope with their chronic pain. The other advantage is there are no side effects or risks involved.
Biofeedback: Your body’s stress-related processes are monitored. With the results obtained, techniques to control and reduce your perception of pain are developed.
Acupuncture: Numerous studies have shown acupuncture to be effective in treating relieving pain caused by diabetic neuropathy and two types of peripheral neuropathy: Bell’s palsy and carpal tunnel syndrome
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References
Lalenoh, D., & Dalimunte, C. (2017). Diabetic Neuropathic Pain Pathophysiology and Pain Management. Academia Anesthesiologica International, 2(1). doi: 10.21276/aan.2017.2.1.6
Merskey, H. (2006). The Neuropsychopharmacology of Neuropathic Pain. Pain Research And Management, 11(suppl a), 3A-4A. doi: 10.1155/2006/304543
Moulin, D. (2000). Opioid Analgesics in the Management of Neuropathic Pain. Pain Research And Management, 5(1), 89-91. doi: 10.1155/2000/734239
Moulin, D. (2006). The Clinical Management of Neuropathic Pain. Pain Research And Management, 11(suppl a), 30A-36A. doi: 10.1155/2006/359752
