What is Pain Management?

The question I get asked the most when I tell people what type of medicine I practice is, “What exactly IS pain management?”  Most people think I do one of two things: inject people with steroids or prescribe people opioids. Happily for me, my day-to-day practice is a lot more interesting than just this!  Yes, sometimes these things are aspects of a treatment plan, but rarely by themselves. In fact, it is really unusual for me to have a plan for a patient that uses only one treatment modality- I’ll discuss more about what that means later.

It might be helpful to take a step back and talk a little bit about what a typical path is for someone like me, who practices pain management full-time.  I went to a traditional medical school and after 4 years, graduated with my medical degree. Before a physician can practice, we complete further training in a specific field, which is called residency.  I did my 4 years of residency in anesthesiology. Then, many physicians choose to subspecialize further, in an additional year or several years of training, called fellowship. To be board certified in pain management, a one year fellowship is required before taking the board certification exam.  

If this sounds like a lot, it is! Pain management is a very complex field because it encompasses a lot of different specialities: anesthesiology, psychology, neurology, physical medicine and rehabilitation (PM&R) and addiction medicine, just to name a few.  There are multiple different residencies that a physician can complete before doing this type of fellowship, but the most common ones are anesthesiology, PM&R and neurology. There are even talks of making pain management its own residency, but that has not happened yet.

Everyone who practices in the field of pain management has their own treatment philosophy, but I believe that pain management needs to be multidisciplinary.  This means two things: 1. that I work closely with other providers (physical therapists, psychiatrists, neurologists etc.) who are treating a patient’s pain, and 2. that the treatment approach utilizes multiple different modalities.  The broad categories of a treatment plan include medications, other modalities, diagnostic testing and interventions.

Medications include a wide variety of options including nerve pain medications, muscle relaxants, anti-inflammatory medications, and ointments. I do occasionally use opioid medications to treat pain, but as a specialty we are starting to move away from these medications for many reasons, which I will detail in another post.  “Other modalities” is a catch-all which includes things like physical therapy, acupuncture, bracing, psychotherapy, TENS, mindfulness based therapies and diet changes. Diagnostic testing is ordered by me if more information is needed to rule in or out a certain condition. Interventions include different pain management procedures, like steroid injections (X-ray or ultrasound guided), nerve blocks and radiofrequency ablation.  

It takes someone who is able to sort through all these treatment modalities, and who is also a good diagnostician, to help develop the best plan to help a patient manage their pain.  In my experience, looking at pain from only one angle leads to an incomplete, and ultimately unsuccessful treatment.

In the future, I plan to blog about many different types of conditions that cause pain.  I’ll also give information about a wide variety of treatment modalities. It is impossible to neglect the environment in which I practice medicine, so some posts will focus on why certain aspects of medicine are the way they are, like dealing with prior authorizations and coverage issues.  Of course, none of what I blog about is meant to substitute for you going in person to see a pain management physician- this is all general information to make you a more informed participant in your health, not to provide specific diagnoses or treatment plans.