WHICH PAIN SPECIALIST IS RIGHT FOR ME?

INTRODUCTION

OK, so you’ve got this relentless, persistent, pain that no one seems to know how to deal with and you might have even been told to live with it. And you say something along these lines:,

“Is that it for me? This pain is draining and exhausting. This nerve pain is excruciating. In today’s modern times, surely there are options to manage my pain?”

The answer is yes, there are options for pain management. Perhaps you were not looking in the correct place or perhaps your primary doctors or specialists have not pointed you in the right direction yet.

With the world changing, modern medicine is changing too. This is true for how we manage pain in all its forms: chronic pain, cancer pain and acute pain.

Here are a few reasons why the practice of pain management is changing and why experts may be needed to manage your pain:

  1. Persistent (chronic) pain is common – see how common here.
  2. Chronic pain is complicated! Hence chronic pain management is complicated!
  3. Chronic pain occurs in all of the medical fields and specialties like neurosurgery, neurology, orthopaedics and even paediatrics, so much so that those specialists are not able to manage all the different types of pains they see on top of performing their medical specialty they practice.
  4. The modern art of reducing pain does not just mean taking opioid medications for the rest of your days!

Assessing, diagnosing and managing pain is complicated and has led to a new medical specialist, the pain specialist physician. In Australia the Faculty of Pain Medicine was born in 2005.

WHAT IS A PAIN SPECIALIST PHYSICIAN?

A pain specialist physician is a dually qualified medical doctor who has completed advanced medical training in the assessment, diagnosis, and treatment of all types of pain. Pain includes acute pain, chronic pain and cancer pain and sometimes a combination of these. Pain can occur for many different reasons such as following surgery, an injury or trauma, nerve damage, and medical problems such as diabetes. Sometimes pain can even be the problem all by itself, and just occur without any reason.

As we understand more about the complexities of pain, it important to have physicians with special training knowledge and skills to treat these complex problems.

WHAT DO PAIN SPECIALIST PHYSICIANS DO?

Pain specialist physicians;

  • Understand how pain occurs (the physiology of pain) and how pain affects the body and people of all walks of life, young and old, sick and healthy.
  • Have the skills to evaluate people with complicated pain problems.
  • Have an understanding of the specialised tests used to diagnose different painful conditions.
  • Are qualified to prescribe multiple types of pain medications to help manage pain.
  • Can perform highly technical procedures like nerve blocks, radiofrequency ablations, spinal injections and other advanced pain interventional techniques like implantation of neurostimultor devices for some pain conditions or the implantation of intrathecal pump devices for cancer pain.
  • Are uniquely trained to use their new knowledge safely and effectively to manage pain.
  • Plays an important role in coordinating additional pain care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with, what we call a multidisciplinary approach to the treatment of complex pain.

WHAT SHOULD I LOOK FOR IN MY PAIN SPECIALIST PHYSICIAN?

The most important consideration in looking for a pain management specialist (sometimes called chronic pain specialist), is to find someone who has the correct training, expertise and experience to help you and your specific pain problem. It’s also very important that you feel comfortable with him/her and they have earned your trust.

Since managing chronic pain requires a complex treatment plan that might include pain medications, advanced pain interventional techniques (various injections), and further coordinated care, pain specialists need the correct training and expertise. The widely accepted standard for pain specialist training today is a fellowship in pain management.

You should ask about how your pain specialist physician was trained and whether he/she holds a fellowship in pain medicine in the country that they practice. In Australia it is Fellow of the Faculty of Pain Medicine of the Australia and New Zealand College of Anaesthetists (FFPMANZCA). The pain fellowship program in Australia and New Zealand is between 1 and 2 years of advanced training in all aspects of pain management. Then once training is completed to get board certified, the pain fellow is required to do a combination of various examinations.

The FFPMANZCA is a world-recognised qualification in pain medicine and considered one of the highest medical qualifications in pain management.

Make sure your pain specialist holds the correct pain qualification. See the Faculty of Pain Medicine of the Australian and New Zealand’s Fellowship Directory for a list of pain specialist physicians

This is what the pain and anaesthetics logos look like from the Australian and New Zealand College of Anaesthetists.

This is what the pain and anaesthetics logos look like from the Australian and New Zealand College of Anaesthetists.

HOW DO I KNOW IF I NEED TO SEE A PAIN SPECIALIST?

If you are experiencing any of the following you should see a pain specialist?

  • You have pain that is persistent. It can be any type of pain in any part of your body. Pain specialists manage all types of pains.
  • The pain has not being adequately managed by therapies and techniques you have already tried
  • The pain is affecting various aspects of your life like for example the pain is preventing you from doing things in life that you enjoy.

HOW CAN I BE REFERRED TO A PAIN MANAGEMENT SPECIALIST?

The best way to be referred to a pain management specialist is through your primary care physician. Most pain physicians work closely with their patients’ primary care physicians to insure good communication, which in turn helps provide the optimum treatment for their patients. Patients are also often referred by specialists who deal with different types of pain problems. Back surgeons, neurologists, cancer doctors, as well as other specialists usually work regularly with a pain physician and can refer you to one. How to know if a pain specialist is right for me?

ASK THE FOLLOWING QUESTIONS WHEN YOU ARE EVALUATING AND DECIDING ON A PAIN SPECIALIST:

  • Do they have the correct medical qualification(s)? Your pain specialist should hold the correct medical pain qualifications. In Australia it is called FFPMANZCA.
  • Do they have expertise in managing my type of pain?
  • Are they able to perform all the necessary pain intervention procedures needed to help me manage my pain? Some pain conditions may be treated with pain injections or even neurostimulators. They key with pain injections is that they should be combined with other forms of pain therapy like physiotherapy because if your pain can be reduced by pain injections then you may need help in getting your body moving again.
  • Do they work as part of a team of pain experts? Pain specialists should works within an allied health team of pain experts. This team may include physiotherapists, occupational therapists, psychologists and nurses.
  • Who do they refer to for other treatment options such as surgery, psychological support or alternative therapies?
  • What is their overall philosophy of pain management and why do they practice pain management?
  • Will they believe me and care about me?

WHAT SHOULD I EXPECT DURING MY FIRST VISIT TO A PAIN MANAGEMENT SPECIALIST?

Managing pain is a journey. It can sometimes take time. On your first visit to a pain specialist physician, he or she will get to know your pain and how it is affecting you and your life. If your story is complicated, it may even take more than one visit for your pain specialist to get a handle on your pain.

The more information you provide, the better equipped your pain specialist will be to piece together your story of pain.

  • Fill out any questionnaires about your pain, that you receive, and use as much detail as you can. Take in all your relevant scans and investigations like as X-rays, computed tomography (CAT) scans, or magnetic resonance imaging (MRI) scans.
  • You pain specialist will take a detailed story of your pain. This might include finding out about your other medical problems and past surgeries. He/she may perform a physical examination and look at the various tests you have had in the past.
  • Your pain specialist will give you a diagnosis of your pain or at least, a plan of action to ascertain the cause of your pain. He/she will likely discuss treatment pathways and what may be best for you. Your pain specialist should take your views and opinions into consideration before making a treatment plan.

CONCLUSION

Living with chronic pain can be hard at the best of times. Most people are usually at their wits end by the time they see a pain specialist physician. The aim is for you to find the correct pain specialist as early on as possible by asking the right questions, so take the time and do your research on who can best manage you and your pain.

Good luck.