What is pain medicine?
Pain medicine is a medical specialty that has been growing
in recent years with the increased awareness on the part
of medical doctors and others in the medical community of
the role and value of treating pain.
The field is predominantly filled with anesthesiologists,
although in recent years, rehabilitation doctors and others
have sought to be trained in this field.
What type of pain is treated by the pain physician?
Patients who have spinal problems such as low back and neck
pain are often in need of pain control.
Cancer pain control is another aspect of pain medicine.
There are also syndromes of nerve-injury pain that can be
treated. Headaches as well as problems related to stroke
related pain may be treatable.
What qualifications should a pain physician have?
The most established and well-recognized board that tests
and qualifies specialized medical doctors in the United
States is the American
Board of Medical Specialties.
Patients and referring doctors can feel comfortable if the
pain physician holds a diploma from this board that recognizes
the pain medicine qualifications of the various specialties
such as The
American Board of Anesthesiology.
A diploma holder of this specialty board has had to undergo
at least 1 year of specialized training in a program that
is recognized by the board as having the depth of knowledge
and experience to deal with matters related to pain.
IN OUR OPINION, IT IS VERY IMPORTANT THAT A PATIENT OR REFERRING PHYSICIAN ASK IF THE PROSPECTIVE
PAIN PHYSICIAN HAS THIS QUALIFICATION.
What causes pain?
Pain is a complex, multi-factorial experience that may or
may not be caused by injury to nerves, tissue or bones,
back discs and joints, or even tendons and ligaments.
Signals are transmitted ultimately by the nervous system
to the central nervous system and brain, where it is processed
and interpreted. This can result in an unpleasant condition
that may be short or long term and mild, moderate, or severe
Mediators of pain include chemicals produced in the body
caused by damage to structures in the body or even the nervous
Pain is also, to a greater or lesser extent, an emotionally
straining and draining experience. A vicious cycle of pain
that is exacerbated by overlying stress leads to a challenging
process of diagnosis and treatment.
What is the difference between acute and chronic
We talk of acute pain being something that is short-lived,
generally in the order of 0 to 4 or 6 months. Pain that
lasts beyond 4 or 6 months is referred to as chronic pain.
Chronic pain is usually more of a diagnostic and therapeutic
challenge than acute pain.
Can pain be treated? If so, how?
The answer, fortunately, is yes.
Improvements in medications, devices, and procedures in
recent years have enhanced the ability of the pain medicine
doctor to offer a variety of treatments that may enable
the patient to cope with the pain and even significantly
reduce the symptoms of pain and improve the patient's quality
It requires a process of diagnosis combined with treatment.
This diagnosis may take the form of imaging studies, lab
work, and even referrals to other doctors. The combination
of diagnosis and treatment can lead to a satisfactory outcome.
It is important to note that the patient should be an active
participant in their care and be compliant as well as realistic
about their situation.
Are there different treatments available?
Treatments range from the simple to the complex.
Something as simple as exercise and weight reduction may
be helpful but sometimes medications and procedures and
even implanted devices may be necessary depending on how
complex that a patient's pain problem is.
A lot of our patients undergo minor procedures that involve
in-clinic cortisone shots done under x-ray guidance and
joint or nerve blocking with local anesthetics, with some
sedation, that treat the affected areas.
The worst pain may require implanted devices such as spinal
cord stimulators. Also, implantable pumps that contain morphine
or other substances, which are delivered into the spinal
fluid by a catheter, may be effective. These procedures
are done as out-patient surgeries.
It is important to mention that each individual's problem
is different and may require different approaches.
What should the patient expect on the first visit
to the clinic?
The patient's first visit will be a comprehensive examination
of the patient's medical history as well as a physical examination.
At the conclusion of the visit, the physician will discuss
the problem with the patient and get a treatment plan, which
often involves a minor procedure such as a cortisone injection
or a nerve or joint block. It may also involve further studies.
However, it may also involve only recommendations for that
patient to follow.
It is very rare that a patient will get a procedure performed
on the first visit, as it is felt that the pain physician
needs to get a good idea of that particular patient's problem.
If a procedure is recommended, it will be scheduled at the
time of the visit and the instructions will be given to
the patient. The majority of the procedures are done in
the clinic itself in a procedure suite.
This may involve a series of procedures over a matter of
a few weeks.
What if the procedure does not help?
The majority of patients get significant relief with the
various procedures that are performed. However, if a given
procedure does not help, then the possibility of other sources
of the pain must be considered. This may involve further
procedures to isolate the cause of the pain or possibly
further testing or referral.
Are these procedures covered by insurance and if
so, what types of insurance are accepted at the clinic?
Yes, these procedures are generally covered by insurance(Please note that individual policies vary in their coverage of certain procedures).
The clinic accepts the majority of private insurance carriers
with indemnity, PPO and HMO, such as: Aetna™, Blue
Cross/Blue Shield™, United Healthcare™, Cigna™,
and Humana™, as well as other private insurance.
The clinic also treats injured workers with worker's compensation.
The clinic accepts Medicare patients.
Does the patient have to pay a large deductible
for the procedures?
For in-office procedures, the cost to the patient is generally
less expensive than a similar procedure done in a surgical
facility or hospital.However,the fees for the patient depend on the individual insurance plan, please discuss this with our billing department.