What does a pain management doctor do?
A pain management doctor is specially trained in the practice of pain relief. These specialists usually address chronic (long-term) pain relief due to a disease, medical condition, or injury. Treatment options are varied and can include medications, physical therapy and talk therapy (psychotherapy).
- A pain specialist may be trained in anesthesiology or may be a physiatrist (a physical medicine and rehabilitation doctor), a specialized orthopedic doctor, or other type of pain management healthcare provider.
- Healthcare providers may be medical doctors (MDs) or a doctor of osteopathy (DO). Other healthcare providers, such as a physician assistant (PA), nurse (RN) or a nurse practitioner (NP) may offer care, as well.
- A palliative care specialist is another type of healthcare provider that can help you or a family member manage pain from cancer or other serious illnesses.
- These healthcare providers may work in a medical pain clinic devoted to treating patients with serious, long-term or intractable pain. They have extensive medical training in pain management.
Pain doctors may specialize in the management of specific kinds of pain, for example: spine or neck pain, arthritis pain, cancer pain, fibromyalgia, migraine headache or nerve pain.
Many healthcare providers that specialize in pain management are members of the American Academy of Pain Medicine (AAPM), a specialty organization that encourages a multidisciplinary approach to pain treatment. Many medical pain doctors are also certified by the American Board of Pain Medicine.
Why is my doctor sending me to pain management?
Your primary care doctor can usually treat any initial pain problems, but sometimes you need more specialized care. Pain management doctors can help to direct your care in a stepwise and safe fashion. If you need a pain management doctor, your primary care physician can recommend one in your area.
Most pain can be managed, even if it can’t be cured. Treatment options your pain doctor might recommend includes medications, psychotherapy (talk therapy), physical therapy, specialized procedures or holistic approaches. Sometimes these treatments are combined for a greater effect. You may visit more than one type of healthcare provider to help manage the pain you feel.
You may benefit from specialized care for pain management if:
- The pain is not controlled with prescribed doses of medicine.
- You continue to have breakthrough pain in between your medication doses.
- You are having serious side effects from the pain medicine that do not respond to initial treatments.
- You develop a new type of pain.
- You need help in learning to take an active role in your pain management to better cope with your pain.
- Pain is affecting your quality of life, including your emotional health, ability to sleep, perform normal daily activities such as hygiene and bathing, eat meals, attend school or work, or enjoy social interactions.
- You would benefit from a team of specialized healthcare providers to manage your pain.
What should I expect from a pain management doctor?
A pain management doctor is trained in various techniques and procedures to diagnose and address your pain. In addition to excellent medical care, your pain management doctor should offer you good communication and listening skills, medical experience, and compassion for your condition. Treatment should be guided by your doctor following your wishes and belief system.
You may wish to take a family member or friend to your medical appointments to help you record any instructions and lend support. Be sure to take a full, written list of your medications and doses.
On your first visit, your pain doctor will ask you questions about the history of the pain, your current symptoms and any patterns to the pain you experience. They will review your medication list, and look at your prior medical diagnoses, lab results and X-rays, if needed. They will perform a physical exam.
Think about the following questions that your pain specialist may ask, such as:
- Where is the pain? How long have you had it?
- How does the pain feel? Is it sharp, dull or burning?
- When does pain occur? How often? Does it come and go?
- What makes the pain you feel worse? Does changing positions help with the pain?
- What helps your pain (for example, certain medicines) or other actions like exercise or sleep?
- Do you have other symptoms besides pain? (depression, loss of bladder or bowel control, constipation, weight loss)
Your doctor may ask you to rate the pain you feel on a scale of 0 to 10. Zero is no pain, and 10 is the worst amount of pain you could imagine. They might also show you a special diagram of faces with pain expressions and ask you to point to the one that resembles your level of pain. You might mark on a drawing the locations where pain occurs in your body.
Your doctor may ask you to keep a pain diary or journal to help track your pain. You’ll record where it occurs in your body, and how severe it is at different times, and what makes your pain better or worse. This can help you learn patterns of the pain you experience and gain better control over it.
A pain doctor should offer you an option of different treatments and should accept medical insurance for payment. Pain clinics that only accept cash payments could be "pill mills", which are illegal or unlicensed clinics that provide opioids for non-medical reasons. They may resemble a regular pain clinic, but patients do not receive regular physical exams, safety monitoring, or follow-up.
What medicines do pain management doctors prescribe?
Most pain medicine specialists will address your pain in a stepwise fashion, choosing the safest medicine with the least side effects that provides the best relief for your pain.
For example, pain due to muscle injury or joint inflammation may be treated differently than pain due to a nerve injury, cancer pain or a migraine. In addition, a multi-pronged approach may be used, including use of physical therapy, talk therapy (psychotherapy), or appropriate exercise to manage the pain you feel. In some cases, pain medicine may not always be needed.
A variety of medicines are available to treat pain, and include over-the-counter (OTC) medicines and prescription drugs. Do not exceed the recommended dosages of any medicine you take, and review all safety warnings and directions with your doctor before treatment.
Common examples of medicines used for pain management include:
- Acetaminophen (Tylenol)
- Non-steroidal antiinflammatory drugs (NSAIDs) - for example, aspirin, ibuprofen, naproxen or celecoxib
- Topical creams, gels, lotion or patches - capsaicin or lidocaine
- Muscle relaxants - baclofen, carisoprodol, cyclobenzaprine or methocarbamol
- Antidepressants - SSRIs, SNRIs or tricyclic antidepressants (TCAs)
- Anticonvulsants (often used for nerve pain) - gabapentin, pregabalin
- Anesthetics - numbing medicines like lidocaine
- Anti-anxiety medications - benzodiazepines or antidepressants
- Corticosteroids - short-term use: prednisone or methyprednisolone
- Local injections for pain - for example, spinal or knee joint injections or trigger point injections
- Injections that may lubricate the joints - viscosupplementation, often used for the knee
- Opioids (narcotics)
Opioids (narcotics) are used for pain but many doctors prescribe them for short-term use and more severe acute pain due to the risk for addiction and serious side effects. Opioids include medicines such as codeine, oxycodone, hydrocodone. Other options are often selected with safer side effects and less risk of addiction.
If you do need opioid treatment for a longer period of time, a pain specialist will be able to prescribe these medicines, and help you stop them safely, to lower your risk for any dangerous side effects. Do not suddenly stop taking opioids or any other medicine without your doctor’s consent.
Some opioid treatments may be combined with acetaminophen in one pill for added relief. Be sure not to exceed the recommended dose of acetaminophen per day for all the medicines you take, as this can cause liver damage. If you drink alcohol, speak with your doctor if it is safe for you to use acetaminophen.
Do not drink alcohol if you are using opioid medications. This may worsen drowsiness and slow or stop your breathing. Do not chew, crush or split your pain medicine in half if it is supposed to be swallowed whole. Ask your doctor or pharmacist if you are not sure.
These medicines can be especially dangerous in older patients due to dizziness, sedation or falls. Do not drive or operate dangerous machinery while taking opioids.
Can I treat pain without medicine?
Medicine is not always the best option for pain management. In many cases, you may be able to combine lower doses of pain medicine with non-drug options for a greater effect.
In addition, while some non-drug methods may not work alone, they may help to enhance the effect of prescription medicines and may allow you to lower your dose.
Speak with your medical healthcare provider about which non-drug options may be most successful for your pain treatment regimen.
Non-drug options for pain management
- Physical therapy / Other forms of doctor-approved exercise
- Psychotherapy or group therapy (talk therapy or counseling)
- Application of ice / heat
- Transcutaneous electrical nerve stimulation (TENS)
- Spinal cord stimulation
- Rehabilitative massage therapy
- Mind-body therapies (for example: yoga, breathing / relaxation techniques, meditation, guided imagery, Tai Chi, biofeedback, hypnosis)
- Chiropractic treatment
- Weight control or weight loss
- Assistive devices such canes, splints or a walker
- Music therapy
How do I change my pain management doctor?
If you feel that your pain is not being addressed adequately, speak to your pain management doctor or primary care doctor. It may be that you need added therapies or adjustments to your medication to help with any breakthrough pain you may be experiencing.
You can always ask your primary care physician for recommendations for specialized healthcare providers for any medical need you may have. In many cases, your primary care doctor may be able to address your medical conditions and pain.
Will I get addicted to pain medicine?
Addiction is a possibility for anyone taking an opioid pain medicine, especially if they are misused. Regular use of opioids can lead to dependence upon the medication.
Based on national guideline recommendations, many doctors prefer to prescribe opioid medicines for more moderate-to-severe pain and for a short period of time to help prevent addiction, dependence or other serious side effects.
If you are using opioid medications for pain, or have in the past, be sure to tell your healthcare provider. Let your doctor know if you or a family member has a history of alcohol or drug abuse.
What is the difference between addiction and dependence?
- Addiction is the compulsive use of prescription of illicit drugs, with drug-seeking behaviors, despite a known harmful effect. The person cannot stop use of the drug and it interferes with work or family obligations. Dependence, tolerance and withdrawal can occur along with addiction.
- Physical dependence occurs with prescribed drugs even if taken as directed by your doctor. Physical dependence also occurs with addiction.
Opioid addiction can be treated. Tell your doctor if you or someone you know needs help with opioid use disorder. Do not stop taking an opioid treatment without specific instructions from your doctor. You may need to slowly stop it to prevent dangerous side effects.
In many cases, pain can be addressed with non-addicting medicines such as acetaminophen, NSAIDs, antidepressants, many anticonvulsants, and non-drug therapies like exercise or talk therapy. Ask your doctor if your medicine is habit-forming and how you should discontinue it. But do not stop taking any medications without first speaking to your doctor.
Why do pain management doctors drug test?
Your doctor may decide to periodically drug test you to help follow your treatment and ensure that it remains safe and effective for you. Drug monitoring by testing can occur with patients taking controlled substances for chronic pain relief or for people undergoing an opioid use disorder treatment plan.
You may be drug tested:
- Before you start a new pain treatment,
- If you are changing treatment to another doctor
- If there is a need to change opioid medicines due to side effects or lack of effectiveness
- If there are signs of misuse, such as “doctor shopping”, early refill requests, or reports of lost or stolen medications or prescriptions.
Your doctor may need to test you to look for misuse of prescription drugs like opioids (hydrocodone, oxycodone) or benzodiazepines (lorazepam, diazepam) and be sure you are adhering to an agreed-upon treatment plan. The drug test may also look for use of illegal drugs like heroin or cocaine. Your doctor will determine the most appropriate drugs to test for.
Drug testing is also used to help discourage drug misuse and abuse and to help prevent drug diversion, which is the illegal sale or transfer of controlled substances for illicit use, often on the streets.
What drugs do drug tests look for?
Drug testing is usually ordered by your doctor and tailored to your individual needs or requirements. Drug testing may occur in variety of settings, including chronic pain management, in the setting of Opioid Use Disorder (OUD) treatment, or for workplace or government-mandated drug testing.
Testing urine is the most common method of testing, but blood, saliva and hair are other options. How often you are tested is determined by your doctor and will depend upon the predicted risk level of opioid misuse.
Two levels of drug testing are performed, if needed, to help prevent the occurrence of false results, or “false negatives or “false positives”.
Learn More: Drug Testing FAQs
A panel of drugs are usually tested for and may include:
- Opiates: Morphine, Codeine, 6-Acetylmorphine (heroin metabolite)
- Opioids: Fentanyl, Buprenorphine, Methadone, Tramadol, Oxycodone, Oxymorphone, Hydrocodone, Hydromorphone, Meperidine, Tapentadol
- Benzodiazepines: for example: Lorazepam, Alprazolam, Diazepam
- Muscle Relaxants: Carisoprodol
- Cannabinoids: Marijuana, THC
- Cocaine: Metabolite
- Barbiturates: Phenobarbital, Butalbital
- Mahajan G, et al. Urine drug testing for patients with chronic pain. Up to Date. Accessed 8/24/2021 at https://www.uptodate.com/contents/urine-drug-testing-for-patients-with-chronic-pain
- Hoffman R, et al. Testing for drugs of abuse (DOAs). Up to Date. Accessed 8/24/2021 at https://www.uptodate.com/contents/testing-for-drugs-of-abuse-doas
- Is there a difference between physical dependence and addiction? National Institute of Drug Abuse (NIDA). Accessed 8/24/2021 at https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence-addiction
- Jenkins A. The Role of Urine Drug Testing in Pain Management. Quest Diagnostics. Accessed 8/24/2021 at https://www.questdrugmonitoring.com/blog/2017/the-role-of-urine-drug-testing-in-pain-management
- Dowell D, et al. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 MMWR Recomm Rep 2016;65(No. 1): pages 1-49. Accessed 8/24/2021 at https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf
- Pain: You Can Get Help. National Institute on Aging. Accessed 8/24/2021 at https://www.nia.nih.gov/health/pain-you-can-get-help
- Drugs with Highest Rates of Positivity in the Workforce. Quest Diagnostics. Accessed 8/24/2021 at https://www.questdrugmonitoring.com/blog/2020/drugs-with-highest-rates-of-positivity-in-the-workforce
- ACPA - Stanford Resource Guide to Chronic Pain Management. 2021 Edition. American Chronic Pain Association. Accessed 8/24/2021 at https://www.theacpa.org/resources/acpa-resource-guide/
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