We all have our own feelings about how our pain should be treated, as do the providers who treat us. Our ideas are based on our previous experiences, our family culture, etc. There are over 100 million scenarios, because there are that many Americans living with conditions that cause chronic pain.
Some of us are open to all available treatments, while others are not. Maybe we have undergone expensive medicine trials or treatments that didn’t work. Maybe opioids worked well, but our provider no longer feels comfortable prescribing them. Maybe alternative treatments are not available to us. That’s why the right fit between patient and pain doctor is important.
Are all pain doctors created equal?
No, not all pain doctors are the same. Pain management physicians have differing clinical backgrounds and may have differing pain management board certifications. According American Society of Regional Anesthesia and Pain Medicine, there are three pain management board certifications recognized by the American College of Graduate Medical Education. Eligibility for a subspecialty board certification in pain management requires board certification, and fellowship as an anesthesiologist, neurologist, or physiatrist.
- Anesthesiology – A great number of pain specialists are anesthesiologists. They use interventional procedures, such as nerve blocks, epidurals, implantable devices (i.e. nerve stimulators or pain pumps), and some do ultrasound-guided trigger point injections. Many also prescribe medications to treat pain.
- Neurology – A neurologist may practice in a pain management group and do the same procedures as an anesthesiologist or specialize in management of chronic migraine, diabetes, or other conditions that cause nerve pain. They also perform diagnostics such as an electromyography (EMG), and offer pain management with medication.
- Physiatry – By training, physiatrists are rehabilitation physicians who focus on identifying contributing factors, physical and occupational therapy, and movement. Those who have a subspecialty in pain management also do interventional procedures and implant medical devices to treat chronic pain. They may also offer medication pain management.
Regardless of their primary specialty, what you want in a pain doctor is a good diagnostician with the right skills, and an approach you feel will work for you.
Other considerations when looking for a pain doctor:
- Is the provider in your insurance network?
- Can you live with their bedside manner?
- What is their experience?
- Does the physician perform a thorough physical exam?
- Does the doctor rush to do an interventional procedure the first time they see you? If they do, run* Does the doctor make sure you understand and discuss your treatment plan with you?
- Does the provider discuss all your options, such as physical therapy, interventional treatments, and the risks and benefits of opioid therapy?
- Does the pain specialist use a patient-centered care model, consider your lifestyle, family support, and your ideas when devising a plan?
- Is the provider a good fit for you?
Personality matters. My own pain physician is a puzzle solver and he is a listener. He knows more about my personal life, my stressors, and my joys than most of my family members. Having someone like that on our team balances our center of gravity.
Two cents and a pound of gold
I asked my pain doctor extraordinaire, Karl Hurst-Wicker, M.D., if would share his thoughts with us. This is what he had to say.
“If I had to pick one critical component to finding a pain management doctor, I would say it is finding someone you connect with and trust. Being a pain management physician involves many different aspects of medicine, from diagnostician to listener, and critical thinker to fixer and changer. Every day I use aspects of care that come from my training, often times going back to things I haven’t thought about, or treated since medical school. Critical to all of this is the relationship I have with my patients.
Treating pain is a team effort, requiring input and work from the physician, patient, and often other health care professionals like physical therapists, etc. It’s hard to form a good team and get positive results without mutual trust.”
We are certainly on the same page.
Additional helpful reading:
Q&A on Chronic Pain with Dr. Karl Hurst-Wicker
10 Reasons You Should Find a New Doctor
Doctors’ Scores on Communication Predict Complaints to Authorities