What is the difference between acute and chronic pain?
Acute pain is pain of a short, limited duration which is usually the result of an injury, surgery or medical illness. Acute pain typically goes away within the normal healing process. Chronic pain continues for longer periods of time, and can be associated with frustration, depression and anxiety. Treatments for acute and chronic pain often differ greatly.
What is interventional pain management?
Interventional pain management is the discipline of medicine devoted to the diagnosis and treatment of pain-related disorders with the application of interventional techniques in managing subacute, chronic, persistent and intractable pain, independently or in conjunction with other modalities.
Who are doctors specializing in pain management?
Pain specialists come from various primary specialties with advanced training and expertise. They are mainly anesthesiologists, physical medicine & rehabilitation specialists and neurologists. However, they may include orthopedic surgeons and interventional radiologists with the proper training.
Can interventional pain management physicians find the cause of my pain?
While your pain specialist cannot guarantee that they will be able to find the underlying cause of your pain, they are highly trained in the methods that would allow them to do so. They conduct a thorough physical examination, review your medical records and analyze the description of your pain. Many doctors review additional diagnostic studies such as x-rays, CT scans, MRI’s, nerve conductions studies and detailed history and physical exam.
What are interventional pain management techniques?
Interventional pain management techniques are minimally invasive procedures including, percutaneous precision needle placement, with the placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques such as laser or endoscopic diskectomy, intrathecal infusion pumps and spinal cord stimulators.
Are there psychological effects of chronic pain?
Yes. Chronic pain often produces feelings of anger, sadness, hopelessness and even despair. In addition, it may alter one’s personality, affect their sleep patterns, interfere with work and have an effect on other family members. It is normal to have psychological problems with pain.
When should a primary care physician refer a patient?
This really depends on the comfort level of the primary care provider and the complexity of the patient. At times, we receive referrals to endorse an ongoing treatment strategy created by another physician, while at other times we evaluate a patient for a new or refractory diagnosis.
How do you evaluate a patient?
Almost universally, patients will tell us, “pain is pain,” but in fact, it is much more complex. We work through the pain complaint often using a physician-directed history in addition to diagnostic imaging to understand the nuances and reach a diagnosis. Once we have a diagnosis, we discuss treatment options, home-based therapies, and medications to address the pain as well as try to set the correct patient expectations.
What types of interventional treatments are available?
While epidural steroid injections are well known, there are a much broader range of spinal and non-spinal injections, as well as minimally invasive surgical procedures and a growing number of implantable devices now available. Pain physicians select from a variety of approaches or techniques and tailor treatment based on each patient’s unique pain condition.
Should every patient receive an injection?
In general, interventional pain procedures are reserved for relatively focal pain areas like a particular joint rather than diffuse polyarthralgias. Studies have largely disproven the effectiveness of interventional treatments (such as trigger point injections) for widespread pain conditions like fibromyalgia. Treatment should always be tailored to a diagnosis, and some pain conditions are better treated with noninterventional approaches.
What are the advantages of interventional therapies?
Interventional pain therapies continue to serve as an effective treatment option for patients suffering with select acute, subacute and chronic pain conditions. Joint injections, nerve blocks and epidural injections have been associated with functional improvements, cost savings and require little or no downtime for the patient.
Can you tell us more about selecting patients for pain treatments?
The importance of a correct diagnosis cannot be stressed enough. When the diagnosis and the treatment don’t align, the patient is unlikely to realize benefit from a pain treatment plan. That includes medications or injections. In addition to a pain diagnosis, an evaluation of medical comorbidities, an assessment of patient expectations and a risk-benefit analysis are always necessary.
It’s also important to remember that psychiatric diagnoses can make a pain assessment more complicated. Depression and anxiety are common, but a physician should also assess for psychosis and suicidal tendency. There are black box warnings for many commonly used pharmaceutical treatments, and overlooking a patient’s comorbidities could worsen a psychiatric diagnosis.
What about implantable devices?
With advancements in technology and a growing body of outcome data, greater numbers of patients are now able to get relief from implantable devices such as spinal cord stimulation. Data from the past few decades shows that when utilized for select pain diagnoses, certain implantable technologies are more cost effective than repeated nerve blocks, medical management or surgery. Complex regional pain syndrome is a good example of where we often try to introduce the spinal cord stimulation soon after diagnosis.
How do costs play a role in chronic pain management?
In a few cases, payors are beginning to see the cost savings that can be realized by use of interventional therapies over long-term medical treatments or surgery. This may become more important over the next decade as more patients join Accountable Care Organizations that provide lump sums of payments for treatment of episodes of care. We can optimize care and ultimately save healthcare costs by offering tailored pain therapies to select patients who suffer from acute and chronic pain conditions. With more than 100 million Americans suffering from chronic pain, there is a lot of opportunity to give people some relief.