Thursday, December 4, 2008

How Specialists Can Help You Tackle Your Chronic Pain

Most patients in chronic pain go to primary care providers—general practitioners, nurse practitioners, and physician's assistants. The problem is that too many of them stay there. In the past two decades, pain management has emerged as a distinct field, with its own physician, the pain specialist, but a 2005 study showed that less than 5% of chronic pain sufferers ever see one.

Pain specialists come from many fields, have extra training in pain management, and are certified in pain management from a specific specialty board or the American Board of Pain Medicine. So that means you could see an anesthesiologist, a neurosurgeon, a physiatrist, a neurologist, an orthopedic surgeon or even a psychiatrist who is also a pain specialist.

Pain specialists take a multi-treatment approach
The benefit to the patient—and the possible dilemma, when it comes to insurance coverage—is that many pain specialists will take a multi-treatment, team-based approach. Pain patients often need a range of treatments: not just painkillers, but perhaps nerve blocks and trigger-point injections, spinal cord stimulation, transcutaneous electrical nerve stimulation and radiofrequency lesioning—to cite from the menu offered by the New York University Pain Management Center in New York City. Other approaches include cognitive behavioral therapy, acupuncture, even meditation training.

"An integrative approach to pain treatment means using the best evidence-based tool at the best time," says Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in San Diego. "As a physician you should be as comfortable suggesting back surgery as you are biofeedback therapy," explains Dr. Bonakdar.
The price to a chronic pain patient of a single-track approach to treatment can be high.

"Pain is physical, it's emotional, it's psychological, it's social, it's economic." says Chuck Weber, spokesman for the American Pain Society. And the longer you wait to address your pain, the more complicated it can be for one expert to treat it.

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