Pain Management Myths and Facts

Orthopedic conditions have one thing in common: pain. While some pain can be treated with surgery, some pain is best treated using a nonsurgical, multimodal approach that combines physical therapy, oral medications, analgesic techniques such as nerve blocks or epidural injections, or noninvasive outpatient procedures. Depending on the type of pain and how it may best be treated, many patients opt to consult a pain management doctor, a specialist who can help treat pain by managing a combination of all of these treatment options.

There are several common misperceptions about pain management that are important to dispel so that patients can make informed medical decisions. Read more to find out what is myth and what is fact.

Myth: Pain management doctors usually prescribe opioids

Fact: Pain doctors will usually treat pain using several different methods, often including rehabilitation, injection treatments and non-opioid medications.

No studies have ever proven that opioid medications help treat long-term, chronic pain (pain that lasts longer than three months). In fact, a 2018 study from the Journal of the American Medical Association (JAMA) suggests that patients who were prescribed opioids to manage long-term pain did not have better pain control than patients who were not prescribed opioids. While patients may in some cases be prescribed a short course of opioids, they are typically meant to treat specific, acute (short-term) pain, or to be part of a more comprehensive treatment plan for chronic pain.

Myth: Pain management is only meant to manage pain after surgery so patients can begin physical therapy

Fact: Outpatient pain management physicians manage many different types of pain in many ways. Surgery may not always be the advised treatment.

While some patients may benefit from surgery, many patients who are referred to pain management physicians are more likely to manage their pain better with alternative strategies overseen by pain management specialists. These physicians are trained to manage all aspects of a patient’s treatment, which can include monitoring physical therapy progress and coordinating alternative treatments such as acupuncture, to performing outpatient procedures such as epidural steroid injections or spinal cord stimulator insertion to help patients live with pain that isn’t best treated through surgery.

Myth: Pain management specialists don’t understand how my pain is affecting my life

Fact: Pain management physicians see all sorts of patients, ranging from those with fibromyalgia or cancer pain to those with recurring lower back pain and arthritis.

Working with all of our patients and learning how their pain affects them helps us treat pain more effectively. In many cases, there are multiple factors that contribute to one person’s pain.

One of the most important things to consider in pain management treatment is incremental progress. Just as when a patient is recovering from short-term pain associated with surgery, patients who have chronic pain learn how to measure and quantify their pain and work with a pain management specialist to see the bigger picture – it’s not about returning to your daily routine a few short days after the first appointment or treatment, but rather about how you progress through the stages of managing and circumventing pain so as to return to a daily routine. Having one physician to manage and oversee how all these pieces work together helps patients see the "big picture" and better manage their ongoing, recurring pain.

Myth: Opioids are the only pain medications that work

Fact: There are a wide variety of medications other than opioids that can be used to reduce pain, and they fall into a number of different drug categories.

Because inflammation is frequently a significant cause of pain, anti-inflammatories are often useful for pain control. These include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
  • more powerful glucocorticoid corticosteroid medications, which can be used for short-term treatment

Pain related to nerve functions, which encompasses many different situations, can be reduced with medications that modulate activity in the nervous system. The types of medications used for nerve pain are usually from one of two categories:

  • antidepressants such as amitriptyline or duloxetine
  • antiepileptic drugs, such as gabapentin or pregabalin

In many cases, these types of medications are better tolerated than opioids, and they are generally associated with much lower levels of risk and side effects than opioid medications.

Getting treatment for chronic pain

Whether your pain is a symptom of a more complex, chronic condition or the result of a back injury or disc herniation, or simply occurs with little improvement over time, a pain management specialist may be just the right doctor to see in order to manage this pain and improve quality of life.

Dr. Robert Griffin is a pain management physician within the Department of Anesthesiology, Critical Care and Pain Management.

Authors

Image - Photo of Robert S. Griffin, MD, PhD
Robert S. Griffin, MD, PhD
Director, Ambulatory Pain Medicine Program, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College
     

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