Our spine is a complex structure with many types of pain generators. Everybody experiences neck or back pain at some point in their lives. Most of the time, there are simple reasons for this pain, such as overuse injuries. Fortunately, in the majority of the cases, pain gets better on its own in a few days. Brief rest, activity modification and simple over-the-counter pain medications may be all you need. However, if the pain does not improve after approximately 4-7 days, further investigation by a clinician may be required.
If there is still no significant improvement following physical therapy or medications, it’s necessary to involve an interventional pain specialist to evaluate your condition, further evaluation by your clinician may include ordering more advanced diagnostic tests such as MRI scan.
Who exactly is an interventional pain specialist?
As the field of medicine learns more about the complexities of pain, it has become more important to have physicians with specialized knowledge and skills to treat these conditions. A pain management specialist is a physician with special training in the evaluation, diagnosis, and treatment of all different types of pain including:
- An in-depth knowledge of the physiology of pain
- The ability to evaluate patients with complicated pain problems
- An understanding of specialized tests for diagnosing painful conditions
- Appropriate prescribing of medications to varying pain problems
- Skilled to perform procedures (such as nerve blocks, spinal injections and other interventional techniques)
In addition, the broad variety of treatments available to treat pain is growing rapidly and becoming more complex. With an increasing number of new and complex drugs, techniques, and technologies becoming available every year for the treatment of pain, the pain management physician is uniquely trained to use this new knowledge safely and effectively to help his or her patients.
What role does an interventional pain specialist play in your treatment?
If the pain continues to be a problem after approximately 2–3 weeks of duration despite utilizing conservative therapies, your clinician may consider a referral to an interventional pain medicine specialist.
A thorough evaluation by an interventional pain management specialist typically consists of:
- A review of your history
- A physical examination
- A neurological examination
- A careful review of all medical records and diagnostic studies.
There is a variety of spinal interventions that may be considered not only for treatment purposes, but also for diagnostic purposes. A correct diagnosis is the first and the most important step in the treatment of debilitating and unresolved pain.
Spinal interventions, including epidural steroid injections and nerve blocks, are performed under image guidance such as x-ray or ultrasound for precision, These interventions are extremely helpful in diagnosing the actual pain generator within the spine. They may also help a patient avoid surgery if it is not necessary. Nerve blocks prevent pain generating from the small joints in the spine, known as facet joints. If adequate pain relief is obtained by these diagnostic nerve blocks, a radiofrequency procedure may be recommended to provide long-term pain relief. Typically, radiofrequency procedures are very effective in alleviating the spinal pain for many months or years.
Often, the patient has multiple pain generators, so diagnostic studies do not correlate with the patient’s history and physical examination.
Who should see an interventional pain management specialist?
Typically, these are the patients who have failed conservative therapies and yet are not found to be a candidate for spinal surgery. Other type of patients may have undergone spinal surgery, yet are still complaining of residual pain despite a reasonable recovery period. In this case, pain may exist because of development of scar tissue around the surgical area, partial nerve damage that occurred prior to problem is fixed by the surgery, development of the new pain generators such as a new mechanical, soft tissue or muscle problems, recurrence of the problem or rarely unsuccessful spinal surgery. Sometimes, interventional pain management procedures may be considered earlier than 2–3 weeks, if the pain is so severe that the patient is not able to perform home exercises or physical therapy effectively. In such a case, effective pain control with an interventional pain procedure may be considered prior to resuming or starting home exercises and physical therapy.
What can interventional pain medicine specialists do?
Interventional pain medicine specialists may be able to figure out and treat the cause of your pain, and direct you for the right treatment options after determining the most likely pain generators. Interventional pain management is different from other pain management practices because it emphasizes the importance of a precise diagnosis so treatment can begin immediately. Rather than just prescribing medication or only recommending physical therapy, an interventional pain management specialist utilizes all sources of treatment to eliminate pain in the fastest and most effective way possible for each individual patient.
Also, an interventional pain medicine specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with a multidisciplinary approach to the treatment of their pain.
How can I be referred to a pain management specialist?
The best way to be referred to a pain management specialist is through your primary care physician. Back surgeons, orthopedic surgeons, neurologists, rheumatologists as well as other specialists usually work regularly with a pain physician and can also refer you. Most pain physicians work closely with their patients’ referring physicians to insure good communication, which in turn helps provide the optimum treatment for their patients.
Dr. Semih Gungor is board-certified in anesthesiology and pain medicine. He has specialized in pain management since 2001 and believes that each patient’s condition is unique and requires comprehensive assessment with the highest quality of pain-focused medical care.