Specialists often take a team approach, but you should ask about insurance coverage.(ISTOCKPHOTO)Most patients in chronic pain go to primary care providersgeneral 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.
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Pain specialists take a multi-treatment approach
The benefit to the patientand the possible dilemma, when it comes to insurance coverageis 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 lesioningto 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.
Next Page: It's worth the effort [ pagebreak ]It's worth the effort
Andrea Cooper, 52, a fibromyalgiasufferer from Phoenix, Md., has benefited from a whole-patient approach to her pain. "In my opinion the most skilled pain specialist is someone who sees you as a whole person, and not just a bunch of presenting symptoms. My doctor will ask me what's going on in my life outside my medical situationkids, marriage, diet, exercise, what's going right and wrong, me as a person, my emotional life. It's all important. You can't separate one thing from other. And as a patient being respected in that way makes me want to be a bigger player in my recovery."
How to find a pain specialist
- The American Board of Pain Medicine lists doctors who are board-certified pain specialists (click on "Diplomates").
- The American Academy of Pain Medicine lists medical doctors who regularly work with pain, and may or may not be board-certified pain specialists.
- The American Academy of Pain Management lists health-care providers who regularly treat pain, though they may not be board-certified pain specialists or medical doctors.