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Role of the Pain Management Specialist

Pain management specialists are concerned about the patient's ability to function and their quality of life. When pain is chronic or complicated by other medical conditions, the patient's primary care physician may refer the patient to a pain specialist, such as a physiatrist. Physiatrists are medical physicians who specialize in physical medicine and rehabilitation with a special interest in musculoskeletal conditions. Some physiatrists have advanced training in Interventional Pain Management (IPM). IPM is an area of medicine devoted to the diagnosis and treatment of pain related disorders.

A pain management specialist develops a treatment plan to relieve, reduce, or manage pain and help patients return to everyday activities quickly without surgery or heavy reliance on medication. To make sure all the patient's needs are met, the physician coordinates care through an interdisciplinary team of health professionals. Such professionals include:

  • Physiatrists
  • Anesthesiologists
  • Internists
  • Oncologists
  • Surgical specialists
  • Psychiatrists
  • Psychologists
  • Nurses
  • Occupational Therapists
  • Physical Therapists

Pain management specialists are most concerned with the patient's overall quality of life. To that end, they treat the whole patient, not just one part of the body.

Diagnosis: The Cause of Pain

Before the physician can treat the patient's pain, he must understand the cause of the pain. In some pain cases the cause may be obvious, such as a spinal fracture. In cases of chronic pain, the cause(s) may be elusive and make diagnosis difficult. The physician relies on the patient's medical history, physical and neurological examinations. Additional diagnostic tools help to support or rule out a suspected diagnosis.

Detailed Patient History
The physician and patient talk in-depth about the patient's current problem and medical history. The physician may ask when and how the pain started, for a description of the pain, about activities that increase or reduce pain, and current or past treatments.

Physical and Neurological Examination
A physical examination assesses the patient's vital signs; pulse, respiration, heart beat, blood pressure, and so on. A neurological exam evaluates the patient's sensory (feel) and motor (function) capabilities including reflexes, balance, ability to walk, muscle strength and muscle tone.

An X-Ray or Radiograph is a common test performed to reveal the condition of the body's bony structures. Results may suggest more testing is necessary.

A CT scan (Computed Tomography) is a 3-dimensional imaging study also used to evaluate bone and soft tissue. Each detailed anatomical picture resembles slices or cross-sections of the specific area of the body.

An MRI (Magnetic Resonance Imaging) is a powerful imaging tool. MRI is commonly used for musculoskeletal evaluation as it provides great detail about bones and soft tissues.

A PET scan (Positron Emission Tomography) uses small amounts of radionuclides (radioactive isotopes) to measure tissue changes at the cellular level. This test is performed when cancer is suspected.

Discography allows the physician to evaluate the intervertebral discs (one or more) as a possible pain source. The test evaluates the structural integrity of the discs and may be used to replicate back or leg pain. The procedure involves the use of a contrast dye injected into each suspect disc to be examined by x-ray or CT scan.

Electrodiagnostic tools include NCS (Nerve Conduction Study) and EMG (Electromyography).

An NCS (Nerve Conduction Study) evaluates the speed of nerve impulses as they travel along a nerve. This test can help determine if there is nerve damage, the extent of the damage, and if nerves have been destroyed.

An EMG (Electromyography) uses nerve stimulation to evaluate electrical activity within selected muscle fibers. The test measures muscle response and detects muscle damage and disease. It can help to distinguish between a muscle and nerve disorder.

Usually, both tests are performed, although an NCS may be performed without an EMG.

Updated on: 01/12/10
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