What Is a Pain Management Doctor?

• What is a pain management doctor?
• What does a pain management doctor do?
• What is "interventional" pain management?
• Am I the right type of patient?
• How does pain management differ from other specialties?
• What types of pain are treated?
• When should I see a pain management doctor?
• What should I expect during an appointment?
• How do pain management doctors evaluate pain?
• What treatments do pain management doctors offer?
• What are the advantages of interventional pain management?

What is a pain management doctor?

A pain management doctor is a specialist with training in the evaluation, diagnosis, and treatment of painful medical conditions. Pain management physician skills include:

• An in-depth knowledge of the physiology of pain.
• The ability to evaluate patients with complicated pain disorders.
• Determining which specialized tests to order to diagnose painful conditions.
• Appropriate prescribing of medications for various pain conditions.
• Performance of interventional procedures such as nerve blocks, spinal injections, and other pain relief techniques.

Every pain management doctor is board-certified in a primary specialty (such as anesthesiology, neurology, physiatry, psychiatry, or internal medicine), and then spends at least one additional year of fellowship training certified by the Accreditation Council for Graduate Medical Education (ACGME), which provides a separate board examination in pain management. Your pain management specialist should be double-board-certified.

What does a pain management doctor do?

Pain management specialists are skilled at diagnosing and treating painful medical conditions with nonsurgical treatment.

At HSS, our pain management doctors are called “interventional pain doctors” because they specialize in interventions that aim to resolve various kinds of orthopedic and musculoskeletal pain. Some of the most common interventions our doctors perform include epidural steroid injections for conditions such as sciatica, spinal cord stimulation for conditions such as complex regional pain syndrome, radiofrequency ablation for neck and back pain, or cortisone injections for joint pain, among many others.

An interventional pain medicine specialist also plays an important role in coordinating a comprehensive treatment plan, including physical therapy, psychological therapy, and rehabilitation programs, and, when necessary, surgery.

What is the difference between pain management and interventional pain management?

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 uses a variety of treatments to eliminate pain as quickly and effectively as possible.

Treatments provided by interventional pain management specialists offer two potential benefits: the treatments may resolve the pain on their own, or they can provide a more precise diagnosis to be used by another specialist, such as a surgeon.

Many interventional pain management specialists are anesthesiologists or neurologists by training who are already skilled at performing nerve blocks and procedures through the course of their residency. Pain management specialists undergo additional fellowship subspecialty training to better hone these procedural skills for diagnosing and treating common neurologic, orthopedic, or spine-related painful conditions.

Am I the right type of patient for an interventional pain doctor?

Often, ideal patients for interventional pain doctors are those who have a painful condition that may be resolved by a procedure less invasive than surgery. Typical patients are those who have had no prior workup for their painful condition, are not sure if they are candidates for surgery, or do not want or require surgery for their painful condition. Surgeons will often refer patients to an interventional pain doctor first to try conservative treatments before opting for surgery.

Here are a few cases in which patients may be best suited to see an interventional pain management doctor:

• Patients who are still experiencing pain after trying more conservative therapies, but who are not candidates for spinal surgery.
• Patients who have undergone spinal surgery but are still experiencing 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 surgery, development of new pain generators such as a new mechanical, soft tissue or muscle problem, recurrence of the original problem, or rarely, an unsuccessful surgery.

The ideal patients to see an interventional pain doctor usually have conditions such as back or joint pain that may be diagnosed or resolved using interventional procedures. Some common procedures include epidural steroid injections, cortisone shots, radiofrequency ablation, trigger point injections, sacroiliac joint injections (SI joint injections), and spinal cord stimulation, just to name a few.

If an interventional pain doctor is the right type of physician for you to see, the best way to be referred to a doctor is through your primary care physician. Spine surgeons, orthopedic surgeons, neurologists, rheumatologists, and 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 ensure good communication, which in turn helps provide the optimal treatment for their patients.

You can also book an appointment directly with one of our interventional pain management doctors.

What is the difference between interventional pain management doctors versus other specialties?

Pain management encompasses many different specialties because there are so many different conditions that cause pain. Compared to other services that provide interventional treatments for orthopedic pain, pain management provides a more comprehensive and in-depth coordination of the clinical care involved in your recovery, including treatments that involve medication. In addition, most interventional pain management specialists are anesthesiologists who undergo further training and have more experience performing pain-relieving interventions, such as targeted nerve blocks and epidurals. Interventional pain management doctors also have expertise with spinal cord and dorsal root ganglion stimulation.

What types of pain do interventional pain doctors treat?

Pain management physicians treat an extensive array of conditions that cause pain, from sports injuries, spinal conditions and arthritis to pathologies of the muscles, nerves or other soft tissues, to migraines.

HSS interventional pain management specialists treat all of the following and more:

• Spine pain, which may include:
  • degenerative disc disease
  • facet joint arthritis
  • herniated (slipped) intervertebral discs
  • cervical and lumbosacral radiculitis (inflammation of the spinal cord, pinched spinal nerves, sciatica)
  • spinal stenosis
• neck and low back pain
• muscle pain and injuries
• joint and arthritis pain
• tendon and ligament pathologies
• sports injuries
• postsurgical pain
• complex regional pain syndrome/reflex sympathetic dystrophy (RSD)
• headaches and migraines
• nerve-related (neuropathic) pain (peripheral neuropathy, small fiber neuropathy)

If I am in pain, when should I see an interventional pain management specialist?

Everybody experiences pain at some point in their lives – neck and back pain are especially common. Most of the time, there are simple reasons for this pain, such as overuse injuries. In many cases, pain gets better on its own in a few days with brief rest, activity modification and over-the-counter pain medicines. However, if the pain does not improve after about 4 to 7 days, a doctor may need to investigate further.

If pain continues to be a problem after approximately 2 to 3 weeks despite conservative therapies such as physical therapy or medications, your clinician may consider a referral to an interventional pain medicine specialist.

Sometimes, if pain is so severe that performing home exercises or physical therapy is not possible, interventional pain management procedures may be considered earlier than 2 to 3 weeks. It may be necessary to manage the pain with an interventional procedure before beginning or resuming home exercises and physical therapy.

What should I expect during an interventional pain management appointment?

During the first visit, your doctor will conduct a thorough physical exam and history. A thorough evaluation typically consists of a review of your history, a physical examination, a neurological examination, and a careful review of all medical records and diagnostic studies. You can help your doctor by bringing all prior pain management and relevant surgical notes, as well as scans and scan reports, which will allow your doctor to best assess your problem and determine the best course of treatment.

After carefully evaluating your case, your doctor will make specific recommendations for how to proceed with your treatment.

How does an interventional pain management doctor evaluate pain?

When evaluating potential causes of pain, getting a comprehensive history and conducting a physical exam are usually the first steps. Further diagnostic and imaging studies such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans can be ordered if necessary. In some cases, diagnostic studies outside of radiology can also be ordered, such as nerve conduction tests. Then, interventions may be used to treat the pain and pinpoint its exact cause.

In addition to providing pain relief, many interventions can also provide more specific diagnoses into the exact cause of pain. For example, if a hip surgeon is not sure whether a patient’s pain is emanating from their hip, a pain management specialist may use ultrasound guidance to inject local anesthetic into the joint. If the patient feels better, then their pain is likely stemming from the injected region of their body.

Another common example is that spine surgeons may ask pain management specialists to identify sources of pain by targeting specific spinal nerve roots with fluoroscopic guided injections. Based on the patient’s response to the injection and their degree of pain relief, the spine surgeon will have more information about which areas of the spine to operate on.

What medications or treatments do pain management doctors offer?

Pain-relieving medications commonly prescribed by pain management specialists include:

• prescription strength anti-inflammatories (NSAIDs, oral corticosteroids)
• nerve stabilizing medications (gabapentin, duloxetine)
• muscle relaxants

While opioid medications can be helpful for managing acute or immediate postsurgical pain, any benefits from long-term use of this class of medication have yet to be definitively determined from any high-quality research studies. However, it is known that long-term use of opioid medications increases the chance of getting into a motor vehicle accident, increases the risk for both fatal and nonfatal overdose, depresses the immune system's protective functions, and alters hormone levels, including testosterone. All HSS providers prescribe opioid medications conservatively. They do not routinely prescribe long-acting opioids, do not prescribe more than a short-course of short-acting opioids, and do not refill lost, stolen, or destroyed prescriptions.

Common pain-relieving interventions performed by pain management specialists include:

• spine procedures directed at herniated discs, pinched spinal nerves, or spinal zygapophyseal (facet) joints
• joint injections
• tendon and ligament injections
• muscle injections
• targeted nerve blocks
• examples of injected medications include but are not limited to:
  • cortisone (an anti-inflammatory)
  • local anesthetics such as lidocaine
  • regenerative therapies such as platelet rich plasma (PRP)
  • viscosupplementation (hyaluronic acid – a synthetic lubricant)

Pain conditions often respond best when treated using multiple methods of pain relief (called a “multimodal” approach). Depending on the condition, a pain management doctor may use multiple treatments for pain relief including:

• rehabilitation and physical therapy
• pain psychology to teach pain coping and distraction techniques
• non-opioid medication therapy
• interventional pain-relieving procedures.

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, pain management doctors are uniquely trained to use this new knowledge safely and effectively to help patients.

What are the advantages of interventional pain management?

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.

Nearly 75 million Americans aged 20 years and older report having pain that lasts more than 24 hours. For these patients, consulting a pain management doctor can help restore vitality and improve quality of life.

As previously stated, in addition to providing pain relief, pain management interventions may offer substantial diagnostic value. A patient’s response to localized pain medicine can provide a strong indication about whether or not the treated area contains a significant pain generator.

Additionally, the treatments used by interventional pain doctors may provide effective and lasting pain relief for many patients, enabling them to get back to their lives – in some cases, without resorting to more invasive treatments like surgery.

To get help for your painful condition, book an appointment directly with one of our interventional pain management doctors.

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Posted: 2/2/2024

Why HSS for Pain Management?

Hospital for Special Surgery has been nationally ranked No. 1 in orthopedics for 14 consecutive years, and our pain management doctors are consistently ranked as some of the best in NYC. In addition to being board certified in a primary specialty such as anesthesiology, neurology, physiatry, psychiatry, or internal medicine, our pain management doctors are also board certified in pain management and have completed ACGME-accredited fellowships. If pain is preventing you from living your best life, a provider on our team can help.
 
Our experienced providers deliver the most up-to-date care. Using minimally invasive interventions, including administering injections using the latest ultrasound or XR guidance for accuracy, our doctors relieve pain and restore function fast. Patients are back to their usual activities within days or weeks, many pain-free.
 
Ready to take control of your life, and stop pain from holding you back?

Start your journey of recovery. Find a pain management doctor at HSS.
 

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