A pain specialist is a doctor who is trained in pain medicine. They receive special training to be able to evaluate, diagnose, and treat pain of all kinds. Pain specialists can be doctors of other areas of medicine before they train in pain medicine. This is common. Dr Dmitry Arbuck, president of a pain management clinic in Indianapolis, notes that “any doctor from any specialty- for instance, emergency medicine, family practice, neurology- may be a pain physician”. Indeed, in Australia and New Zealand, a doctor trains in pain medicine after they receive a primary specialist qualification.
What is pain medicine?
A quick note: the terms “pain management” and “pain medicine” are used interchangeably. You may not have been aware that it existed as a separate field of medicine. This has only been the case for a matter of decades. (The work of pain management was typically completed on the side by anaesthetists.) This is striking given that pain is a universal concept across medical fields and has quite literally been a complaint since the dawn of the human species.
A history of pain treatment
There have been cultural problems treating pain under that name. In the book of Genesis, God makes claims that pain is a deserved punishment of the human race (indeed, the word “pain” is derived from the Latin poena which denotes “punishment” and “penalty”). There is even the following statement to Eve, the first woman: “I will greatly multiply your pain in childbearing”. Consequently, attempts to target the pain of childbirth, and the budding field of anaesthesia, have been construed as sinful and met violence and resistance. A watershed moment to overcome this resistance was Queen Victoria’s use of chloroform during the birth of her youngest son Prince Leopold in 1853. Crawford Long, a surgeon from North Georgia, is credited with the discovery of anaesthesia, and had his wife inhale ether during childbirth. He was chased from Georgia to Texas for his discovery, by contemporary Christians who considered him a heretic! Eventually, Pope Pius XII spoke out: “the patient may, relieving pain [..] use the means discovered by science, which are not immoral.”
Pain was formed as a field of medicine in the 1960s. John Bonica was a Sicilian American anaesthetist and is the founding father of Pain Medicine. He believed a team approach was required in pain management and established it as a multidisciplinary field. Roger Collier notes that “by the 1970s, the field had a dedicated research journal (Pain) and association (International Association for the Study of Pain)”. Nowadays, there are many associations across the globe and pain medicine is a thriving discipline. In Australia and New Zealand, a career as a specialist pain medicine physician involves qualifying as a fellow of the FPMANZCA. What does this stand for? Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists. Pain medicine has only been recognised as “a separate specialty since 2005 in Australia and 2012 in New Zealand”. There is a nice clip which interviews Australian fellows and their reasons for pursuing pain medicine.
When do you need to see a pain specialist?
Dr Eduardo Fraifeld, president of the American Academy of Pain Medicine, explains the time. The answer is in the difference between chronic and acute pain. The typical events of pain we all experience, warnings that we have been hurt, are not necessarily reason enough to consult a pain specialist. This is “acute” pain: examples include burning your finger on a hot dish or breaking your leg. You seek medical care to heal the injury. What can happen is that the pain exceeds the effect of the injury or feels interminable and begins to compromise everyday function. Pain is considered “chronic” if it lasts for more than three months. Consult a pain specialist if you are combating chronic pain. It is not uncommon to experience chronic pain and require the service of a pain specialist while already under the care of a primary physician, or a doctor of another specialty. You can be at the centre of a web of support, and a pain specialist may consult your medical history and coordinate your care.
Where can I seek pain treatment?
You might be referred to a pain clinic. A clinic is an outpatient medical facility where there will be multiple doctors and other health professionals. (If you’re an outpatient, you receive services without formal admission to a hospital. For example, you could consult a specialist or be tested, and while not having filled out all that admission paperwork or stayed overnight.) The field of pain medicine is multidisciplinary. The theory is that many factors influence the experience of pain. Pain transcends the biomedical facts. Maris Pasquale, who worked at a Pain Management Clinic, gave a presentation in 2008 which explained that as complements to physical injury a patient’s spiritual beliefs, socio-economic status and emotional response will influence their subjective experience of pain. Furthermore, we know that an individual’s lifestyle and management of stress is integral in the treatment of chronic pain. Therefore, at a pain clinic, there may be doctors of different specialities and a variety of pain management techniques available.
What can be used to treat pain?
Drugs like ketamine, antidepressants, nonsteroidal anti-inflammatory drugs (this mouthful of a word is reduced with the acronym NSAIDS, and an example is aspirin), cannabis, and beta-blockers may be used. An example of an interventional procedure in pain medicine is an epidural injection. This involves the injection of a local anaesthetic and steroid into the spine. There are also exciting new avenues of pain management such as rTMS, which passes small electromagnetic currents through parts of the brain. The work of a pain specialist is thorough and many-faced. Work continues to grow in this promising field.
Contact Anodyne to book a consultation with one of our pain management specialists to begin your treatment journey.
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