What to Expect From Pain Management?

People often erroneously think of treatment by a pain management specialist as consisting of only narcotic “pain killers.”

However, the practice of pain medicine or pain management is diagnosis driven just like other medical specialties. Just as one goes to a cardiologist for an evaluation of heart disease and receives treatment based on a unique diagnosis, a visit to a pain management specialist results in unique treatment because every patient with pain is also different. The discipline of pain medicine is concerned with the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders.

Pain affects more Americans than diabetes, heart disease and cancer combined. There are approximately 116 million Americans with chronic pain, defined as pain that has lasted more than three months and 25 million people with acute pain.

Like other doctors, the pain management specialist must examine each patient and create a treatment plan based on the patient’s symptoms, examination and other findings. For example, the cardiologist must first examine you and make several determinations. These include deciding whether your heart disease will respond to weight loss and exercise, whether you have high blood pressure and need medication to lower your blood pressure or whether your cholesterol is elevated or whether you have a blockage and need an interventional procedure or as a last resort, whether you might need to be referred to a cardiac surgeon for coronary bypass surgery.

All patients with heart disease do not take the same medications. It depends upon the cause of the problem. Just as there are different treatment options available for heart disease, there are a vast number of treatment options available for spinal or orthopedic pain.

While patients may go to a pain management physician because they “hurt,” just as they go to a cardiologist because they all have heart problems, all pain does not respond to narcotics. It is an unfortunate and common misconception that if patients go to the pain management doctor, they will be treated with narcotics.

Treatments for spinal or orthopedic pain vary just like treatments for heart disease vary. It depends on what is the cause of your problem.

First of all, it is important to understand that there are different types of spinal or orthopedic pain. One might have muscular pain, ligamentous pain, joint pain, bone pain, pain due to a herniated disks, pain from a fracture, or pain from a pinched nerve or a nerve injury. Pain medicines are prescribed based upon the source of the pain.

Some patients who come to pain management never need pain medications. They may respond to an injection, other intervention, bracing, or to physical therapy. Our knowledge has increased to where we understand more on how poor posture and walking improperly all perpetuate musculoskeletal pain. With sophisticated use of exercises, tailored to a patient’s specifics needs, physical therapy may be helpful.

An evaluation in physical therapy may reveal that the patient’s pain is a result of poor movement, tight muscles, stiff muscles, weak musculature, or postural problems. For example, we know that patients who have degenerative disk disease, where the disk between two bones has started to wear and tear, can decrease the pressure on the disk by doing exercises to increase your core musculature and eliminate or reduce back pain.

Like the cardiologist who performs interventional procedures such as cardiac catheterizations, pain management physicians perform interventional procedures to eliminate or reduce pain, and surgery as in other areas of medicine should always be the last resort.

When you initially go to your cardiologist because of a minor problem, I am sure that most of you would not ask “do I need surgery?” One usually wants to explore other options before surgical interventions are explored.

From experience, I have learned that patients do best with treatment by a pain management specialist when they come with the same open mind and attitude where they are willing to explore numerous options and not become focused primarily on getting narcotics or thinking that surgery is their only option.

I used the example of the cardiologist because I know that most of us would prefer that the cardiologist explore all options before referring us to a cardiac surgeon. This is the same approach that one should use when they have an orthopedic or spinal problem. Always ask about non-surgical options for your orthopedic or spinal pain.

The pain management physician, like the cardiologist, does not perform surgery. The cardiologist does interventional techniques, prescribes medications, and oversees your cardiac rehab program. Likewise, a pain management physician manages and directs your physical therapy or rehabilitation program, prescribes medications, and performs interventional procedures. Both the cardiologist and pain specialist will refer you to a surgeon when needed.

Timing is key to the success of your treatment. You should not delay an evaluation for heart disease, nor should you continue to ignore spinal or orthopedic pain, and wait too long before seeking an evaluation with a pain specialist. I have seen far too many patients wait too late in their treatment before seeking care with a pain specialist. Like other specialties, early intervention might lead to a better outcome.

Pain management is a process. It consists of many treatment options and more importantly, the treatment for your pain may not be the same as it is for your neighbor. Just like a pacemaker may be the treatment of choice for your spouse but not the treatment of choice for you when you see a cardiologist.

With advances in pain management there are a number of treatment options and narcotics are not the treatment of choice for everyone who sees a pain management specialist

Pain Management After Plastic Surgery

After any surgery, pain control will be a priority for you and your doctor. And while there is a level of discomfort and pain to be expected after any type of surgery, your doctor will take preventive steps to provide you ways to manage your pain. This isn’t only to keep you comfortable, but when your body is in pain, it can’t heal as quickly as it should.

When you are about to have surgery, your doctor will go over your current medical well-being as well as your medical history. Always be honest and advise them of any type of medication you are taking, especially if you are already taking medication for managing your pain.

The Types Of Pain To Expect

After surgery, you may experience pain in places that will be a surprise. Many times it is not at the surgery site. Some areas where you may experience discomfort or pain after surgery are:

• Muscles – You may feel discomfort or pain in the area of your back, chest, neck, or shoulders muscles. This comes from lying in one position on the operating table or the “handling” the team may do with you while in surgery.

• Throat – Your throat may feel scratchy or sore. This is from having any tubes in your mouth or throat. Movement – Any movement like sitting up or walking will be uncomfortable and painful. Even coughing or sneezing will cause increased pain.

Keeping Your Pain Under Control

You will have a big part in your own pain management simply by keeping your doctor and the nursing staff advised about your pain. Your main will be measured and during your hospital stay, you will be asked to rate your pain on a scale using numbers zero through ten. Zero is no pain and ten is the worst possible pain. This system is helpful for your medical team to know how the pain management treatment is working or if there is a need to make changes.

Who Will Help You Handle Your Pain?

You and your doctor will talk about your pain management prior to surgery, determining what is acceptable for you. Sometimes doctors will bring in a pain specialist to work with you after your surgery.

At the end of the day, though, you are the one that will make the ultimate decision. Your medical history and current health condition will be used by your doctor and the pain specialists to provide you the options for pain management.

The Different Types of Pain Management Treatments

It is common for a patient to be given more than one type of pain management treatment. It is based on their needs and the type of surgery they had. Your doctor and the pain specialist will make certain they are effective but safe, although, there is some level of risk for any type of medication. Some of the most commonly used pain management treatments are:

• Intravenous PCA (Patient-Controlled Analgesia)

PCA is a pump that is computerized and allows the patient to self-medicate safe amounts of pain medications. The unit is programmed and will only release a specific amount within a certain amount of time.

• Nerve Blocks

A nerve block controls pain in small, isolated areas of the body. This method of pain management may be distributed by an epidural catheter for prolonged pain management.

• Oral Pain Medications

After surgery at some point, your doctor will most likely order some form of pain management medication that is taken orally. You will need to let the nursing staff know when you are experiencing pain and if it has been within the usual four-hour timeframe, they will give you the prescribed dosage.

Pain Management Without Medication

There are ways to achieve pain management too. Such as guided imagery, a focused relaxation method that works by the patient’ creating calm and peaceful images in their mind. This mental escape can be enhanced by listening to music and changing positions.

Your doctor may give you instructions for cold and heat therapy. This will reduce your pain and any swelling you may be experiencing. For surgery in the abdominal or chest area, using a pillow when you a cough, sneeze or take deep breaths will help as a method of pain management.