Background Medical Specialites

Doctors bring differing expertise to the table of pain care based on the training from their original specialty board. When a physician then becomes additionally board certified in pain medicine, he or she becomes trained across the boundaries of other specialties to apply a multi/inter-disciplinary comprehensive pain care program. If your physician works in a multidisciplinary or interdisciplinary setting, he or she should be coordinating treatment among other specialties when necessary. A comprehensive Pain Medicine Evaluation and diagnosis will guide the appropriate treatment plan and will dictate the types of doctors and specialists that should be involved in your care.

Pain Medicine Specialty

Pain medicine is a medical specialty with its own board certification from the American Board of Pain Medicine (ABPM). Physicians in the United States who are board certified, or "diplomates" of the American Board of Pain Medicine, have been trained to comprehensively diagnose and manage people in pain and have passed the examination to be certified by the ABPM. Generally, physicians who are pain medicine specialists come from other medical specialty backgrounds such as anesthesiology, neurology, neurosurgery, physiatry, psychiatry and many others. So, in addition to their background medical specialty, they are also "pain medicine doctors."

Pain Management Sub-Specialty

Pain management is a subspecialty practice. The types of doctors who sub-specialize in pain management also include anesthesiologists, neurologists, neurosurgeons, physiatrists and psychiatrists among others. Doctors who sub-specialize in pain management often have undergone an examination to receive a certificate in pain management from their original specialty (for example, the anesthesiologist who received a certificate in pain management from the anesthesiology specialty board, the ABA). This is true for most specialty boards that offer a certificate in pain management. Physicians who have credentials in pain management and focus their practice on the treatment of people in pain are "anesthesiologists" or "neurosurgeons," for example, who are sub-specializing in pain care.

Physicians Without Pain Credentials

There are many physicians who are expert in particular conditions and/or in repairing certain injuries. After a condition or injury has resulted in chronic pain, however, you may need to find someone expert in pain treatment. Physicians who are neither certified in Pain Medicine, nor credentialed in pain management have not received extensive training in diagnosing and treating pain as a disease from a comprehensive perspective, including structural, emotional, cognitive, and body memory points of view. So, a doctor who can perform certain treatment options for patients in pain is not necessarily skilled or expert in pain medicine. On the other hand, they may be quite skilled in the use of one or more therapies to treat pain, and might limit their practice to providing these therapies. They may even be a part of an interdisciplinary pain care team, where their skills are applied as needed.

Here is a general description of how different background specialties bring different skills to the field of pain medicine, although it is up to you to confirm what options are offered at any pain practice:

• Anesthesiologist: Anesthesiologists have specialized training in the relief of pain and total care of the patient before, during, and after surgery. They have specialized knowledge about how medications work to relieve pain and how they interact with the systems of the body (e.g., circulatory, respiratory). Most anesthesiologists who specialize in treating pain have also become board certified in pain medicine. In addition to coordinating comprehensive pain diagnosis and pain care within a pain program, an anesthesiologist treating people in pain will typically offer nerve blocks, trigger point injections, and oral medications. Some have also been trained to perform various surgeries and can provide implantable devices such as pumps and stimulators.*

• Neurological Surgeon: Neurosurgeons are specifically trained in surgery as it relates to parts of the nervous system. Some are more involved with the spine and peripheral nerves (nerves that transmit information from the brain and spinal column to the rest of the body), and some are more involved with the brain. A neurological surgeon treating pain typically can provide spine or peripheral nerve surgery, nerve blocks, oral medications, and sometimes can also provide implantable devices and pain-relieving surgical procedures to the spinal cord or brain.* For patients who need a discectomy, disc replacement or spine fusion, a neurosurgeon often can perform this surgery as well. Neurosurgeons who are also board certified in pain medicine have comprehensive training to diagnose pain and coordinate pain care.

• Orthopedic Surgeon: Orthopedic surgeons are trained in bone, tendon and joint repair. When treating people in pain, they can provide procedures like joint replacements and/or spine surgery, oral medications, nerve blocks, and sometimes implantable devices.* Although orthopedic surgeons may be able to perform a specific procedure, many orthopedic surgeons may not be ideal for, or even offer, long-term management of chronic pain.

• Neurologist: Neurologists are trained in electrical and chemical processes of the nervous system. When treating pain, neurologists typically can provide oral medications and nerve blocks, and may be trained in implantable procedures for stimulators or medication pumps.* Many neurologists sub-specialize in headache management. Some neurologists may also be board certified in pain medicine.

• Urologist or Urogynecologist: These doctors focus on problems of the pelvic region, and can typically provide people in pain with oral medications, nerve blocks, pelvic surgery, and can sometimes offer implantable devices. Not many physicians with these backgrounds are also specialized in pain medicine or pain management. They may be able to perform certain surgical or non-surgical procedures to treat pelvic pain, but should not manage long-term pain care unless they also are specialized in the treatment of chronic pain.

• Physiatrist: These doctors are trained in physical medicine and rehabilitation and offer patients the physical treatments that often help painful conditions. These treatments can include physical therapy, occupational therapy, recreational therapy, and even speech therapy. Physiatrists focus on movement, reconditioning, exercise, and the improvement of your functional status. In addition, some physiatrists are trained in performing nerve blocks as well as in implanting stimulators and medication pumps.*

• Psychiatrist: Psychiatrists who treat pain can typically provide cognitive behavioral therapies, hypnosis, family counseling, group therapy, EMDR (Eye Movement Desensitization and Reprocessing), biofeedback, oral medications, and psychological pain assessments. These treatments are designed to deal with the person's reaction to their pain, the changes in their quality of life, the associated emotional conditions of pain such as depression or anxiety, the meaning of the pain to someone's life, and the body memory component of pain.

* To read more about spinal cord stimulation implantable technologies and implantable drug delivery systems, click here.