Working with Your Provider

Your Health Care Team

While TOS can be a chronic and often frustrating condition, there are health care providers who understand and know how to treat it. Remember, you are an important member of the health care team. Learn as much as you can about TOS. Ask questions and work as a team member with all the health care professionals who are treating you.

Members of your health care team may include:

• Primary care provider
• Pain medicine specialist
• Neurologist
• Physical and occupational therapists
• Mental health professional (such as a psychiatrist, psychologist or social worker)
• Surgeon – most surgeons who specialize in TOS are vascular surgeons or thoracic surgeons

Finding Health Care Providers

It is important to find health care providers who understand TOS, muscular bracing and chronic pain management. Ask your primary care provider for some names of pain medicine doctors, clinics and centers. Or, search the Pain Care Provider Directory to find health care providers, clinics or centers near your town.

Pain medicine doctor
Find a doctor who is board-certified in pain medicine by the American Board of Pain Medicine or holds a special certificate in pain management from the American Society of Anesthesiologists, the American Board of Neurology or the American Board of Physical Medicine and Rehabilitation. Ideally, the pain medicine doctor should work in a recognized pain clinic that includes several types of treatment. Remember that such clinics are not available in all areas of the country. Be aware that many doctors and other health care providers call themselves pain specialists, but may not be as well-trained or experienced in treating chronic pain conditions.

Some vascular or thoracic surgeons specialize in the diagnosis and treatment of TOS.

Pain medicine clinics and multidisciplinary centers
"Multidisciplinary" means that the clinic or center contains a number of different doctors, nurses, therapists and other health care providers. A pain clinic or center can provide medicine and non-medicine services in a single location. This allows you to go to only one place instead of a number of different locations for therapy.

Make appointments with a number of pain doctors, clinics or centers to help you decide which group is best for you. Compare the results of each interview until you are satisfied that your choice of a pain management doctor, clinic or center is the best one for you.

Some questions to ask during each interview include: 

• How many cases of TOS have you treated? 
• What are your special qualifications to treat people with TOS?
• What experience do you have treating muscular bracing? 
• What are your thoughts on pain management in terms of medicines, injections, non-drug therapies and complementary or alternative therapies?
• What types of medicines do you generally prescribe? 
• What types of non-drug therapies do you use? 
• Where do you refer patients who need additional treatment? 
• Is your clinic listed with any professional societies?

Thoracic Outlet Syndrome Treatment Options

There are many treatment options for TOS, and you may benefit from a combination of techniques. Treatment usually begins with exercises and physical therapy to improve your posture and core strength, increase your range of motion, and help you learn better ways to move your arms and shoulders. Medication sometimes is recommended for pain and inflammation. If conservative treatments do not help, your symptoms worsen, or your pain is unbearable, your health care provider may recommend surgery.

Your health care plan may include one or more of the following treatments:

• Medication 
• Physical therapy
• Injections
• Surgery
• Psychological treatments
• Complementary/alternative techniques

Resources

Patient Guide to Pain Care Providers
Tips for Finding a Pain Physician
American Society of Anesthesiologists
The Management of Pain Brochure
International Association for the Study of Pain (IASP)
Desirable Characteristics for Pain Treatment Facilities
American TOS Association