"Pain Specialists" — Pain Clinics and the Team Approach

Pain treatment has come a long way. There are specialists who can help you.

Last week, we discussed FBSS (Failed Back Surgery Syndrome): its name, causes, and an overview of treatments. This week, we'll look at pain clinics, which specialize in treating pain, and the multidisciplinary team approach to chronic pain.

What Is a Pain Clinic?

A Specialty Practice Focused on Pain

A pain clinic is a medical practice that specializes in treating pain itself.

Orthopedic surgeons treat structural problems with bones and joints. Pain specialists treat the pain directly as their area of expertise.

Who Are the Doctors?

Most pain clinic physicians come from an anesthesiology background.

Anesthesiologists are experts at taking away pain. They have adapted the techniques used to control pain during surgery to treat chronic pain.

• Many countries have dedicated pain medicine certification and training programs
• Pain specialists practice at university hospitals, general hospitals, and private clinics

When Should You Consider Going?

• Pain has persisted for more than 3 months after surgery
• Treatment from your orthopedic surgeon (medication, rehabilitation) hasn't helped enough
• Pain is interfering with your daily life
• Structural problems alone can't fully explain the pain

You may not need a formal referral, but bringing a referral letter and your imaging data makes the process much smoother. Ask your surgeon: "Could you refer me to a pain specialist?"

Chronic Pain Is Hard for One Doctor to Treat Alone

This is where acute and chronic pain differ.

Acute pain (like a broken bone or pain from a surgical wound) goes away when the cause is treated. One doctor can often handle it.

Chronic pain involves psychological and social factors on top of the physical problem, and they affect one another.

The Pain Spiral

Pain --> Can't move --> Muscles weaken --> More pain
  |                                          ^
Anxiety/depression --> Sleep problems --> Fatigue --> Lower pain threshold
  |                                          ^
Social isolation --> Less activity --> Physical decline --> Pain worsens

Breaking this cycle requires a team approach with several specialists working together.

The Multidisciplinary Team

The specialists may not all be under one roof. What matters is that they work together as a coordinated team.

Treatments Available at Pain Clinics

Nerve Blocks

Nerve blocks are the main treatment at most pain clinics.

Nerve blocks are used for both treatment and diagnosis. By seeing which injection relieves the pain, the specialist can pinpoint the source.

Medication Optimization

Pain clinics can provide more specialized medication management matched to the type of pain.

• Nociceptive pain (from inflammation) --> NSAIDs, acetaminophen
• Neuropathic pain (from nerve damage) --> Pregabalin, mirogabalin, duloxetine
• Mixed-type pain (which most chronic pain is) --> Combinations of several medications

If nothing has worked before, the right medication may simply not have been tried yet.

Cognitive Behavioral Therapy (CBT)

CBT eases the experience of pain by changing thought patterns and behaviors around it.

• "I'm in pain, so I can't do anything" --> "I'm in pain, but I can do this"
• "This pain will last forever" --> "Today is a little easier than yesterday"
• "No one understands" --> "I'm working on this with professionals"

CBT is a scientifically proven treatment that changes how the brain processes pain. It goes further than "thinking positive."

Exercise Therapy

Exercise is still an important part of treatment at pain clinics.

• Working with a physical therapist to find exercises that are safe despite the pain
• Breaking the cycle of "it hurts, so I won't move"
• Graded exercise (increasing activity step by step in a planned way)

"Living with Pain" Is Not Giving Up

When you hear "Let's learn to live with the pain," you might think: "So they've given up on treating me."

In chronic pain management, living with pain is an active strategy.

Active Coping

Research shows:

Even when pain levels are the same, people who practice active coping have a higher quality of life.

Modern chronic pain treatment aims for more than removing pain. The goal is to build the ability to live a full life even when pain is present.

Emerging Treatment Technologies

When standard treatments don't give enough relief, newer technologies can be considered.

Next week (Week 22), we'll take a close look at one of them: Spinal Cord Stimulation (SCS).

SCS:

• Works on pain through a completely different mechanism from medications or injections
• If it does not suit you, the device can be removed
• Has advanced a great deal in recent years

Start a Pain Diary

If you plan to visit a pain clinic, a pain diary helps your specialist a great deal.

One week of records is enough for a specialist to start seeing your pain patterns.

Summary

• Pain clinics: Specialty practices that treat pain itself, often staffed by anesthesiology-trained physicians
• Chronic pain treatment works best with a multidisciplinary team
• Treatments include nerve blocks, adjusting medication, cognitive behavioral therapy, and exercise therapy
• "Living with pain" is not giving up. It is an active strategy
• Active coping leads to better quality of life
• Keeping a pain diary helps your specialist provide better care