1. What is a Pain
Management Doctor?

2. Question: What is Pain Management?
Pain management is a branch of medicine that applies science to the reduction of pain. It
covers a wide spectrum of conditions including neuropathic pain, sciatica, postoperative
pain and more.
Answer: Pain management is a rapidly growing medical specialty that takes a multi-
disciplinary approach to treating all kinds of pain. Dr. SamehYonan, a pain management
specialist at the Cleveland Clinic, says "we evaluate, rehabilitate and treat people in
pain." Your doctor may refer you to pain management if she or he determines that your
pain has become out of control.
Pain Management Specialists: What They Do, How to Find One
Doctors who specialize in pain management recognize the complex nature of pain, and a
pain doctor "approaches the problem from all directions," Yonan said. Ideally, treatment
at a pain clinic is patient-centric, but in reality this may depend on the available resources
of the institution. Currently, there are no established standards for the types of
disciplines that must be included, and this is another reason why treatment offerings
will vary from clinic to clinic.

3. But at the very least, experts say that a facility should offer to patients three types of
physicians: a coordinating physician, who provides consultation to specialists on your
behalf, a physical rehabilitation specialist, and a psychiatrist, to help you deal with any
accompanying depression or anxiety, especially if you have chronic pain.
Other medical specialties represented in pain management are anesthesiology,
neurosurgery and internal medicine.Your coordinating physician may also refer you for
services from occupational medicine specialists, social workers and/or alternative and
complementary medicine practitioners.
To qualify as a pain management specialist in the eyes of the American Board of Medical
Specialties, a health care provider should be an MD with board certification in at least
one of the following specialties:
 Anesthesiology
 Physical rehabilitation
 Psychiatry and neurology.
Dr. James Dillard, an assistant professor of medicine at Columbia University College of
Physicians and Surgeons, says that the pain management physician should also have her or
his practice limited to that specialty in which they hold the certification.You can check to
see if the doctors at the pain management clinic you are considering are board certified
by going to the American Board of Medical Specialties web site.

4. Goals of Pain Management
While some types of pain come from primary sources such as headaches, and others from
secondary sources such as from surgery, the field of pain management treats all of it as a disease.
This allows for the application of science, and the latest advances in medicine to relieve your
pain. And while many patients, especially those in chronic pain, see a psychiatrist or therapist as
part of the experience, learning to cope with pain is less and less the focus of treatment.
"We now have many modalities, including medication, interventional pain management
techniques (nerve blocks, spinal cord stimulators and similar treatments), along with physical
therapy and alternative medicine to help reduce the pain," says Yonan.
 The goal of pain management is to minimize pain, rather than eliminate it. This is because quite
often it is not possible to completely do away with it. Two other goals are to improve function
and increase quality of life. These three goals go hand-in-hand.
 As a first-time patient in a pain management clinic, you might experience the following:
 Evaluation.
 Diagnostic tests, if necessary, as determined in the evaluation.
 Referral to surgeon, if indicated by the tests and evaluation.
 Interventional treatment, such as injections or spinal cord stimulation.
 Physical therapy to increase range-of-motion and strength, and to prepare you to go back to
work.
 Psychiatry to deal with depression, anxiety and/or other issues that may accompany your
chronic pain.
 Alternative medicine to provide a complement to your other treatments.

5. Back and neck pain sufferers who do best with a pain management
program, says Yonan, are those who have had multiple back surgeries,
including failed surgeries, and are still in pain, those with neuropathy, and
those for whom it has been determined that surgery would not benefit their
condition.
"People who have become addicted to pain medication actually need more
sophisticated help than what a pain management program can offer them. A
chronic pain rehab program is a better choice for these people," he says.
According to Pain Physician, results from research studies on pain
management are not always applicable to the problems patients come in
with to the clinics on a day-to-day basis. Unfortunately, this has a negative
effect on insurance reimbursement and other payment arrangements, as
well as standardization of this medical specialty.
"Better understanding of pain syndromes by communities and insurance
companies and more studies on pain will help increase insurance coverage
for pain management treatments. In the future, the use of technology will
help improve the outcomes of interventional pain management techniques,"
Yonan says.

6. Sources:
Manchikanti, L. MD, Mark V. Boswell, M. MD, PhD., James Giordano, J. PhD Evidenced Based Interventional Pain Management:
Principles, Problems, Potential and Applications Pain Physician 2007; 10:329-356
Personal Interview. Dr. SamehYonan, MD, Pain Management Specialist at Hillcrest, Willoughby and South Pointe Pain Centers at
Cleveland Clinic Health System
James N. Dillard, MD., DC. CAc. The Chronic Pain Solution:Your Personal Path to Pain Relief Bantam Dell a division of Random
House New York 2003
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http://backandneck.about.com/od/chronicpainconditions/f/painmanagement.htm