Name that Pain—before moving on to “Management”
I get a lot of calls asking about if I “do pain management” in my medical practice.
Upon inquiring further, it often becomes clear that no diagnosis has really been made by a health care practitioner before recommending to someone with a chronic pain condition that they “learn to live with it” or see a doctor who practices “pain management”.
In my view, these 2 options represent opposite ends of a spectrum with a big black hole in the middle! It is so important to make a diagnosis of what is the root cause of the pain. Is that back or neck pain caused by a herniated disc, strained ligaments, or muscle tension? Is arm and hand pain from carpal tunnel syndrome, tendonitis, or thoracic outlet syndrome?, When a health practitioner understands the reason(s) for a particular patient’s pain and dysfunction, that knowledge informs what kind of treatments or self help would most directly benefit the problem. Otherwise, how to choose conventional (medications, physical therapies, injections, surgery, etc) or so called alternative (acupuncture, chiropractic, yoga, biofeedback, hypnosis, etc) therapies? Often, it is just a random, shot-in-the-dark approach, with not much chance of hitting the target. Unfortunately, there are few integrative physicians or other health care practitioners familiar with, experienced in, and understanding how to apply a wide variety of treatment options to different clinical conditions that cause pain.
Of course, people with chronic pain do have to make changes and adaptations to their life style such as slowing down, pacing, taking rest breaks, and attitudinal adjustments.
Frequently though, “learn to live with it” is what patients are told when their practitioner cannot guide them toward more specific self help tools such as land or aquatic exercise, yoga, pilates, tai chi, etc., or doesn’t refer to other practitioners who can provide therapies that could really help. “Pain management” too often is thought of as chronic prescriptions for narcotic drugs and procedures with needles—epidurals, nerve blocks, etc. These interventions can indeed be useful tools, but most appropriate after reasonable “conservative”(meaning less drastic) treatments have been offered.
I have been exploring alternative musculoskeletal therapies for over 30 years, even before I became a doctor. It never made sense to me that all that people with non surgical orthopedic injuries could do was to “learn to live with” them. Working outside my own office with a pain specialist colleague 2 afternoons a week for 3 years gave me a deep appreciation for how his “pain management” interventions can help people. However, I felt an even deeper frustration that so many of those patients arrived at the practice without first trying much less invasive and expensive treatments that could very possibly helped them significantly—that rainbow colored “middle of the spectrum”! Perhaps with a new health system on the horizon, things may change.