I am new to the boards (1st message), but I was wondering if someone could tell me what exactly is a pain management doctor? Do they do physical therapy or meds? Also, what is the difference between endocet and roxicet, if any besides the maker of the pill?
Hi Kel, Ansthesiologist normally practice the interventional side of PM , meaning the do the injections like epidurals, nerve blocks, pump and scs management, but Physiatrists "physical medecine and rehab also have a PM accreddation program and so do Neruologist, Ostopaths often practice PM, and basically anyone that can write a script from surgeon that have lost their hopital provlideges or mal practice insurance can write script sna darange POT. PM is about more than any one speialty can truly provide.
I go o a clinic where the director is a Psychiatrist/neurologist, he has a partner that is a anesthesiologist /DO who does most of the needle work, there are 2 physical medecine docs that also do triger pont injections and they have an onsite psychologist that teaches relaxation techniques like Bio feedback or self hyynosis or guided magry. Every doc whether a Anesthesiologist or a DO brings something a little different to the table. When it comes to procedures where a needle comes anywhere near the spin I would certainly rather have a anesthesiologist that's don e thousands of nerve blocks before there even was an acredidation process in any of the fields that practice PM.
Because one modality or one type of treatment doen't fit all or cover every problem someone with chronic or intractable pain is going to experience, you can't reallys say what the best doc to see is. If your pain can b e managed with with minimal medications and doesn't require a pump or spinal cord implant, a hysiatrist may be fine for some people. Tougher cases are going to require a multi faceted aproach to manageing chronic pain.
Treating depression is a good analogy, Your gP can prescribe any anti depressant he wants in the US, He can also prescribe any opiate pain med up to the most potent Aqtiq pops without any aditional training. But just because a GP is prescribing an anti D for depression or OxyC for chronic pain, doesn't mean your getting the best care available. Statistically treating depression with anti depressants alone is no more effective than treating depression with counseling alone, but when you combine thetwo types of treatment you more likely going to get better rsults much faster.
We live in an instant gratification society, with the net it's simple to find the name of the stronges med or to come to a forum and se what other people are using to treat a condition smilar to yours, but even if we both had the exact same DX, it doesn't mean we would both respond to the same procedures or the same meds.
There are anesthesiologist that do nothing but run block shops and don't use opiates, There are Physical medecine docs that do nothing but prescribe medication. Is thsis the best way to treat every patient? Of course not. Is an anesthesiologiuist the best person to treat every condition, of course not. What interventional block or injection is an anesthesiologist going to provide to someone with MS or someone with Fibro or migranes.
Idealy you find a multi faceted claproach to PM where every aspect from psych to interventional prodedures to medication management can be offered if there is a chance it will help.
Unfortunately GP's that loose comfort in prescribing pain meds to a patient that isn't going to get better or when they simply feel all the patient wants is pain meds now have an outlet to let someone lse do the dirty work and put their licence on the line. A patient that need a half a vicodin a day doesn't need to go o a PM clinic and learn 4 relaxation techniques have nerve blocks or ES done, thery would likely be better paired with a PM psychologist that can help them learn to addapt to their chronic pain or new injury. The PM psychologist can work with any doc that's abl to prescribe anti depessants, or any other med they see fit, but pain meds are not the only solution when it comes to pain. There are many PM docs that don't use opiates at all, There are PM docs that will say nothing can be done if what they offer doesn't help. PM is trial and error and eduction and learning to adapt and change their lifestyle a bit to deduce pain rather than xpect a oc to provide enoug dope so they don't have to make a single life change.
If someone back hurts after they have been on their feet more than 12 hours or after they play 18 holes of golf. They do have options aside from narccotics which will lead to physical dependnece. A patient that's unbending and refuses to make changes that would improve their own quality of life is being unresonable to ask a doc to dope them up so they can do anything they want and not have to change a thing in their life.
There is a big difference between someone willing totry anything to reduce the apain they have to live with,there are somepatients that won't acept living wit any degree of pain as long as they know there is a stronger med out there or a md to counter the side effects of pain meds so they can continue to take them and simply increase and increase as they become tolerant.
The patient that doesn't understand why they should have to cut back to play 9 holes of golf twice a week instead of the 18 holes 3 times a week prior o an injury, is more likely going to hurt themself more by popping a few 10 mg percs and playng on. Whenthey hurt more, taking more isn't the answer. When the dose is so high it makes them sleepy, amphetmanines are not the answer unless eveything else that could possibly owrk has already been tried.
Find a clincic tha uses a multi faceted aproach or specializes in your individual condition.Or if all you want is pain meds, then shop PM docs untl you find one that will give you what you want because even writing scripts is a lucrative buisness when you have enough patients physically dependent on opiates and they are your only source.
If that's not what your lookng for and that's all that's being offered, then continue consulting with various PM docs. AS much as taking on a new patient is the docs decsion, allowing a doc to treat you is your decision . If you don't agree with his treatment plan, keep moving untill your talking to a doc that makes sense, that's going to do more than an injection or write you a script. Pain management is about managing pain, not obliterating it.
Take care, Dave
An excellent summarization of what a PM is Dave, thank you.
I find that a multi-faceted approach is the best. My PM uses injections, medications, TENs units and refers individuals for therapy and chiropractic care. He also suggests that his patients seek out a Psychologist or Phsychiatrist to help you learn how to cope with the pain and learn techniques such as biofeedback, meditation and guided imagry as well as accepting the pain. Depression is very common in those who suffer from Chronic pain and it's just as important to treat that as it is the pain and medical condition.
By using a multi-faceted approach you're not only treating the initial or immediate pain but you are treating the patient as a whole which is just as important.
_ My Pain Management Doctor is a PHYSIATRIST (fizz-i-uh-trist), not to be confused with a PSYCHIATRIST--HA HA!
1) Physiatrists have been specially trained and certified to help patients who have spine and sports injuries as well as other musculoskeletal problems. Board-certified physiatrists train for four years in medical school, followed by a one-year internship and three years of hospital residency with a specialization in physiatry. They have also received advanced degrees and fellowships in several areas of musculoskeletal specialization.
2) Physiatrists also perform several minimally invasive procedures such as IDET, Nucleoplasty, Radiofrequency Ablation, Fluoroscopic injection procedures, and shoulder and knee lavage. They combine these treatments with medically supervised exercise therapies, as well as medication and orthotics, to restore mobility and function - all without the need for surgery.
I LOVE my Doc b/c he busts BUTT to try and keep me pain free as possible (considering mutiple herniated disks in cervical, thoracic & lumbar spine, Spinal Stenosis, Osteophytes, Facet Joint arthritis throughout)--WITHOUT resorting to gloves and scalpel!
Yes--he dons gloves and sticks hot needles in my back, burning my nerves until I can't feel anything AND I sing his GLORY--ha ha. BUT no cutting or sawing so far.