Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to relieving pain, and improving the quality of life of those living with pain.^[1] The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners.^[2] Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.^[3]

[edit] Classification of pain

Pain usually lasts only until the underlying trauma or pathology has healed; for example, a few days in the case of a small cut, several months for a broken bone. Pain that resolves in less than three months is classed as acute pain, and pain that lasts from three to six months is called subacute. Some conditions, such as cancer, neuropathy and rheumatoid arthritis, can take more than six months to resolve, and the pain associated with them is classed as chronic pain. In some instances, pain persists long after the underlying condition has healed, or exists in the absence of any observable underlying condition. These are cases of idiopathic pain.

[edit] Methods

Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and pain modifiers such as tricyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy). The World Health Organization (WHO) recommended a pain ladder for managing analgesia^[4] which was first described for usage in cancer pain, but can be used by medical professionals as a general principle when dealing with analgesia for any type of pain.

[edit] Medical specialties

Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Palliative Care doctors are also specialists in pain management. Some practitioners have not been fellowship trained and have opted for certification by the American Board of Pain Medicine which is not recognized by the American Board of Medical Specialties and does not indicate fellowship training. However, the American Board of Anesthesiology does have a subspeciality in Pain Managment which is recognized by the American Board of Medical Specialties and does indicate fellowship training. Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures - typically used for chronic back pain - include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators and intrathecal drug delivery system implants, etc. Over the last several years the number of interventional procedures done for pain has grown to a very large number.

As well as medical practitioners, the area of pain management may often benefit from the input of Physiotherapists, Chiropractors, Clinical psychologists and Occupational therapists, amongst others. Together the multidisciplinary team can help create a package of care suitable to the patient. One of the pain management modalities are trigger point injections and nerve blocks utilizing long acting anesthetics and small doses of steroids.

Because of the fast growth in the field of Pain Medicine many practitioners have entered the field, with many of these practitioners being not board certified or being certified by unrecognized boards.

[edit] See also

• Neuralgia
• Neuropathy
• Temporomandibular joint disorder
• Transcutaneous electrical nerve stimulation

[edit] References

[edit] Further reading

• Hilary J. Fausett; Warfield, Carol A. (2002). Manual of pain management. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-2313-2. 
• Bajwa, Zahid H.; Warfield, Carol A. (2004). Principles and practice of pain medicine. New York: McGraw-Hill, Medical Publishing Division. ISBN 0-07-144349-5. 
• Waldman, Steven D. (2006). Pain Management. Philadelphia: Saunders. ISBN 0-7216-0334-3. 

[edit] External links

• Pain Management Resources: PainEdu