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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] Types of pain

Acute pain, such pain resulting from trauma, often has a reversible cause and may require only transient measures and correction of the underlying problem. In contrast, chronic pain often results from conditions that are difficult to diagnose and treat, and that may take a long time to reverse. Some examples include cancer, neuropathy, and referred pain. Often, pain pathways (nociceptors) are set up that continue to transmit the sensation of pain even though the underlying condition or injury that originally caused pain has been healed. In such situations, the pain itself is frequently managed separately from the underlying condition of which it is a symptom, or the goal of treatment is to manage the pain with no treatment of any underlying condition (e.g. if the underlying condition has resolved or if no identifiable source of the pain can be found).

[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. 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