Chronic Pain

Print Page

By Joseph W. Galassi, M.D.

Introduction
When to Refer
What to Refer
How to Refer

Introduction
There are numerous patients who suffer from chronic pain issues. Primary care physicians manage many of these patients. When those patients become difficult for a primary care provider to handle, referral to a pain medicine physician is in order.

Realize that pain medicine is a relatively young specialty. The American Board of Medical Specialties (ABMS) didn’t grant sub-specialty certification to anesthesiologists until 1993.

Since that time, other specialists have become board certified in pain medicine as well. For example, neurologists and psychiatrists were eligible to take their first certification exam in 2000.

As a consequence, there may be a number of physicians who consider themselves pain physicians, but fewer who are board certified. When you are ready to refer a patient to a pain physician, please keep this in mind, because not all pain physicians treat all pain conditions.

In addition, depending on their primary specialty, some pain physicians will have a different approach to pain patients and offer different treatment options based on their education and training. For example, a physician with primary training in neurology or psychiatry may not have training to perform interventional pain medicine but be very good with managing the medications that your patient is taking or dealing with possible addiction issues.

On that same note, anesthesiology-based pain practitioners may have a more interventional approach due to their training.

Nationally, there are few comprehensive pain treatment centers that offer all the available pain treatment modalities under one roof. As such, pain physicians work with other health care providers whenever necessary for the best treatment plan for the patient.

For example, physical therapists, psychologists, acupuncturists and chiropractors are generally not in the same facility as an anesthesiology pain medicine physician. 

> Back to top

When to Refer
When you are uncomfortable treating a patient’s pain symptoms, it is time to consider a pain referral. This can be due to a number of reasons, including but not limited to the following: 
  • Pain refractory to medications you are comfortable prescribing 
  • Pain requiring increasing doses of medications to treat, including opioids 
  • Pain out of proportion to the usual pain noted for a particular injury 
  • Pain not resolving despite evidence for clinical healing after an injury
Referrals can be done to interventional pain physicians to perform a procedure as part of your treatment plan. For example, you may refer a patient with back pain for an epidural steroid injection to treat a radicular pain as part of a plan you have instituted. 

> Back to top

What to Refer
Patients with pain from head to toe can be referred to the appropriate pain medicine physician. Some are comfortable treating all types of pain, whereas others treat only certain kinds of painful conditions such as headaches or back pain.

If you do not know the pain physician in you area well, pick up the phone and give him/her a call. You will then start to learn what his/her limitations are, if any.

Pain medicine physicians treat all types of painful conditions including: 
  • Chronic back pain due to a number of etiologies 
  • Headaches 
  • Myofascial Pain 
  • Fibromyalgia 
  • Neck Pain 
  • Neuropathic Pain 
  • Chronic Regional Pain Syndromes 
  • Cancer Pain 
  • End of Life pain conditions and symptom management
> Back to top

How to Refer
When a patient gets referred to a pain medicine physician, it is important for the patient to send ahead or bring along a summary of what his/her pain symptomatology is, copies or reports of completed imaging studies, a list of prior and current medications, and a list of prior and current treatment modalities.

The pain practitioner will develop a treatment plan based on a review of the patient’s: 
  • History 
  • Physical exam 
  • Imaging studies 
  • Prior treatments for the problem
The treatment plan may include: 
  • Medication adjustments 
  • PT 
  • OT 
  • Psychological therapy 
  • Acupuncture 
  • Chiropractic treatment 
  • Interventional pain procedures
> Back to top

Physicians

Physicians Protecting Patients