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Pain management is a new super-specialty of modern medicine. Many universities or private institutes have post-graduate pain management courses or fellowships in pain management.
Pain specialist doctors are specially qualified doctors. After MBBS, they do MD or MS degrees; after that, they do courses or fellowship in pain management to become a pain management specialist.
Pain management clinics have facilities of modern interventional pain management techniques in their clinic. Mostly, these techniques are nerve blocks, epidurals, joint injections, etc. All these techniques are done under the guidance of images, like ultrasonography, fluoroscopy, etc.
Nursing staffs have an essential role in pain management. They take an initial history, initial assessment of pain before a pain management doctor finally examines them. Pain management nurses are also specially trained for it.
Pain management doctors evaluate the type of pain, find the reasons behind it. Then, in some situations like in cancer or post-operative or post-traumatic pain, they work with other specialists. Initially, they use medicines depending on the cause of pain. Then, if medications do not work, the pain management doctor suggests some interventional pain management. These are either some nerve block or some other highly specialized techniques done in minimally invasive ways.
Interventional pain management is some minimally invasive techniques to reduce pain. These techniques are not simple injections. One can compare these with stents in the heart inserted through needles and catheters. This has minimized open-heart surgeries. These procedures are done by interventional cardiologists, not by surgeons. Same way, in interventional pain management, some catheters, or radiofrequency cannula, or some electrodes are placed at the desired place at the spine or near the nerve to correct pathology or to block pain signals without harming other nearby structures. Interventional pain management can stop or reduce pain without taking pain killer medicines.
Like every other branch of medicine, there are failures. But the overall success rate of interventional pain management is between 80-99%. The success rate depends on the type of procedures, the experience of the doctor, and the equipment used for the interventional procedures. But the essential aspect of interventional pain management is that it is very safe. Complications are rare compared to surgical counterparts for the same diseases.
Yes, it is a specialty. In the USA, it is the 34th specialty. In India, Govt recognizes it as a super-specialty. The majority of medical colleges in India have pain management clinics run by the department of anaesthesiology. In addition, some of the Govt and private hospitals have their pain clinics under the anesthesiology department.
As we mentioned earlier, most pain management doctors come from anaesthesiology. Still, pain management doctors may also come from other branches like neurosurgery, orthopedics, neurology, physiatry, and psychiatry. Therefore, after having MD/MS/MCH from these specialties, they need to take pain management training or pain management fellowship to become a qualified pain management doctor.
Of course, they have to diagnose the condition, and if needed, they may take the help of other specialists. However, without having a proper diagnosis, long-term pain management is not possible.
Interventional pain management procedures are minimally invasive procedures, and these are not open surgeries. Pain management doctors at times do minimally invasive surgical procedures like endoscopic discectomy to avoid open surgeries and their related complications.
First, one should diagnose the cause and then plan pain management. Sometimes medicines and exercises help, but occasionally interventional pain management techniques and used. These can be epidurals, facet joint radiofrequency procedures, sacroiliac joint interventions, or ozone nucleolysis, depending on the diagnosis.
Sure, one of the most common types of conditions treated in a pain management clinic is fibromyalgia. The treatment of fibromyalgia consists of some medicines, exercises, psychological counseling, and some interventional procedures. All these depend on the severity of the condition.
Again, arthritis is a common cause of pain in the back, shoulder, hands, or legs. There are different types of arthritis, and some types of arthritis can be cured or controlled with medicines. However, some types of arthritis don’t have any cure, and some interventional procedures give long-term relief to these patients.
Nerve pain or pain due to neuropathy is one of the prevalent conditions treated by pain doctors. Apart from medicines, there are many different interventional pain management techniques to give long-term or permanent results to these patients.
Pain management is an essential part of cancer treatment. Pain is widespread in advanced cancer or stage-four cancer. Many a time, curative treatment of cancer is not possible in an advanced stage. Pain management is the essential treatment in this stage.
If the pain is widespread due to the metastatic spread of cancer, a morphine tablet is the best option. Sometimes a skin patch that contains morphine-like medicine is helpful. Particularly when a patient cannot swallow a pill, this kind of patch is convenient. Sometimes morphine is infused directly into the spine close to the spinal cord through an exemplary catheter. When morphine is injected close to the spinal cord, the dose is reduced by 300%. So, excellent pain relief is possible with a tiny amount of morphine. A reservoir pump implanted under the skin stores morphine. It is an advanced pain management procedure with minor surgery done under local anesthesia. It gives the best kind of pain relief, but the pump is costly. But when the pain is localized, a nerve block can be the best option. It also gives a good quality of pain relief, and there is minimal need for morphine-like medicines. The disadvantage is that it is costlier than morphine tablets, and only expert doctors can do this kind of nerve block. Also, it can be done in the early stages when there is no distal spread of cancer.
Shingles or herpes zoster causes skin eruptions and severe burning pain during the acute phase and after the skin eruption has healed. A post-herpetic painful condition that starts after healed skin eruption. Apart from pain medicine and anti-viral medicines, epidural steroid injections are beneficial in the acute phase. Post-herpetic neuralgia is a problematic situation, and a multimodal treatment is the best option. This multimodal treatment consists of nerve medicines, lignocaine (a local anesthetic) skin patch, dry needling, acupuncture added with interventional pain management procedures like sympathetic nerve blocks, epidurals, or spinal cord stimulation implantation.
Trigeminal neuralgia is a kind of nerve pain. So, ordinary pain medicines like paracetamol, ibuprofen, or diclofenac will not work here. Even the morphine group of medicines are ineffective. Here nerve medicines like carbamazepine, baclofen, oxcarbazepine, etc. are helpful. But in some patients, these medicines become ineffective after few years. In these situations, nerve blocks or interventional procedures are useful. Nowadays, Radiofrequency and Cryoneurolysis of Gasserian ganglion are the most effective interventional procedures for Trigeminal Neuralgia. Medicines like alcohol, phenol, or glycerol are rarely used nowadays because of short-duration pain relief and other side effects.
Osteoarthritis of the knee is an age-related degeneration or decaying or articular cartilages. It is more common in over-weight, trauma to the joint, or with the presence of other kinds of arthritis. Pain management procedures aim to regenerate decayed cartilages by injection of platelet-rich plasma injection and visco-supplementation. In very advanced situations, knee joint replacement may be the best choice, but blocking pain-carrying nerves can give good results. Cooled radiofrequency procedure is an advanced procedure that is a US FDA-approved technique and is an excellent option to avoid joint replacement surgery.
These are some interventional pain management techniques that need costly, state-of-the-art equipment and the advanced skill of a pain management doctor. Unfortunately, these advanced pain management facilities are not available in every place. Another issue is that some centers have facilities of few advanced procedures, not all. The advanced techniques are radiofrequency ablation, cryoneurolysis, intrathecal pump implantation, spinal cord stimulator implantation, etc. Fortunately, Gaba Pain Center: The Pain Clinic has facilities of all types of advanced pain management techniques.
International Association for the Study of Pain (IASP) has divided pain into three major types. The fourth type is mixed. These are:
1.Nociceptive pain
2.Neuropathic pain
3.Nociplastic pain
4.Mixed type
There are some types of tissue damage or injury other than injury in nerves, and those are responsible for pain. Nociceptors are activated. That’s why they generate pain signals which travel to the brain, and we feel pain. Here, the best examples are accidents and injury, skin infection, appendicitis, etc.
Here, there is damage or disease of nerves. Therefore, these damaged nerves themselves create pain signals without are other tissue damage. Then, these signals reach the brain to generate pain. Examples are painful diabetic neuropathy, herpes zoster, carpal tunnel syndrome, etc.
Here, there is no damage to nerves or non-nerve tissues. Here the pain signals are generated because of abnormal functioning of nerves without any structural damage of nerves. Examples are migraines, tension-type headaches, fibromyalgia, etc.
Here, there is damage or dysfunction of both nerve and non-nerve tissues. An example is chronic osteoarthritis of the knee. Here, there is cartilage damage, and along with that, there is dysfunction of pain-carrying nerves.
Different organizations may provide pain management services in different ways. As a result, there are different types of names depending upon available facilities:
1.Single-discipline ain clinic
2.Multidisciplinary pain clinic
3.Pain management center
4.The pain management department of a hospital
5.Pain management hospital
Here, a specialist doctor runs a pain clinic alone. He or she can be an anesthesiologist, physical medicine doctor, neurosurgeon, or physiotherapist. These pain clinics are introductory level pain clinics as facilities for pain management in different other ways are not available here.
Here, doctors of different disciplines manage patients of pain. John Bonica (1917-1994) first established a multidisciplinary pain clinic concept in the 1950s. Apart from the anesthesiologist, there are doctors of physical medicine and psychiatry.
There are facilities for treatment and research on pain management in a pain management center. It should also have a multidisciplinary team.
In many hospitals, there are separate departments of pain management. Otherwise, the anesthesiology department provides the services of pain management. In India, a hospital with an MD course in anesthesiology must have a pain management section under the department of anesthesiology.
The specialty hospital with beds for admission of patients of pain is a pain management hospital. It should be multidisciplinary, and all kinds of facilities of pain management should be there. Gaba pain center: The Pain Clinic is a pain management hospital with beds for the admission of patients. It is multidisciplinary with all kinds of pain management facilities.
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