Physical Medicine & Rehabilitation

What is pain medicine? | Who specializes in back and neck pain management? | What does it mean to be board certified in pain medicine | The difference in a spine center and pain management center

Pain is the number one reason people seek out a physician. Back and neck pain in particular will affect 80% of Americans at some point in their lives.

What is pain medicine?

Pain medicine is a specialty unto itself. Its areas of expertise include the prevention, evaluation, diagnosis, treatment and rehabilitation of pain. Pain can be caused by a variety of things, from cancer, trauma, systemic problems, muscle and ligament strains to back and neck pain. Within the specialty of pain, providers specialize in niches — like back and neck pain — to gain a better understanding of what can cause a pain complaint, and the most current ways to relieve pain.

Who typically specializes in back and neck pain management?

Back and neck pain is addressed by a variety of specialists, from orthopedic spine surgeons and neurosurgeons, to non-surgical providers like physiatrists, anesthesiologists, chiropractors, acupuncturists and therapists.

Pain management represents a separate specialty that crosses over many niches. A pain management specialist could focus on back and neck pain, pain from cancer, TMJ pain, pain from a traumatic injury, headache pain, etc.

Pain specialists often are referred the complex patients who haven’t had their problem resolved with common surgical or non-surgical options. For example, there are many patients that are not appropriate for surgery, and where other non-surgical treatments have failed. These patients are then often referred to specialists in pain management.

Pain management specialists are typically anesthesiologists or physical medicine physicians who have had advanced training in how to do intricate injections around the spine.

Over the last 10 years, however, the specialty of Physical Medicine & Rehabilitation has also provided spine fellowships that attempt to provide in depth training in lumbar and cervical injections. So today, it’s common to see anesthesiologists and physiatrists working together with spine therapists to help spine patients recover from pain.

Because of the delicate nature of the spinal cord, those physicians performing pain relieving injections around the spine typically need a C-arm that provides an internal picture of the spinal vertebrae, enabling the physician to guide the needle to the precise location for pain relieving medication.

The goal of most injections is to relieve pain symptoms long enough to get the patient moving again, and into some functionally oriented therapy program. Generally speaking, movement and pain relief are the desired goals from injection therapy. So today, the most advanced spine centers focus on getting the person back to activity, recognizing that movement in itself can play a role in relieving pain symptoms.

What does it mean to be board certified in pain medicine?

To be board certified in pain medicine, a physician must go above and beyond regular training. The American Board of Pain Medicine conducts rigorous tests of those candidates who wish to become board certified in pain medicine. If candidates meet the required score on the examination, and possess the appropriate training and credentials, they are presented with a certificate and are deemed Pain Medicine Specialists. Most physicians who seek board certification in pain medicine are typically anesthesiologists and physical medicine physicians (physiatrists).

What is the difference between a spine center and a pain management center?

A spine center typically focuses on those patients who are moving progressively toward a resolution of their back and neck pain problem, either with non-surgical options like therapy and injections, or spine surgery.

Those patients who cease to make progress with these options — in that they suffer from “chronic” pain symptoms that persist for more than six months or a year — typically require specialists in “pain management.” These pain specialists focus on other pain treatments, which can include more complex injections around the spine, the implantation of spine cord stimulators that can mask the pain signal to the brain, or the implantation of drug pumps that provide a regulated source of medication to relieve pain.

Other specialists in a pain center can include psychologists who have advanced training in biofeedback to help patients manage their pain without dependence on drugs.

Because successful pain management involves a focus on movement, a pain center may also have occupational therapists, vocational counselors and social workers who all play a role in the successful recovery from chronic pain.