Pain is a very complex problem. Acute pain is usually associated with discrete injury and tissue damage. As the problem heals, the pain quickly disappears. In subacute and chronic pain, the nervous system changes and sensory nerve actions are perceived as pain.
Treating acute pain is often very straight-forward; treat the cause and the pain resolves. Chronic pain often takes special skills to determine the cause and develop a comprehensive treatment strategy. Many physicians are pain specialists and only do interventions, but a good Physical Medicine pain doctor will work at fully developing a comprehensive plan based on a full evaluation. The patient is more than the next procedure for the physician; they are truly concerned and will find the right solution tailored to the specific needs of that patient.
Physical Medicine pain specialists often have unique training. After medical school they participate in a 4-year training program that is extremely diverse. Time is spent in multiple related disciplines including Neurology, Orthopedics, Internal Medicine, and Rheumatology. The general course also includes extensive training in management of complex chronic medical problems from strokes, spinal cord injuries, traumatic brain injuries, and severe trauma. Extensive outpatient training is also included, especially in all varieties of musculoskeletal disorders, sport injuries, and muscle, nerve and skeletal problems. The training teaches the evaluation and management of every problem that causes pain, and the strategies to correct the issues. Furthermore, the best trained doctors learn early that they are members of a team, and they will coordinate with all the specialists from physical therapists to other physicians to solve a problem.
Pain that is not acute needs a specialist who is willing to fully listen, exam, evaluate and treat the patient as whole. The physician who is mainly interested in performing a procedure may not see the whole picture of what is wrong, and complex problems often are not solved. For the patient this leads to frustration. A good Physical Medicine pain physician will be board certified in his primary specialty and in the subspecialty pain. Many are extremely skilled in intervention techniques and have years of experience. In every specialty, 90% of the physicians will do a good job, and the other 10% are exceptional. They are the ones who really care and will try to find the solution. The 10% are those who are compulsive, some are in academics, some in private practice; they are the ones who have the sixth sense and go the extra mile.
Pain is a complex and frustrating problem. There are new problems and solutions being discovered in this field. Better solutions for complex problems appear to be on the horizon. Take the time to find a specialist who will help develop a plan for your needs.
Thomas Cohn, MD
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