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Spine Pain Management

What is Pain Management?

Pain Management is a medical specialty which treats a wide variety of pain conditions.The management of spine pain often involves managing medications, performing injections, and referring patients for tests or other care.The goal is to lessen the pain to a point where the patient’s quality of life is improved.

What is Interventional Pain Management?

Interventional Pain Management is a specialty of Pain Management which tries to lessen painful conditions by delivering medications directly to the painful area. This often involves injecting medications into inflamed areas of the spine with the help of an X-Ray machine. Other procedures go beyond injections and can include minimally invasive spine procedures.

What is a Pain Management Specialist?

Pain Management Spine Specialists can come from several different specialties:

  1. Anesthesiologists

Anesthesiologists are specialists in anesthetizing patients for surgery. They undergo 4 years of formal training following medical school. As part of their training they are taught nerve blocking procedures for pain control as well as medication management for pain control.

Some Anesthesiologists will complete a formal 1 year Fellowship Training Program in Pain Management. As part of this training they learn about conservative spine care and interventional spine care. Interventional spine care involves injections and other less invasive methods to treat the spine. These specialists will often dedicate their career to Pain Management.

Anesthesiologists who are fellowship trained in Pain Management can achieve a Board Certification in Pain Management which is recognized by the American Board of Medical Specialties.

        2. Physical Medicine and Rehabilitation Specialists (Physiatrists)

Physical Medicine and Rehabilitation Specialists are specialists in treating patients with physical injuries and disabilities, restoring them to the maximum functional potential. They train for 4 years following medical school. As part of their training, they often learn about interventional procedures to treat chronic pain as well as medication management.

Some Physiatrists will complete formal training in the form of a 1 year Pain Management Fellowship Program, just like Anesthesiologists. As part of that training they will learn about conservative and interventional spine care. Often these Fellowship trained Pain Management specialists will dedicate their career to this specialty.

Physical Medicine and Rehabilitation Specialists who are fellowship trained in Pain Management are eligible to achieve Board Certification in Pain Management which is recognized by the American Board of Medical Specialties.

      3. Neurologists

Neurologists are specialists in the medical (not surgical) treatment of the Neurological System. They train for 4 years following medical school.

Neurologists can help in the diagnosis and conservative management of patients with spine disease.

Some Neurologists also complete a formal Fellowship Training Program in Pain Management similar to Anesthesiologists and Physical Medicine and Rehabilitation specialists.

Neurologists who are Fellowship trained in Pain Management are eligible for Board Certification in Pain Management recognized by the American Board of Medical Specialties.

      4. Radiologists

Radiologists are specialists in interpreting and performing radiology procedures. They train for 4 years following medical school.

Some Radiologists complete a formal Training Program in “Interventional Radiology”. This specialty often provides Interventional Pain Procedures, such as injections.

     5. Primary Care Pain Physicians

Some Primary Care Physicians specialize in Chronic Pain Management. They may come from the specialties of Internal Medicine or Family Practice.Their training typically takes 3 years following medical school. Their practice typically revolves around conservative spine care including chronic medication management.

While these specialists are often Board Certified in their primary specialty, they are not eligible for a Pain Management Board Certification recognized by the American Board of Medical Specialties.

What medications do Pain Management doctors use to control pain?

Pain Management doctors can use a wide variety of medications to help with spine pain. Here are some examples:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). Examples are Ibuprofen (Motrin, Advil), Naproxen Sodium (Naprosyn, Alleve
  2. Steroid Medications. Examples are Prednisone, Decadron, Methyprednisolone
  3. Pain Killers
  4. Non-Narcotic Pain Medications. An Example is Tramadol (Ultram)
  5. Narcotic Pain Medications. Examples are Codeine (Tylenol # 3), Hydrocodone (Lortab, Vicodin), Oxycodone (Percocet), Hydromorphone (Dilaudid), Morphine, Methadone, Fentanyl
  6. Nerve Pain Medications. Examples are Pregabalin (Lyrica), Gabapentin (Neurontin)
  7. Antidepressants. Examples are Paroxetine (Paxil), Sertraline (Zoloft)

What kinds of Spine Conditions do Pain Management doctors treat?

Here are some examples of common spine conditions treated by Pain Management doctors:

  1. Disc Herniations
  2. Disc Degeneration
  3. Spinal Stenosis
  4. Spinal Nerve Inflammation and Compression (Sciatica)
  5. Pain after Spine Surgery
  6. Scoliosis Pain
  7. Facet Joint Degeneration
  8. Sacroiliac Joint Pain

Do Pain Management doctors diagnose my spine problem or do they just treat the pain?

Most pain management doctors will try to diagnose a spine problem before they can treat it properly. Here are some of the ways a diagnosis can be made:

  1. The patient’s spine history
  2. The patient’s spine examination
  3. Spine Images such as MRI, CT-Scans, X-Rays, Nuclear Bone Scans, etc.
  4. Spine Injections to diagnose where the pain is coming from

Do Pain Management doctors perform Spine Surgery?

Pain Management doctors are not trained to perform spine surgery. However, there are some minimally invasive spine procedures offered by some Pain Management doctors.

What type of interventional procedures do Pain Management doctors perform?

Here are some examples of interventional Pain Management procedures:

Injections

  1. Trigger Point Injections
  2. Epidural Injections
  3. Facet Joint Injections
  4. Facet Joint Radiofrequency Rhizotomies
  5. Sacroiliac Joint Injections
  6. Sacroiliac Joint Radiofrequency Rhizotomies
  7. Discograms

Minimally Invasive Procedures

  1. Minimally invasive disc decompressions
  2. Vertebroplasty
  3. Kyphoplasty
  4. Spinal Cord Stimulation
  5. Intrathecal Pain Pump Implantations

Do Pain Management doctors work with Spine Surgeons?

Most Pain Management doctors have some association with Spine Surgeons. Here are some examples:

  1. Some Pain Management doctors work directly with Spine Surgeons in the same office. They often combine their knowledge to offer a broad treatment approach.
  2. Some Pain Management doctors work with Spine Surgeons in the same community, but separate offices. Patients are often referred for an opinion if a patient needs surgery. Spine Surgeons will also refer patients to the Pain Management doctor if they do not require surgery.