Understanding Pain: Different Pain Management Doctors for Different Pains?

Dr. Harry Gould III, MD, PhD. is the author of Understanding Pain and is a Professor of Neurology at LSU. He is one of the foremost authorities on managing pain.

Q: Are there different pain management doctors for different pains? Should a patient with a broken bone be seeing the same kind of doctor for pain management as someone with fibromyalgia?

Dr. Gould:  There are many pain clinics and pain physicians, but they are not all the same. Selecting the right physician and clinic for a particular pain problem is important for achieving the best and most appropriate care. Remember that pain is a multifaceted condition that is unique to the perceiver. Pain can have many sources and triggers and can affect many systems in the body.

Likewise, treatments vary depending on the underlying cause and patient susceptibility to different treatment modalities. The treatment of pain should fit the pain that is presented and thus should be tailored to the patient. Physicians generally try to do the best they can do to do what is best for their patients, but are limited by the scope of their training and thus tend to manage problems with the modalities they know best; surgeons operate, internists use medications, psychiatrists offer counseling, but no one approach meets all needs. In general, one’s selection of a physician should begin with an assessment of the likely cause, e.g., possible fracture (orthopedist), headache following trauma (emergency room physician, neurologist or neurosurgeon), menstrual pain (ob/gyn).

If the cause is unclear then finding someone with more general knowledge is the best place to start. In the pain field, physicians may choose to limit their practice to a particular treatment modality, e.g., nerve block, laser therapy, massage, acupuncture. This type of facility may be just what is needed for some problems, but the caution here is that modality-specific treatments may not be appropriate for all pains, may treat something unrelated to the presenting pain and miss important, less obvious conditions [just because a possible cause is identified, doesn’t mean that it is THE reason for the pain].

Other physicians restrict their practices to a particular pain problem or syndrome, e.g., back pain, headache, sport injury, and employ physicians to provide in-depth evaluation and many treatment modalities to manage the condition and provide good coverage within their area of expertise. Patients with complex problems, such as fibromyalgia, complex regional pain syndrome, post-laminectomy back pain, post-traumatic stress disorder, however, should consider a comprehensive pain center that offers the personnel and facilities to be able to perform a complete physical and psychological assessment of the pain problem and the resources to provide a broad spectrum of treatment options that can be tailored to the individual.

Comprehensive pain centers will be able to manage the routine as well as the complex pain problems, but the reverse is not true.  It is easier to manage many complex problems if recognized and treated early, than if identified after months or years of treatment failures.