Today I came across these articles on the net:
How to choose your pain doctor by Mark L. Allen Recently I was asked by one of my patients who was moving, how they might find another pain physician to continue their care. I have been asked this several times over the years. There are my recommendations to assist you in finding a caring and compatible pain physician or clinic. First, you should ask for recommendations. Your primary care physician is a good source. So are friends and family who have experience with pain management physicians. Experience counts, so check out your prospective physician. How long have they been practicing pain management? Are they certified by one of the nationally recognized Pain Management Boards that evaluate physicians? This information will allow you to choose an experienced, and dedicated, pain physician. Check pain management center programs as well as physicians. Does the center offer comprehensive programs? Do they offer verbal and written information about their programs, treatment options, and insurance participation? Insurance participation has become an important component in assessing your ability to be seen at a certain hospital or clinic to undergo tests or treatment. You will need to find an experienced clinic which has knowledgeable staff who can guide you through the insurance maze. You should make sure coverage is complete and that tests and procedures are pre-certified by your insurance carrier in order to avoid insurance coverage conflicts. The center should offer comprehensive evaluations and treatment options, with each patient receiving individualized treatment plans. Convenience of location, access, hours of operation and ease of making an appointment are also important especially if you are in pain! Sometimes, however, the most convenient location does not offer the most comprehensive program or is not covered under your insurance plan. The financial counselor of the pain clinic should be able to help determine any insurance requirements prior to your first visits, but remember to ask questions. Choosing a physician or a clinic dedicated to quality and compassionate treat of your pain is primary importance. The physician or clinic you choose should be of the right quality so that they can effectively implement the treatment plan designated for your specific problem. Although you may suffer the same symptoms and diagnosis as many other patients, there is no one specific treatment plan for each and every set of symptoms or diagnoses. Each patient is an individual and will respond differently to specific treatments. Thus, a well educated, specialized physician should be able to identify your symptoms and/or diagnoses and be able to formulate an individual response. Outcome studies are currently in progress regarding specific treatments, but at present your best guide is an experienced physician. Take time for research and study before you choose a new pain management physician or center. A caring and compassionate physician should help reduce your pain symptoms and improve your ability to perform your daily activities.
Mark L. Allen, M.D., is certified by the American Board of Anesthesiology and is a Diplomate of the American Academy of Pain Management. The Suburban Pain Treatment Center at Merida South Point and Community Hospital.
What you want to know about pain management by John H. Nickels, MD Director, Grace Hospital Pain is a horrible sensation. When it strikes it can keep you home from work, prevent you from doing the things you want to do and make your life miserable. There are many causes of pain. It can come from accidents, work injuries, medical problems, burns and other sources. When it strikes it can be mild, moderate or severe, depending on the injury and the length of time it has been present. The good news is that most pains go away by themselves over a short period of time. But, if they persist over three months, you need to seek help. Pain management is the newest specialty to deal with chronic pains. Although doctors have been treating pain for years, pain management specialists have gone further in their understanding and treatment of chronic pain. When your regular doctor can not resolve your pains, you should go to, or be referred to, a pain management specialist. The specialty of pain management deals with the diagnosis and treatment of pain. Just as you wouldn't go to a foot doctor for heart surgery, you should seek the most trained specialist to treat your pain. In pain management, we begin with a complete history, detailing the cause of your pain and everything that effects your pain_ what makes it better, what makes it worse. The more we learn about your pain, the better we are at treating it. We then perform a physical exam to help confirm any suspicions we have about what is causing your pain. We also perform a neurological exam to see if there are any problems associated with your pain. We might then send you for X-rays (including MRI and CT scans), laboratory tests and even referrals to other specialists, including neurologists, orthopedists, internists or psychiatrists. After the initial exams, we will sit down with you to discuss our findings and explain what we believe to be causing your pain. It is every physician's duty to explain each and every test performed and to let you know the results of these tests. Each patient has to be involved in understanding the pain, what is causing it and what the treatment plan will include. Because the treatment of pain can he very complex, a multidisciplinary approach to pain management is called for. This usually begins with medications, including muscle relaxers, anti-inflammatories and pain relievers. Next, is physical therapy. Treatments range from the traditional hot pack, traction, stretches and exercises to newer modalities, which provide electrical currents to relieve pains. Fortunately, this new method does not hurt in any way and therefore does not lead to further discomfort. Aqua-Med beds are also used to treat many CPS
Several reasons to seek out a pain management by John H. Nickels, M.D. Director, Grace Hospital "If you need open heart surgery, you wouldn't go to a general doctor but rather to a highly trained specialist. The same goes for pain." The typcial questions that patients ask each and every day are: "What can a pain management center do for me that my own doctor cannot? How do their treatments differ from my own doctor's? Can they stop my pain?" Most pains can be easily treated by your own doctor. They are well trained in the treatment of acute pains. If you sprain your ankle, or your back goes out on you, your doctor can help you with medications to ease your pains and recommendations for RICE (rest, ice, compression and elevation). When your pain persists beyond 3 months, then it has become chronic and deserves a specialist to treat it. If you needed open heart surgery, you wouldn't go to a general doctor but rather to a highly trained specialist. The same goes for pain management; you want the most qualified doctor for the job. Most pain management centers are run by board certified specialists in pain management. This is all they do and what they are trained for. The see pain patients every day and are up to date on all the newest medications and treatments for your pains. They differ from your general physician in that they have specialized in pain management and have studied it as their field of expertise. What then can pain management do for your pains? Pain management starts with a detailed pain history: what makes it hurt, what makes it better, when does it hurt the most, etc... You first go through a detailed physical exam with neurological testing. This might be followed by X-ray, MRIs, or formal neurological testing to determine the exact cause of your pain. Once the diagnosis has been made, the treatment plan can begin. Normally, treatment begins with medications. This can include an anti-inflammatory, a muscle relaxant, a pain reliever, and some of the new neurological medications for pain. The patient is then evaluated for physical therapy needs, including exercise and stretching, if appropriate. Traction and electrical therapies, as well as hot packs and massages, might be utilized depending on the pains. There are a lot of new electrical therapies that show great promise in treating pains today. Nerve blocks are another highly specialized treatment that has helped numerous patients received relief from their pains. Nerve blocks involve taking a very potent anti-inflammatory medication along with a local anesthetic and placing it directly on an irritated nerve that is causing the pain. If we can get the nerve to heal, the pain will subside. This type of treatment has shown great success in treating lower back and neck pains. Pains from headaches, shingles, and cancer are often treated with nerve blocks. Shoulder, knees, and joint pains can also be treated with nerve blocks. A pain management center, then, takes a specialized, multi-disciplinary approach to the treatment of pain. This means that we utilize other specialists in the field of pain management to diagnose your pains and form a treatment plan. We try to eliminate as much of your pain as humanly possible and then rehabilitate you to keep the pain from returning. If your pains have persisted for more than 3 months, then you owe it to yourself to see a board certified pain management John H. Nickels, M.D. is board certified in Pain Management and a Diplomate of the American Academy of Pain Management. He is the founder and Director of the Cleveland Back and Pain Management Center, located at Grace Hospital and the Highland Medical Center. He is also Director of the Department of Anesthesiology at Grace Hospital. CPS
Can Comprehensive Rehabilitation Teams improve chronic pain?
by Lisa Higginbotham, OTR/L
Pain can be a signal of disease or injury, alerting one to seek treatment. However, there are times when no cause can be identified or when pain persists after treatment. When pain continues for several months, it is referred to as "chronic pain." This condition can cause prolonged physical and emotional problems which may result in disrupting the lives of the patient and family members. A holistic team approach to outpatient therapy is based on the unique relationship between chronic pain patients, their primary care physician, and an interdisciplinary staff. This unique form of team treatment can include the following: occupational, physical, and speech therapy; exercise and athletic training; aquatic therapy; social work; psychology; pharmacy; dietary; rehabilitation nursing; audiology; tai chi; massage therapy; and physiatry. This comprehensive team approach helps to restore not only the chronic pain patient's whole body, but their mind and spirit as well. The main goal of comprehensive rehabilitation is to maximize a patient's activities of daily living, leisure, and work activities. The occupational therapist's goal is to assist patients in restoring their maximum functional independence. These activities of daily living can include: dressing, bathing, grooming, cooking, home management, and shopping. These essential core functions of our daily lives may be limited or absent due to chronic pain. The "depressed" body may also effect the patient's self esteem, which may impact family relationships. Therefore, developing coping strategies for patients and families is a significant part of the comprehensive rehabilitation program. A case manager/social worker works closely with the psychologist and other team professionals to assist each patient in the development of personal goals. This can be accomplished by group education, counseling, and other activity sessions. The final goal of comprehensive rehabilitation is to increase overall endurance and activity levels for daily tasks. Treatments of physical therapy, massage, and athletic training can increase the mobility, strength, and flexibility of each participant through various individualized exercises. Aquatic therapy is an excellent source of stretching and cardiovascular endurance. Water therapy has been proven to be very beneficial in decreasing the stress that gravity places on the body. Comprehensive rehabilitation is a series of modalities that provide medical care. It also teaches people how to make the most of their lives - physically, mentally, and socially. Comprehensive rehabilitation enhances the independent function of people who become disabled as a result of trauma or disease. Mastery of their daily routines allows patients with chronic pain to be more independent and helps them return to the workplace and society with strengthened self esteem. Lisa Higginbotham is an occupational therapist who as worked with a wide variety of pain diagnoses. She is currently the Coordinator of Outpatient Rehabilitation and part of the Comprehensive Rehabilitation Team at Meridia South Pointe Hospital, 4110 Warrensville Center Road 44122. 216-491-6180
"Comprehensive treatment uses rehab team therapies" By Edgar L. Ross, M.D. Chronic pain refers to a symptom that is uncomfortable and has remained or been present for longer than three months. Accommodation to chronic pain occurs with the patient typically having other co-existent symptoms and problems. Primarily depression, withdrawal from social circles, as well as loss of income; in addition physical deconditioning occurs.Therefore treatment of chronic pain involves a multifactorial approach to maxmize the improvement potential of the patient suffering from chronic pain. A multi-disciplinary team is used to improve the long-range goals and outcomes. Numerous types of teams can be formed and found in various Pain Management Centers. If a Pain Management Center has a large referral base which involves occupational injuries, the team may include expertise to address those problems. Teams dedicated to the management of cancer pain may have a different emphasis. Pain that has lasted long enough to be defined as chronic will not readily respond to symptom-based treatment alone. Teams are extremely important to help the patient surmount the numerous obstacles they find on their way to recovery. In order to function ideally, a multi-disciplinary team should be located in one location where therapy for the patient is being undertaken. This facilitates communication and tight coordination of care and allows the Interdisciplinary team to provide treatment in one location that is best able to address the patient's varying problems as they occur; as well as addressing obstacles that may not be apparent early on in recovery but later become paramount. Patients present with a large variety of different problems and the solutions often require integration of the different professional backgrounds of treating team. This team flexibility not only provides the best outcomes, but also enhances cost effectiveness of the treatment as well. In addition, Alternative Medicine is serving an increasingly important role in the treatment of chronic pain. Alternative Medicine also functions best within a multi-disciplinary team approach. Alternative Medicine should not be reserved solely for patients who have not responded to more traditional therapies. In that role, the failure rate will be rather high. Understanding the pathophysiology of pain, allows a team to approach a patient on a more rational basis. Problem lists should include the primary cause of the chronic pain as well as all other difficulties the patient may have.Treatment plans should be in writing and should be revisited weekly to monitor progress, and activity. Treatment goals should be modified based on resolution and on expectations the patient and team may have for problem solving. It is not unusual for goals to be changed as treatment progresses and the team participate in the patient's rehab. Reassessing goals and guiding the patient toward realistic ones is therapeutically important. This reduces the patient's frustration in trying to obtain unrealistic goals and also enhances the possibility of success. The treatment team should remain consistant. Patients often bond therapeutically to various members of the team. The consistency of treatment and the rapport that develops between team members and the patient is not only desirable, but should be encouraged because it will greatly enhance the patient's progress. Treatment of chronic pain must not only be intensive, as described above, but must also be time limited. Patients must develop a complete understanding of their problems, therapies and practice the skills they have learned. This is the only way long-standing benefits can help patients and allow them to return to function on an ongoing basis. Chronic pain is a very complex problem. Many treatment strategies have been developed, and no one single treatment is successful for every single patient. Treatment plans need to involve different specialists with different professional backgrounds. Constant and thorough communications about the patient, family, and treatment team is vital for optimal outcomes and for the long-term success in the management of chronic pain. Edgar L. Ross, M.D., is certified by the American Board of Anesthesiology and is a Diplomate of the American Academy of Pain Management. Dr. Ross has been a member of the medical staff of Meridia Suburban Hospital. He established The Pain Management Center with Prasad Perumbeti, M.D., and served as its Medical Director. Dr. Ross specializes in the tratment and management of chronic and acute pain syndromes and is currently heading pain management to Brigham and Women's Hospital in Boston, MA, a teaching affiliate of Harvard Medical School.
Hope this helps.
-- Lin