If you’re like most people, the doctor you see most often is your primary care provider, likely a family physician or internist. And that’s certainly the place to start when you’re dealing with pain. Estimates are that primary care physicians treat about half of all people living with chronic pain.
However, if your pain remains uncontrolled, it might be time to seek out other practitioners.
In an ideal world, you would have access to a pain management specialist, one board certified in pain management. The American Board of Anesthesiology, the American Board of Psychiatry, the American Board of Neurology, and the American Board of Physical Medicine and Rehabilitation all offer certification after physicians complete a fellowship in pain management.
These physicians typically work in pain management centers and employ a holistic approach to your pain involving medical treatments, psychological counseling, and alternative approaches like those described below.
At the Mayo Clinic, for instance, a three-week patient-oriented pain management program involves physical and occupational therapy, education to better understand your pain, and breathing and meditation exercises to reduce anxiety related to flares. One study of 373 patients who attended the program – half of whom had been taking opioids before enrolling – found significant improvement at six months after the program ended, regardless of the amount of opioid medication they were taking prior to treatment.
However, there are a very small number of these physicians and teams available, with one study estimating that just 2 percent of people living with chronic pain receive care from these professionals in a typical month. If there are no pain specialists or teams in your area, ask about telehealth consultations. Studies find that these approaches can be just as effective as in-person visits.
Other physicians who can provide pain management services include neurologists, orthopedists, anesthesiologists, and rheumatologists. Most of these specialists deal with only one type of pain – the type involving the part of the body they treat. And while a physician should be an important part of your pain management team, you shouldn’t stop there. Studies find that an integrative approach – one that combines conventional medicine with self-care and complementary approaches – is more effective at addressing chronic pain than conventional medicine alone.
You may see several physicians as you search for pain relief. These include:
Indeed, guidelines from the CDC, American College of Physicians, and other medical organizations recommend starting with non-opioid alternatives as a first-line treatment for chronic pain, including acetaminophen (Tylenol), nonsteroidal anti-inflammatories (i.e., Motrin, Aleve), antidepressants, and anticonvulsants. They also recommend non-medication approaches such as cognitive behavioral therapy – in which you learn to think differently about your pain – physical therapy, movement therapy or exercise, and also complementary approaches such as acupuncture, massage, and chiropractic services.
There are other practitioners who can work with you and your physician to relieve your pain. Among them:
When complementary or alternative approaches are appropriate, it is important to make sure all of your providers are communicating with each other. Simply substituting a healing practice such as massage for a medication does not make for good care. The complementary practice must be integrated properly into your treatment to be safe and effective. Sometimes, you need to act like a good quarterback to make sure your healthcare team is providing you with treatments that are complementary and not redundant or harmful.
In this day of 15- or 20-minute office visits, many physicians find themselves rushing from exam room to exam room without time to even take a breath. This can make it difficult to spend the time required to manage chronic pain. Here are some strategies to make it easier on both of you.
Focus on building a strong patient-doctor relationship – one that helps you improve your quality of life. For those looking to move away from opioids, remember that there are effective, accessible, non-drug options. With the right team supporting you, you can be in control of your own path to healing.