Whom Should I See for Chronic Pain?

As there are many types of chronic pain, there are many options for who can evaluate and treat your chronic pain.  There are several issues I think are most important:

1. First, know what body system your pain is in.

Many fields of medicine treat disorders that cause pain. For example, a rheumatologist would treat arthritis, a cancer specialist would treat cancer, and a neurologist would treat headaches. You should get a good evaluation, a specific diagnosis, and a plan for treatment from someone who specializes in your particular disease. This person can follow you over time, or serve as a consultant to your primary care doctor. The important point is that someone should follow your condition and work with you, in an ongoing way, to monitor how you’re doing and make adjustments to treatment as needed.

2. Do you need a pain management expert?

There are physicians who specialize in treating chronic pain. They are in fields such as neurology, anesthesiology, psychiatry, and rehab medicine, but their primary interest and expertise is treating patients with chronic pain. These practitioners are invaluable in your care, especially if pain is one of your primary symptoms.

If you see your primary care doctor or specialist, and that clears up your pain, that’s wonderful. But if your pain remains, it’s very worthwhile to see someone who specializes in chronic pain.  Again, this can be a consultation or ongoing treatment. Chronic pain is often very difficult to treat, so you want to have an expert on your treatment team.

Lastly there are diseases of the pain systems in your body, where pain is not a symptom of something else, but the disease itself is in the systems of your body that control pain. These are diseases like CRPS (Complex Regional Pain Syndrome, or RSD), central pain, and diseases that cause sensitization of your nervous system. In these diseases, it’s very important to see someone who specializes in them.

Where do you find a pain management expert? The best option is to ask your primary care doctor for a recommendation, or to look in an academic health center or in a health system for a pain management center. Many of the national pain societies also have directories of members where you can look for someone in your area.

3. What if experts recommend different treatments?

This can be confusing and scary, especially if you’re told that your current treatment is dangerous or preventing you from getting better.  Why does this happen?  Doctors, even within 1 field, have different levels of knowledge and expertise. Also, a lot is unknown about chronic pain.

What should you do?

  • Learn as much as you can about your pain condition and treatment options, so you’re an informed patient. Ask questions of your doctor about why she’s recommending one treatment versus another, so you know what her thinking is.
  • See a pain specialist. In general, you’ll probably get more up-to-date care for chronic pain.
  • Try to tolerate the unknown. For many issues in pain management, we just don’t know. It is hard not to get definite answers! But trust that almost all doctors are trying their best to help you.
  • Don’t expect magic cures. Treatment for chronic pain often takes many types of treatments all working together. It takes time to see results, so be patient, which is hard when you’re in significant pain.
  • Don’t expect all your pain to go away immediately, and for some patients, complete pain relief is unrealistic. It doesn’t make sense to switch doctors until you’ve given a doctor time to work with you, and it will hurt your overall care to keep switching doctors after only a few sessions with each. On the other hand,
  • Don’t wait forever to see about other options. If your doctor says that’s all there is, it’s always worthwhile to see what someone else can offer. If you’ve worked with someone for a while, but aren’t satisfied with the results, a second opinion is always an option. Don’t be afraid of offending your doctor – all good doctors encourage second opinions.
  • Stick with someone you’re comfortable with. Are you working with someone who is helping you? Whose overall approach you agree with? Has a good bedside manner? Is supportive to you? Is at a comfortable mix of conservative/cutting-edge for you? While a consultation with someone else is always an option, stick with what is working overall.

Other articles:

Should I see a pain management psychiatrist, psychologist or therapist?

How to be a great patient