The Management of Acute,
Chronic and Cancer Pain
For thousands of years, doctors have been helping to relieve
their patients' pain with a variety of medications and treatments.
Like other areas of medicine, a new subset of doctors have
become specialists in treating pain. They are focused on
managing all types of pain - studying what causes it, how
the body reacts to it, how different medications dull or
eliminate the pain, and how other treatments can be used
to relieve many painful conditions.
DOCTORS WHO SPECIALIZE IN TREATING PAIN
Doctors who manage pain are frequently anesthesiologists.
Anesthesiologists are doctors of medicine (M.D.) or osteopathy
(D.O.) who make sure that you are safe, pain-free and comfortable
during and following surgery. They also provide their services
in other areas of the hospital - especially in the labor
and delivery area - or in doctors' offices where painful
medical tests or procedures are performed.
But not everyone realizes that decades of research and
work done by anesthesiologists have led to the development
of newer, more effective treatments for patients who have
pain unrelated to surgery. Many techniques used to make
surgery and childbirth virtually painless are now being
used to relieve other types of pain. In fact, the work pioneered
by anesthesiologists that led to these new medications and
treatments also has created a new category of medicine called
pain medicine.
Frequently the anesthesiologist heads a team of other
specialists and doctors who work together to help you manage
your pain. The anesthesiologist or other pain medicine doctors
(such as neurologists, oncologists, orthopedists, physiatrists
and psychiatrists) and nonphysician specialists (such as
nurses, nurse practitioners, physician assistants, physical
or rehabilitation therapists and psychologists) all work
together to evaluate your condition. Then this "team"
of specialists will develop a treatment plan designed just
for you.
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What type of training does a pain medicine doctor have?
Like other physicians, anesthesiologists earned a college
degree and then completed four years of medical school.
They spent four more years learning the medical specialty
of anesthesiology and pain medicine during residency training.
Many anesthesiologists who specialize in pain medicine receive
an additional year of fellowship training to become a "subspecialist,"
or an expert in treating pain. Some also have done research,
and many have special certification in pain medicine through
the American Board of Anesthesiology (ABA). The ABA is the
only organization recognized by the American Board of Medical
Specialties to offer special credentials in pain medicine.
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When would I need to see a pain medicine doctor?
People develop pain for many reasons. Pain from a recent
surgery, injury or medical illness is called acute pain.
In many cases, this pain can be managed immediately and
will usually get better in just a short time. For more serious
pain, however, your primary care doctor may ask a pain medicine
doctor to help manage your pain while you are healing.
If your pain persists after the healing process should
be over, you might have what is called chronic pain. If
the current treatment you are receiving stops working or
your pain begins to get worse over time, your primary care
doctor may suggest that you see a pain medicine doctor.
Cancer pain is another condition that can be managed by
a pain medicine doctor while the patient continues to receive
treatment for various types of cancer. The pain can be due
to cancer surgery or treatment procedures, including radiation
therapy and chemotherapy, or the tumor itself.
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What does a pain medicine doctor do? Can these doctors
find out why I hurt?
Pain medicine doctors are experts at diagnosing why you
are having pain as well as treating the pain itself. Some
of the more common pain problems they manage include: arthritis,
back and neck pain, cancer pain, nerve pain, migraine headaches,
shingles, phantom limb pain for amputees and pain caused
by AIDS.
They also manage acute pain caused by surgery, a debilitating
illness or a serious injury. Examples include: pain after
a knee-joint replacement, pain during recovery from a car
accident, pain following stomach or chest surgery, or pain
associated with sickle cell disease. You may be treated
in the hospital or in an outpatient clinic.
- The pain medicine doctor will work closely with your
primary care doctor.
- Pain medicine doctors will review your medical records
and X-rays as needed.
- They will ask you to describe your pain in detail, such
as where it hurts, for how long, what makes the pain worse
or what makes it feel better.
- They may ask you to fill out a detailed questionnaire
that helps them to assess the impact that your pain is
having on your lifestyle and if it is interfering with
your daily activities.
- They also will do a complete physical examination on
you.
- They may need to order other tests and will then review
all of their findings to determine what is causing your
pain and how the problem can be corrected.
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MEDICATIONS FOR MANAGING PAIN
Due to rapid advances in medicine, a wide variety of medications
and treatments are available for acute, chronic and cancer
pain. Patients often will be prescribed medications before
receiving other forms of therapy. In addition, your pain
medicine doctor may conclude that a combination of medication
and treatments may be right for you. Your therapy plan will
be tailored to your specific needs and circumstances.
Your pain medicine doctor may suggest that you use certain
over-the-counter pain relievers or may prescribe stronger
medicine for your condition. DO
NOT MIX PAIN PRESCRIPTION DRUGS WITH OVER-THE-COUNTER PAIN
RELIEVERS WITHOUT CONSULTING YOUR DOCTOR. Advise
your doctor if you are taking any herbal medicines or dietary
supplements.
Common pain relievers - Nonaspirin pain relievers such
as acetaminophen (Tylenol®) can relieve headaches and
minor pain but do not reduce swelling. They are sometimes
used in combination with other drugs to provide greater
pain relief.
Anti-inflammatory drugs - Aspirin (Anacin®, Bayer®),
coated or buffered aspirin (Ascripton®, Bufferin®)
and aspirin with acetaminophen (Excedrin®) may be used
to reduce swelling and irritation as well as to relieve
pain. There also are non-steroidal anti-inflammatory drugs
(NSAIDs, commonly called "N-sayeds") such as ibuprofen
(Advil®, Motrin®) and naproxen (Aleve®). Anti-inflammatory
drugs are used to relieve pain, inflammation and fever.
There also are steroidal drugs (like cortisol and prednisone),
available only by prescription, that are used to treat more
serious inflammatory conditions such as chronic arthritis.
Opioid pain medications - Morphine-like drugs
called opioids are prescribed to treat acute pain or cancer
pain. They are occasionally used for certain chronic, noncancer
pain as well.
Anti-depressants - These drugs were originally
used only to treat depression. Studies now show, however,
that they also can relieve certain pain. Available only
by prescription, they often are used to help you sleep better
at night.
Anti-seizure medicines - These medications
are used to relieve what some patients describe as "shooting"
pain by decreasing abnormal painful sensations caused by
damaged nerves.
Other medicines - The doctor may also prescribe
other types of medication that will be helpful for your
specific pain problems. In addition, medications that counteract
the side effects of opioids or treat the anxiety and depression
associated with pain may also be prescribed.
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TREATMENTS FOR MANAGING PAIN
Medication alone may not be enough to manage certain kinds
of pain. Some medicines are more effective in fighting pain
when they are combined with other methods of treatment.
In some cases, the patient's pain condition may respond
to treatment instead of medication. In fact, for some patients,
certain therapies may eventually replace the need for taking
any pain medicine, or less of it, over time. Here are just
some of the available treatments being used successfully
to treat pain patients.
Injection treatments - Local anesthetics
(such as Novocain®), with or without cortisone-like
medicines, can be injected around nerve roots and into muscles
or joints. These medicines reduce swelling, irritation,
muscle spasms and abnormal nerve activity that can cause
pain.
Nerve blocks - Often a group of nerves, called
a plexus or ganglion, that causes pain to a specific organ
or body region can be blocked with local anesthetics. If
successful, another solution that numbs the nerves can then
be injected.
Physical and aquatic therapy - The physiatrist
or physical therapist may suggest an exercise program tailored
for you that will increase your daily functioning and decrease
your pain. Other treatments may include whirlpool therapy,
ultrasound and deep-muscle massage.
Electrical stimulation - Transcutaneous electrical
nerve stimulation (TENS) is the most common form of electrical
stimulation used in pain management. It is not painful and
does not require needles or medicine. TENS consists of a
small, battery-operated device that can diminish pain by
stimulating nerve fibers through the skin.
Acupuncture - This ancient Chinese practice
uses very thin needles at very specific points on the skin
to treat disease and pain. Practitioners of acupuncture
undergo specialized training in these techniques and may
offer this treatment for certain painful conditions.
Psychological support - Many patients
who are in pain feel the emotional effects of suffering
along with the physical aspects of pain. These may include
feelings of anger, sadness, hopelessness or despair. In
addition, pain can alter one's personality, disrupt sleep,
interfere with work and relationships and often have a profound
effect on family members. Support and counseling from a
psychiatrist or psychologist, combined with a comprehensive
pain treatment program, may be needed to help you manage
your condition. These trained professionals also can teach
you additional self-help therapies such as relaxation training
or biofeedback to relieve pain, lessen muscle spasms and
reduce stress.
Surgery - When necessary, surgical treatment
may be recommended. In rare instances when severe pain has
not responded to other treatments and procedures, surgery
on certain nerves can be done to give the patient some relief
and allow them to resume near-normal activities. Usually
all other avenues of treatment are tried before surgery
is considered.
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PAIN TREATMENT CENTERS
Because this is a highly specialized field of medicine
that is still growing, not every community has a pain treatment
center yet. These centers are called by many different names,
including: pain clinic, pain management center, pain center,
pain unit or pain service. These facilities may be in a
wing of your local hospital or medical center, in a separate
medical-professional building or in a doctor's office. Some
are affiliated with medical schools and large health care
centers.
Where can I find a pain treatment center, and how do
I decide if it's the right one for me?
There are many different forms of pain treatment and therapy,
and one center may offer a service or specific kind of specialist
that another center does not have. Some have pain medicine
doctors on staff, and others may offer only nonmedical treatments
such as acupuncture and massage therapy. Thus before consenting
to treatment, it is best to find out what types of pain
therapies are offered, what the specialists' credentials
are and if they have successfully helped others with your
type of pain.
To find a pain medicine doctor or pain specialist, generally
your regular doctor should be able to refer you to an individual
or group who offers services that are best for helping your
specific pain problem. If your doctor is not able to refer
you, try the sources below:
1. Call your local hospital or medical center and ask if
they have a pain treatment center there or if they are affiliated
with a pain treatment center or clinic nearby.
2. If your area does not have a specialized pain treatment
center, ask the hospital to connect you to the Department
of Anesthesiology. They may have doctors on staff who can
provide treatment or who can refer you to another hospital.
3. If your local hospital does not have information on
a pain treatment center, contact the nearest school of medicine,
which is usually affiliated with a private college or state
university. (Medical school listings are available at the
public library.) Ask them if they offer pain treatment or
if they have research programs that study pain.
4. If you have access to the Internet, you can obtain information
through the American Society of Anesthesiologists (ASA).
While ASA does not maintain a list of pain centers nationwide,
we may be able to assist you with some additional information
in your area.
Throughout the generations, pain has been a unique, often
misunderstood condition that affects every age, gender,
ethnic and social group all over the world. It can occur
for many reasons, and there is no one "silver bullet"
that can cure pain. Yet great progress in pain medicine
has been made in recent years and is expected to advance
further as doctors learn more about the causes of pain.
Anesthesiologists, through ASA, will continue to support
research, medical training and patient education to help
those who suffer from pain - whether it is acute, chronic
or cancer pain - so these patients can live comfortably
and be productive members of their families and communities.
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"The Management of Acute, Chronic and Cancer Pain"
has been prepared by the American Society of Anesthesiologists
through the cooperative efforts of the Society's Committee
on Communications and the Committee on Pain Medicine.
Certain product names used in this brochure are included
as a point of reference for patients and should not be considered
all inclusive or construed as an endorsement by ASA, its
committees or its members.
Patients should consult their physicians for recommendation
or prescription of an appropriate course of treatment.
© Copyright 2001 by the American Society
of Anesthesiologists
All rights reserved.
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