Chronic Pain Relief: When to See a Pain Specialist
An estimated 100 million Americans live with chronic pain—pain that continues beyond a normal period of healing that is not expected to resolve itself.
Chronic pain can affect your ability to sleep at night and concentrate during the day. It can also zap your energy and affect your quality of life. If you’re experiencing chronic pain, a pain specialist can help you manage your pain and return to the activities you enjoy.
Interventional Pain Management
Dr. Kelsey Pohler and CHI St. Joseph Health Pain & Spine Associates specialize in interventional pain management, a discipline of medicine devoted to the diagnosis and treatment of pain-related disorders. Patients can have a wide variety of conditions, including neck and lower back pain, joint or muscle pain, cancer-related pain, peripheral nerve pain, or headache disorders.
Treatment often is multi-modal and can include epidural steroid injections, spinal and peripheral nerve blocks, joint injections, a variety of nerve radiofrequency ablative procedures, implantation of spinal cord stimulation devices, vertebroplasty, and kyphoplasty.
Vertebroplasty and kyphoplasty are procedures used to treat painful vertebral compression fractures in the spinal column, which are often due to osteoporosis.
“The majority of procedures are fluoroscopy-guided and performed in a clinic setting under local anesthesia,” said Dr. Pohler. “Some more invasive procedures are performed in the hospital (or surgery center) using IV sedation or general anesthesia, if necessary.”
When to See a Specialist
If you continue to experience chronic pain, Dr. Pohler recommends asking your provider for a referral to a fellowship-trained and American Board of Anesthesiology-certified MD or DO.
“Determining a course of treatment is similar to the same method any physician uses to diagnose and treat their patients,” said Dr. Pohler. “This starts with a thorough history taking and physical exam. The history focuses on the location and type of pain.”
The doctor will ask whether the pain is sharp, dull, electric, burning, or aching, whether it radiates, whether it’s constant or intermittent, what makes it better or worse, its severity, how it limits their functioning, and what treatments or diagnostic testing they may have already undergone. They will also ask how the pain affects your life—your ability to work, perform everyday tasks, exercise, play with your children or grandchildren, or enjoy your favorite activities.
Next, the specialist will perform a focused physical exam, directed by his or her assessment of information gathered in the history. “This provides useful information which, in conjunction with the history, is used to establish a differential diagnosis of likely sources of an individual’s pain,” said Dr. Pohler. “For example, low back pain can be due to a number of different problems, each of which I may treat using different, specific techniques or injections.”
Then, the specialist would perform diagnostic testing to help further narrow down the diagnosis and lead to a specific diagnosis that is causing your pain.
“Sometimes it’s challenging to pinpoint a specific reason just based on this information, as pain is a subjective experience that a lot of people have a hard time describing,” said Dr. Pohler. “Additionally, imaging tests don’t show pain. They only show the presence or absence of pathology that can potentially cause pain.” Once the specialist arrives at a final diagnosis, he or she can direct treatment recommendations.
While Dr. Pohler says his primary focus is in providing interventional treatments, other modalities—like medications, physical therapy, exercises, massages, chiropractic adjustments, behavioral therapies (such as cognitive-behavioral therapy or biofeedback) and treatment of mental health conditions—are all important. Some patients may require surgery to help their pain.
If chronic pain is part of your daily life, talk to your doctor. CHI St. Joseph Health Pain and Spine Associates will work with you and your referring physician to develop an overall treatment regimen to help ensure your pain levels are as tolerable as possible.