15 Apr 2014

Pain Management Referral: What To Expect

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Many patients referred by their primary doctor or a surgeon to “pain management” have little idea of what to expect.  Those thinking of scheduling a pain management appointment on their own may also have concerns about how they will be treated.  Although every pain management practice is different, this outline of the patient experience in my practice may help you get a better idea of what the first and follow-up appointments may be like for you.

Before Your First Appointment

Gathering Information: Understanding the underlying cause of your pain symptoms is very important.  Medical records from other doctors who you have seen for your painful problem should be sent to your pain doctor in advance.  This usually means calling those doctors and having your records faxed.  This can take some time, so it is best to do it a few days before your appointment.  If you have your own copies of X-rays, MRI’s, EMG’s, or other medical studies, bring them to your initial consultation.  If you have tried many different medications in the past, it can be helpful to bring a list of everything you have tried so far.  Having all this information ready will prevent delays or repeated tests.

Check Your Doctor’s Credentials: Not all doctors who practice pain management have formal training.  When scheduling your appointment, ask if the doctor has done a fellowship in pain, and if the doctor is board-certified in pain medicine.  Fellowships are accredited programs that ensure proper training and experience in the diagnosis and treatment of chronic pain.  Board certification demonstrates that your doctor has passed testing and meets the training requirements of a nationally-recognized board, such as the American Board of Medical Specialties.

Pain History and Physical

Chronic pain has countless causes, and effective pain management is best achieved when the underlying cause or mechanism can be found.  The most important clues come from a detailed history, so expect to answer many questions about what your pain is like and how it began.  Chronic medical conditions can influence your treatment plan, so be sure to share all of your medical diagnoses and medications with the pain doctor.  Prior surgeries, family history, work history, and other elements of your history may also come up.  Although some areas may seem personal, such as questions about mental health and substance use, it is important to answer these questions honestly.

Your doctor should also perform a physical exam.  The nervous system and musculoskeletal system will be a focus for most patients.  A thorough physical examination by an experienced pain physician can often identify specific underlying problems that other doctors may have missed.

Treatment Plan

Depending on your individual situation, your doctor should propose a plan involving some of the following:

  • Diagnostic testing, such as X-ray or MRI imaging.  In some cases, a diagnostic nerve block may be offered to conclusively identify a pain source.
  • Referrals for conservative treatment options like physical therapy, acupuncture, or manual therapies.
  • Medication therapies.  Your doctor should explain the rationale behind particular medications and the potential side effects.  Some medications come with additional risks or legal restrictions that can require testing or other investigations prior to prescribing.  For this reason, pain doctors are often unable to prescribe medications at a first visit — if another doctor is referring you, do not schedule your appointment on the day you are to run out of medication from that doctor.
  • Interventional therapies.  Some painful problems, especially back and neck pain, respond well to minimally-invasive procedures that target the pain source directly.  Not all chronic pain responds to interventional therapies, however.
  • Surgery.  Although the goal of pain management is often to avoid surgery, in some cases surgery may be the best treatment option.  A pain specialist can refer you to an appropriate surgeon.

About Leo Lombardo, M.D.

Leo Lombardo, M.D. is a dual-board-certified pain physician and founder of Ventura Pain and Spine Physicians, a medical practice serving Ventura, Oxnard, Camarillo, and all of Ventura County.


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