Family doctors and GPs do their best to help patients manage pain. When their efforts are not enough, they refer patients to specialized pain clinics staffed by doctors and nurses whose jobs center around pain management. As a general rule, pain clinics are a better option for chronic pain patients whose family doctors or GPs struggle to help them.
For the record, pain medicine is a recognized medical specialty. It is what we specialize in here at KindlyMD. If it is your first time visiting our pain clinic, our number one goal is to help patients take control of their own care while we work with them to find the best possible avenue for long-term pain relief.
Pain clinics can be standalone practices or part of group practices or hospital groups. One way or the other, a pain clinic is a facility whose mission and staff are focused on two main goals: diagnosis and chronic pain management. You will not find pain management doctors dealing with things like the common cold and infant colic. Most cases involve chronic pain.
Clinic staff can also vary. A typical clinic team includes:
Some pain management clinics go so far as to have psychologists on staff. In other cases, doctors may refer patients to independent psychologists.
The primary goal of a pain clinic is to help manage chronic pain. In essence, the whole purpose of pain medicine is to help patients maintain a high quality of life through the proper management of chronic pain. Included in a high quality-of-life is maximum function.
Chronic pain is such that it can be debilitating. It can cause a loss of function in the affected body parts. If that loss is severe enough, it can prevent a person from working, pursuing hobbies, and doing many of the things that the rest of us take for granted.
Pain management physicians look to relieve pain. They look to restore function so that a patient can go back to doing all those things that were done prior to onset.
The most notable thing patients can expect from pain clinics is the actual approach. It starts with a diagnosis. A good pain management physician doesn't just ask a few questions and then guess at a diagnosis. Rather, proper pain medicine technique requires doing a thorough evaluation in an attempt to get to the root causes of pain. Evaluations are often complemented by diagnostic tests.
Once the root cause of a patient's pain is discovered, a pain medicine doctor works with the patient to come up with the best course of action. How does this differ from the experience at a GPs office? For starters, rare is the pain management physician who immediately pulls out the prescription pad and writes a prescription for pain medication.
There are other ways to treat pain that don't require opioid medications or other pain-relieving drugs. Pain clinic staff might encourage patients to look at physical therapy, dietary changes, exercise, and other options. This is not to say that pain medications do not have a place in pain management. They do. But pain management physicians don't assume that medications are always the best and first course of action.
If your GP has referred you to a pain clinic, do not stress over it. If you are visiting a pain clinic for the first time, chances are that one of the clinic's pain management physicians will be able to help you more than your GP.
Arthritis is a selection of diseases that takes its toll on the joints and surrounding tissue. The most common form is osteoarthritis (OA). It is a type of arthritis that nearly everyone will experience as they age. The older one is, the more likely OA is a part of daily life.
The question we hear a lot from new patients is whether their joint pain indicates early-stage osteoarthritis. Sometimes that is the case; other times it's not. At KindlyMD, we undertake a thorough evaluation of each new patient with the goal of learning what is causing the pain in question.
Could your joint pain indicate early-stage OA? It is possible. Ask yourself the following questions:
Osteoarthritis is a joint disease. Therefore, pain in the muscles would indicate something else. The same goes for things like headaches and toothaches. If the pain you feel is in the joint, OA is a strong possibility. As a side note, a lot of OA patients experience back pain.
We don't tend to think of the back as a site for OA pain. Rather, our first thoughts are about the knees, fingers, shoulders, and other joints. Yet the spinal column includes more than 360 joints that run from the neck down to the pelvis. Any one of those joints can be subject to OA.
Joints afflicted with osteoarthritis tend to be tender to the touch. If you are experiencing early-stage OA, lightly brushing up against an affected joint probably wouldn't cost too much discomfort. On the other hand, pressing the joint would generate pain. The pain could also be accompanied by swelling and redness. However, swelling doesn't have to be present. In many patients, swelling does not present itself until the disease reaches a more advanced stage.
Osteoarthritis is caused by a loss of cartilage in the joints. Cartilage is the protective, cushioning tissue that exists between the two bones of the joint. As it begins to wear away, the bones do not move so freely. There is more friction between them and, as a result, the joint becomes stiff.
People with early-stage OA often describe joint stiffness first thing in the morning. They describe it as making them feel slow, sluggish, and not able to get going right out of bed. But after taking a shower and getting the body moving, the stiffness disappears.
This sort of joint stiffness is a pretty significant sign of early-stage OA. Other things can cause it, but OA is one of the more likely causes.
Joint stiffness is one of the symptoms of a loss of cartilage associated with osteoarthritis. But there is another symptom: the sensation that your bones are grating on one another. If you have OA, it is not just a feeling; it is exactly what's happening.
In healthy joints, cartilage prevents the two bones from coming into direct contact with one another. But once cartilage is lost, there is nothing to prevent that contact. The two bones in a joint are constantly in contact. There is friction – and that grating sensation – every time the joint moves.
If you have noticed any of these things in relation to your joint pain, there is a possibility you are experiencing early-stage osteoarthritis. The best way to know for sure is to visit with an experienced pain doctor for a complete evaluation. Although OA is fairly common, it is a very treatable disease. Early treatment is one of the keys to maximizing pain relief.
There is a different kind of doctor's office that doesn't treat things like common colds and broken bones. It is not staffed by internists or family doctors. Its doctors and advanced practice nurses do not always reach for the prescription pad. It isn't a GP's office, it's a pain clinic.
Pain clinics specialize in pain diagnosis and management. In nearly every case, patients are dealing with chronic pain. Pain management doctors, like those who work for Kindly MD, look to go beyond the traditional Western-based medicine that dominates so many American practices.
Western medicine is not a bad thing, but it relies too heavily on prescription medications. Yet medication is not always the best avenue for pain management. Sometimes it is most appropriate when combined with other treatments. Other times, it isn't appropriate at all.
Western medicine's general reliance on medications has created a misunderstanding among patients that all they need to feel better is a prescription. They run to the doctor at the first sign of a sniffle in hopes of getting an antibiotic prescription. Not only is this bad medicine, dishing out prescriptions can create more problems than it solves.
Here is the uncomfortable truth about medication: no drug is perfect. No drug works exactly as advertised or helps everybody who takes it. We know this all too well in pain medicine. Rarely are two pain management cases identical. Not only that, but patients also respond to treatments differently.
Treating patients as individuals is one of the things that sets pain clinics apart. It allows for treatment customization, which is the first step in going above and beyond medication to make an actual difference. Our philosophy at Kindly MD is to allow patients to control their own healthcare journey. We work with them as partners in the search for the best option rather than dictating to patients what they ought to do.
If you were to visit a pain clinic in hopes of better managing chronic pain, would you consider yoga? Yoga certainly isn't for everyone. But for one patient profile by a recent USA Today piece, it was the thing that worked best.
The patient, a 66-year-old man with bad knees, nerve problems, and the results of two surgeries on the feet, decided to try yoga after seeing fellow veterans doing things he couldn't do. It was one of the best decisions he ever made. He now bikes five miles every day and is hoping to eventually enter a marathon.
Once again, do not misunderstand the point of this post. The goal is not to dissuade you from taking prescription medications. It is simply to say that there are other ways to manage pain. As for those medications, they can cause problems.
You are familiar with opioid medications and their propensity to cause addiction. That's a serious enough reason to think twice about long-term opioid use.
Pain clinics are no stranger to patients who have tried pain medications to no avail for years. It's not uncommon for them to also live sedentary lifestyles. Why? Because the mentality of Western medicine is to take a prescription and do nothing else. If the medication doesn't work as well as it should, a patient may ultimately become sedentary. That may lead to loss of function, loss of mobility, and even more pain.
That's not what pain management doctors want to see. It is why pain medicine goes above and beyond prescription medications to find other ways to help patients.
Opioid medications are a common tool used by pain management physicians around the country. They can be prescribed for acute pain following surgery, for example. They might also be prescribed as a short-term solution to chronic pain. But generally speaking, pain doctors prefer to gradually taper opioid medications. There are valid reasons for this.
Tapering involves gradually reducing the amount of medication a patient is taking. Ultimately, the goal is to eliminate the opioids. Whether or not that means other medications are given as a substitute is determined on a case-by-case basis. As for why pain management physicians choose to taper rather than immediately stopping, there are three things to consider.
One of the worst aspects of opioids is that they cause dependence. Opioids relieve pain by binding to opioid receptors in the brain. But as is the case with so many other drugs that work in a similar manner, the brain can get used to a certain amount of opioids in the system. And when that happens, pain relief is reduced.
This scenario is known as dependence. When it sets in, the only way for a patient to achieve the same amount of pain relief is to take more medication. Doctors want to reduce the volume of opioids a patient takes in order to simultaneously reduce dependence as well. Otherwise, a patient needs to continue taking ever larger amounts of medication to manage pain.
The nature of opioid dependence is such that attempting to stop using opioid medication almost always produces withdrawal symptoms. Symptom severity can vary from one patient to the next, but nearly every patient suffers some level of discomfort. There is also the danger that withdrawing too quickly could lead to medical complications resulting in injury or death.
In simple English, withdrawing from opioids cold turkey is a risky proposition. Not only does it present a certain level of danger to the patient, but it can also magnify the perception of pain. So now a patient already dealing with chronic pain needs to also endure withdrawal symptoms. Tapering is a way to manage withdrawal in a safer and more compassionate way. As for the symptoms, they are minimized through tapering. Other medications can be given to address them if they become too difficult to bear.
A third and final reason pain management physicians prefer to taper opioid medications is the fact that scientific studies seem to suggest that doing so helps improve pain management. One such study, published in 2019, was conducted by way of a systemic review of previous tapering studies.
The study in question looked at more than 2,100 cases of chronic pain for which patients were gradually tapered from opioid medications. Just over 81% of patients reported better pain management – which is to say they felt better – at the completion of tapering. Some 15% reported no difference in their pain experience while only 3% reported more severe pain.
Science may not fully understand the mechanism here, but the fact remains that opioid tapering seems to help pain management over the long term. So the goal is to gradually reduce opioid consumption and, where necessary, substitute with other medications that don't have as much negative baggage attached.
Opioids are appropriate for pain relief in some cases. But pain management physicians tend to frown on them as a long-term solution. When opioids are prescribed, gradually tapering until they are no longer used is usually the best way to go.
Pain management did not become a recognized specialty in Western medicine until the 1960s. Even at that, pain management wasn't a specialty that a lot of doctors pursued. Only within the last 10 years or so has pain management been recognized as important to helping patients maintain optimal health.
If there are any questions about why Western medicine should continue developing pain management therapies, a study out of the UK provides some insight. The study suggests that the experience of chronic pain in one's 40s can lead to illness and disease in one's 50s.
Extrapolating from the study suggests that getting a handle on chronic pain as early as possible could limit its impacts later in life. Effective pain management can essentially act as a preventative strategy for people in, or approaching, middle age.
The study in question utilized health records and surveys from more than 12,000 patients born during a specific week in 1958. All were born in England, Wales, or Scotland.
Researchers compared survey data collected in 2003 with patient medical records at three age intervals: 50, 55, and 62. The results were quite surprising:
The overall conclusion reached by the researchers was that chronic pain in one's younger years is associated with poor physical and mental health in one's later years.
We can think of two possible explanations that account for the association between chronic pain and poor mental and physical health in the future. Let us start with physical health.
As pain management doctors, we treat patients who find it very difficult to live functional lives due to their pain. Unfortunately, there's a common scenario we observe all too often: pain leads to inactivity, inactivity leads to a loss of function, and loss of function creates more pain.
As a general rule, a pain clinic's primary mission is to help patients feel better and restore as much function as possible. Where that doesn't happen, inactivity and poor lifestyle choices are not uncommon. Poor physical health becomes more likely.
Mental health is also affected by chronic pain. As any chronic pain patient will testify, constantly dealing with pain takes a mental toll. Constant pain is mentally exhausting. It is frustrating. It can absolutely have a negative impact on a patient's outlook.
When left unmanaged, pain can leave a patient feeling less and less optimistic about the future. This can ultimately lead to a variety of mental health conditions, not the least of which are depression and anxiety.
No medical intervention is guaranteed to work in every case. But if chronic pain in one's younger years is a true precursor to future physical and mental health problems, it only stands to reason that early intervention should be a priority.
Early intervention focused on pain management should help most patients cope with their pain as effectively as possible. Where significant relief is found, patients are more likely to remain active and functional. And remaining active should reduce the risks of future health concerns.
There is still a lot to learn about pain management and how it affects future outcomes. But based on the UK study, it would seem that figuring out how to manage pain as early as possible leads to better future outcomes.
At pain clinics all over the country, doctors listen to patient complaints in hopes of understanding why they are experiencing their particular pain. But it's not just pain doctors who hear such complaints. Doctors of all stripes hear about pain – from oncologists to orthopedists and GPs.
Pain is challenging for doctors to address simply because there are so many things that can cause it. Furthermore, there are no scientific tests capable of accurately measuring pain in the same way an x-ray can detect a broken bone. Pain is a matter of perception. Doctors need to rely on patient reports to understand pain as best they can.
So, what are the most common pain complaints doctors hear about? Without trying to rank them, here are five common pain issues compliments of John Hopkins Medicine:
Back pain, particularly pain in lower back, is arguably one of the most significant health problems in America. It is one of the most common complaints doctors hear, as well as a leading cause of inactivity in adults.
You have probably experienced back pain at least once in your lifetime. And if not, you likely will at some point. Lower back pain can be caused by a variety of issues including herniated discs, pinched nerves, arthritis in the spine, collapsed vertebrae, and more.
Next on the list is cancer. Everything from lung to breast and prostate cancer can cause pain. Unfortunately, disease-related pain is not all patients have to deal with. Cancer treatments can cause additional pain. In fact, they often do. Some patients experience treatment pain they consider more severe than the pain caused by the actual disease.
Arthritis is one of the most common joint diseases in the world. There are several types, among them being osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. Each one creates a different kind of pain that can be anywhere from mild to debilitating.
Arthritis pain is especially concerning because it tends to lead to less activity and a loss of function. The combination of both can contribute to additional health problems as time goes on.
According to John Hopkins, millions of American adults suffer from routine headaches. They are almost as challenging to doctors as pain itself because there are so many different types and causes.
In chronic cases, some of the more common headache types include migraines, tension headaches, and cluster headaches. As for their particular causes, it is not an exact science. Triggers can vary greatly among patients.
Last on the list is the more general category of pain disorders. A pain disorder is a disorder in which pain is the main symptom. It may be the only symptom. Fibromyalgia immediately comes to mind.
Once known as fibromyalgia syndrome, the condition used to be difficult to diagnose. Doctors had to listen closely to patient descriptions of pain and then manipulate certain trigger points to see what happened. Though we still don't fully understand fibromyalgia, studies suggest it may be the result of an overactive nervous system.
Neuropathy is another pain disorder. It is often associated with diabetes. In diabetic patients, the disease leads to nerve damage which causes pain in the extremities. However, neuropathy can be independent of other health conditions. It can be a condition all to itself.
Pain clinics do their best to help patients find relief. Sometimes the journey to effective pain management is relatively easy. Other times it proves difficult. Whether your pain complaints are common or not, we are here to help you feel better.
It wasn't too long ago that doctors used to recommend plenty of rest and inactivity to patients dealing with chronic pain. That is beginning to change. Why? Because we are learning more about the relationship between exercise and pain. We are discovering that using exercise to manage pain can have a positive impact on chronic pain.
Pain clinics, like ours, are generally willing to look at anything that might help patients. How about you? Would you be willing to try using exercise as one tool to manage pain? If so, don't be afraid to bring it up with your doctor.
Pain is one of the most studied conditions in history. Over the years, researchers have looked at it from just about every angle. Studies have recently begun focusing on the relationship between exercise and pain perception.
A 2020 study conducted by researchers in Belgium and Australia suggests a positive relationship between appropriate exercise and better pain management. The study was a meta-analysis of 15 previous studies looking into pain syndromes and exercise training.
Here are the three takeaways from that study:
To summarize, researchers concluded that appropriate exercises have a positive impact by increasing a patient's tolerance and making the patient less sensitive to pain perception. Exercises targeted to the local source of pain seem to work better than a broader approach.
As pain management doctors, we can think of several reasons exercise might help certain types of patients. For instance, consider a patient suffering from debilitating osteoarthritis.
No doubt osteoarthritis can be a very painful condition. Many patients find it so painful that they avoid unnecessary activity. Unfortunately, remaining sedentary weakens the muscles, tendons, and ligaments that support bone structures. This can actually increase pain.
Exercises designed to strengthen the muscles ultimately end up improving joint support. With more support from surrounding tissue, arthritic bones do not create so much pain.
Another possible explanation is something will call the endorphin effect. It is well-known that exercise encourages the release of endorphins in the brain. Endorphins are partly responsible for inducing feelings of pleasure.
It could be that increased endorphin production helps minimize pain perception. The fact that endorphins are known in medical science as one of the brain's natural pain relievers surely lends credence to this line of thinking.
Let's not forget that exercise tends to improve health overall. Even people who don't experience chronic pain benefit from exercise. Regular exercise helps improve metabolism, lower blood pressure, reduce the risk of cardiovascular disease, improve diabetes symptoms, and on and on.
It stands to reason that if exercise improves overall health, better health will lead to at least some measure of pain relief. But again, pain perceptions are different from one person to the next. There are no guarantees.
One key thing to remember here is that exercises should be chosen based on the root cause of a patient's pain and their overall health. Not every type of exercise is appropriate for every type of pain. Our advice is to talk to your doctor about the possibility of adding exercise to your routine.
Feel free to ask our pain doctors about exercise when you visit. If it can help you feel better, why not give it a try? It is hard to go wrong with a little bit of daily exercise that keeps you active and fit.
A while back, we put together a blog post discussing the benefits of a holistic approach to pain management for surgical patients. That post has generated a number of questions about holistic pain management and what it looks like. Let's dig into that here.
For starters, a holistic approach in any medical specialty is one that seeks to treat the whole patient in body, mind, and spirit. It is the complete opposite of traditional Western medicine the prefers to zero-in on certain symptoms and deal with them exclusively.
GPs have been known to struggle to help certain patients manage pain effectively. Why? Because pain has so many causes. Furthermore, patient perceptions play a huge role in determining how debilitating pain is.
This is primarily why taking a holistic approach is better. Treating pain holistically goes beyond the mere symptom to delve into its root causes and how said causes are affecting the patient. Pain doctors look at the whole picture rather than just one tiny aspect of it.
At this point, we do not want you to confuse holistic pain management with a medication-free treatment. Doctors and patients may agree together to forgo pain medication in favor of other treatments. But that's not necessarily a given.
Medications are appropriate in many cases. Sometimes they are utilized exclusive of all other treatments, other times they are combined with things like physical therapy, exercise, dietary changes, etc.
Pain medications aside, one of the hallmarks of a holistic approach is utilizing alternative treatments in addition to pain medication or as a replacement for it. Alternative treatments are offered in a variety of forms. Here are some of the most common options pain management doctors tend to recommend:
The one thing all these treatments have in common is the goal of offering them as an alternative to pain medications. In Western medicine, prescription medications rule the day. So it can sometimes be difficult to convince GPs to try alternative treatments. That's where pain management clinics prove most beneficial.
As a specialty, pain management looks to dig deeper than symptoms alone. Digging deeper often leads pain management physicians to the realization that medication is not always the best avenue.
The holistic approach to pain management can include pain medications. But it is also likely to include alternative treatments as well. The idea is to treat the whole person, not just the pain.
Recently updated CDC guidelines on prescription opioids have caused a stir among pain management doctors, clinics, and patients. It is hard to describe the updated guidelines as anything other than a change in course. Whether the course change is good or bad will be revealed over time.
The CDC published its original guidance on prescription opioids back in 2016. Their goal was to help stem the tide of the opioid crisis by encouraging doctors to be cautious about over-prescribing opioid painkillers. In essence, the CDC was telling doctors to stop recommending the medications unless absolutely necessary.
New guidance suggests the CDC believes pain management physicians have gone too far. Though the agency stresses the fact that the new opioid guidelines are voluntary, they are strongly urging doctors to be more compassionate toward patients whose best option for treating pain might be opioids.
It is hard to imagine the CDC was surprised by the backlash their new guidance created. In their defense, they are not throwing caution to the wind here. The updated guidelines represent more of a philosophy of not throwing the baby out with the bathwater.
A brief perusal of the opioid guidelines reveals that the CDC now recommends:
The CDC is also advising against abrupt discontinuation or rapid tapering if doing so presents a life-threatening situation for the patient. Under such circumstances, maintaining current dosage or more gradual tapering is preferred.
While the medical community does its best to implement the new guidance as practically and safely as possible, we would be wise to recognize that opioid pain medications have their pros and cons. Like any medical treatment, opioids need to be considered from multiple angles.
Knowing what we know about their addictive potential though, it still makes sense for pain management physicians to work with their patients in hopes of finding alternative treatments. If the benefits of an alternative treatment can help patients avoid opioids altogether, that seems to be the route to take.
Along those same lines, there is growing consensus among a small group of pain management doctors that simply masking pain with some sort of medication might be the wrong approach. Perhaps pain medications should be prescribed more to take the edge off than anything else. But of course, this is a topic still being debated within the medical community.
It's not yet clear how the CDC's new opioid guidelines will affect the majority of America's pain management clinics and physicians. The pain management specialty may ultimately embrace the guidelines fully and without question. Then again, there may be some legitimate concerns that need to be addressed.
One thing we can say for sure is that frank discussions between doctors and patients are still necessary. In fact, they are now probably more important than they were before. More relaxed CDC guidelines could encourage patients to ask for opioids more frequently. They could encourage doctors to prescribe them more frequently.
The decision to use opioid pain medications ultimately rests with doctor and patient. If you are a pain management patient, do not be afraid to ask questions to your pain management doctor. Don't be afraid to let your thoughts be known. You are your best advocate and the one who must make the final call on whether to use opioids.
