A pain management specialist assesses and treats a variety of pain conditions. A pain management specialist handles both acute pain issues such as headaches and chronic pain problems such as low back pain. Doctors who specialize in pain control have a combination of medication-based therapies and procedures to alleviate pain at its source.
Table Of Contents:
- Pain Management Doctors
- Drug Testing Is Permitted
- Urine Drug Testing (UDT)
- Types of pain management doctors
- When to see a pain specialist
- What do you expect on your first visit?
Pain Management Doctors
Physicians who specialize in pain treatment have received the titles of MD or DO. Some pain doctors are fellowship-trained, which means they earned further training after completing their residency. Interventional pain therapies such as injections, spinal cord stimulation with an implanted unit, or insertion of a morphine pump into the intrathecal space of the spine are often trained in pain fellowships.
The patient's pain gets treated in an outpatient pain centre equipped with procedure space, ultrasound, and X-ray imaging. The operations are often performed in a local hospital by the pain doctor. During your care, some pain specialists may give you sedation.
Drug testing of patients seeking pain management is a proper therapeutic method for ensuring patient safety; state laws also mandate it in some instances.
Drug Testing Is Permitted
Since prescription drug abuse is so common these days, doctors must exercise extreme caution. It's not that they don't believe in you or that they believe you're a drug addict. However, if they prescribe controlled drugs to patients who abuse them or sell them to others, they risk losing their medical license and facing criminal charges. As a result, these arrangements are made to protect the interests of the parties involved.
You must consent to drug tests at any time. This stipulation is usually included before the pain management program because doctors want to make sure you aren't abusing the medications. In addition, they want to make sure you're the only one who's taking the drug. So, as a result, screen you at random and then determine how much substance is in your system.
Screening for drugs or drug groups should only include those that are likely to be present based on the patient's medical history or current clinical appearance, with no overlap. Each medication or drug class being tested must be defined in writing by the referring clinician and recorded in the patient's medical record.
Urine, sweat, serum, saliva, and hair can all be used to screen for drugs. Due to the ease of processing, storage, and examination, urine is the most commonly used tool for testing; however, patients who cannot provide a urine sample when required should be checked using other methods.
Urine Drug Testing (UDT)
Qualitative UDT: It is used for outpatient pain control or drug abuse dependency monitoring and may be deemed medically appropriate for the following reasons:
- Baseline screening should be done before starting treatment if the following criteria are met-
- There is an accurate clinical evaluation of the patient's background and risk of drug abuse.
- There is a strategy in place for how to handle the situation
- Physicians are knowledgeable about test interpretation.
- Treatment stabilization process with weekly qualitative screening for four weeks.
- Treatment in the maintenance process, with tailored qualitative screening every 1 to 3 months.
- Follow-up monitoring phase of care at a pace suitable for the patient's risk level.
Quantitative UDT: It indicates that the amount of medication used for outpatient pain control or substance abuse dependency monitoring could be deemed medically appropriate in the following situations:
- Commercially available immunoassays for the related drug(s) are unavailable.
- The following qualitative urine drug screen results must be present and recorded in particular circumstances when quantitative drug levels are needed for clinical decision making-
- Optimistic for a prescription medication that the patient was not prescribed;
- Negative for a prescription medication that the patient has been prescribed;
- Tested positive for an illegal substance.
When there is a need for drug testing, it is done in the following situations:
- Prescription of a Schedule II or III controlled drug for 90 days or more to manage chronic pain in a calendar year.
- The situation isn't fatal.
- The patient does not appear to be in a hospital or nursing home.
Drug testing frequency:
- More than 30 mg/day of morphine equivalent – at least once every three months on a random basis
- When a doctor decides the patient is suffering unduly pain, testing can be limited to once a year.
- The patient's hardship must be recorded in his or her medical records.
UDT has several clinical advantages:
- Lowering the risk of toxicity in patients who are susceptible to adverse drug effects, preventing medico-legal issues.
- Detecting patient noncompliance.
- Lowering the risk of therapeutic failure.
- Avoiding or detecting drug-drug interactions.
- UDT improves the physician's ability to use medications safely and reduces treatment cost and time.
Unfortunately, UDT has been used by doctors to discharge patients from their practices. Urine drug testing should not be used solely to secure a doctor's license or a pain clinic's reputation but rather improve patient care. It's important to note that the use of UDT is never intended to be punitive. On the contrary, a patient being discharged based on a positive UDT is a disservice to the medical profession. The presence of an illicit drug in urine indicates that the patient has a problem and, as a result, needs assistance and advice from the clinician.
Instead of dismissing the patient, assist in counselling and therapy with an addiction medicine counsellor, physician, or clinical psychologist specializing in addiction intervention and participation in a recovery program.
A basic understanding of drug metabolism is needed for the clinical analysis of test results. The patient drug's concentrations are highest right after administration, while metabolite concentrations peak later. Up to 72 hours after ingestion, most medications or their metabolites can be found in the urine. If it has been 24 hours or more since the drug was last taken, it is not usual to detect only the metabolites in patients who take drugs intermittently. Medications can be identified for a much more extended period, whether they are used often or for a long time.
After the parent drug is no longer detectable, significant levels of the metabolites can remain. Knowing the relative levels of the drugs detected and the time after ingestion will help determine if the findings are consistent with normal metabolism or suggest violence.
Any adverse testing outcome must be reported to the physician, and this response must be recorded in the patient's record.
- When a doctor suspects a patient of abusing prescription medication, the physician must refer the patient to suitable substance abuse treatment.
- When a physician discovers a new medical problem outside his or her area of practice, refer the patient to the proper specialist.
Types of pain management doctors
Anesthesiologists used to be in charge of everything from pain treatment to pain procedures. However, the specialities of anesthesiology and pain management are now separated, and it's crucial to understand the distinctions when choosing a provider.
Interventional pain management
Higher techniques and specialized pain control treatments, such as nerve blocks, spinal injections, and spine implants, are available to this class of physicians. In addition, many interventional pain management providers complete a five-year anesthesiology residency followed by a one-year pain management internship.
Medical pain management
As the name implies, these physicians deal with patients with chronic illnesses that necessitate using opioids or other long-term drugs. For example, a family medicine doctor, an internal medicine doctor, or a psychiatrist may be medical pain control specialists.
A medical pain control specialist will help you navigate the plethora of current pain medication legislation and rules. They will make sure you are getting the proper dosage for a suitable period to reduce the chances of being dependent or addicted.
When to see a pain specialist
Although visiting a pain doctor does not always require a referral, most of the time, these appointments follow visits to your primary care physician (PCP) and another specialist, such as a neurosurgeon or orthopaedic surgeon. The most important thing is to provide all relevant historical information. And evidence to the examining pain treatment specialist so that the visit is fruitful and cantered on the patient and his or her pain issue.
Spine conditions, such as herniated discs in the lumbar (back) or cervical (neck) spine, are the most common problems treated by pain specialists. For example, after a hernia repair, you can see a pain specialist for a nerve block, or a neurologist will refer you to a pain specialist.
A pain specialist will also coordinate with your other doctors to formulate a multidisciplinary treatment plan for you, which could include physical therapy, necessary drugs, injection therapy, or surgery.
Patients should seek advice from experts in four different fields:
General medical care: An internist, neurologist, family physician, or even a rheumatologist, maybe your doctor. This doctor usually has a strong understanding of a variety of medical specialities.
nterventions: This doctor is most likely from a profession like anaesthesiology, where interventions are often used to relieve pain. These doctors are specialists in anatomy and neuroanatomy, as well as physical structure.
Rehabilitation: This provider may be a physical medicine and rehabilitation (PM&R) doctor, physical therapist, occupational therapist, or chiropractor specializing in body function.
Psychology/psychiatry: The patient can also see a doctor, psychologist, or psychotherapist, depending on his or her needs.
What do you expect on your first visit?
If you suspect your pain has become unbearable and you need the assistance of a pain specialist. Inform your primary care physician of your problems and inquire whether a referral to a pain specialist is necessary. They'll be able to tell you if you're on the right track.
It's important to know what to expect during your first pain treatment consultation. Your first appointment is with a pain management nurse, who will go through your pain condition and medical history with you. Next, a nurse, a physician assistant, and the physician will examine you. Finally, a pain management specialist can take your medical history, conduct a physical examination, and go through any test or X-ray findings with you.
So, if you've found a doctor, planning for your appointment will help you transition as smoothly as possible. Start by keeping a pain report to keep track of your symptoms. Please note where the pain is, how it feels, how often it occurs, and whether those positions aggravate or alleviate the symptoms. Records are crucial. Bring a hard copy of every imaging you've had with you to your first meeting if the office hasn't received it yet. Also, make a list of any drugs you're taking, whether prescribed or over-the-counter. Based on your assessment, your doctor will create a personalized pain relief plan for you. This initial evaluation is crucial for designing your customized treatment plan.
Patients are often seen on their first visit. On the other hand, most patients will be scheduled for their procedure after undergoing the required planning.
On your first visit, your doctor might ask you the following questions:
- What is the root of your pain? (what part of the body)
- What is the nature of your pain? (a dull, aching, tingling sensation)
- How much pain do you feel? (How many times a day or night)
- When do you notice the pain? (while exercising or while at rest)
- Are you ready to set the pain? (Is it more uncomfortable to stand, sit, or lie down?)
- What relieves your pain? (Does a particular drug help)
- When you're in pain, have you experienced any other symptoms? (for example, a lack of bowel or bladder control)
Drug testing should never be used as a limitation but rather as a tool to improve patient care. Therefore, this testing method should be promoted to use in pain control procedures.
When the doctor and the patient work together, pain management is most effective. Therefore, understanding our roles in the patient/doctor relationship is critical; we must all work together to attain the best possible result for you when finding pain relief.