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chronic pain

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Who can best care for the chronic pain patient?

Chronic pain management cannot lend itself to the usual facts and research that back up most discussions about chronic pain. A significant problem with chronic pain is the lack of directed care. Few diseases, like chronic pain, do not have a devoted speciality and many practitioners claim to be the specialists in treating chronic pain.

The primary contact provider for chronic pain patient management is the family practitioner. The scope of their practice is comprehensive. They refer patients to other specialities, as need be while maintaining a holistic caring approach for the patient. Over 60% of chronic pain patients start their disease management at the family practice office. These practitioners have a reasonable probability of being open to homoeopathic treatments. 

Minus: Chronic pain is a highly complex disease. Family practice residencies have very little specific training related to chronic pain management. Treatment of chronic pain does not fit a clear-cut medical or surgical speciality, and the need for individualization is imperative. In addition to this, the family practitioner does not have a clear option of referring the patient to a pain management specialist for consultation. Eventually, a team approach is needed to find success for pain relief.

A few Pain specialists have the training to set up a pain management plan. These practitioners are usually family practitioners, internal medicine, or generalists who narrowed their practice to pain management. They set up a management plan and manage co-morbidities.

Minus: Formal training in comprehensive pain management is still in its early stages. The training is informal and lacks a broad-based structured knowledge and skill set.

Anesthesiologists with fellowship training in pain management are team members for managing chronic pain patients. They are well trained in doing invasive procedures to relieve pain. In addition, anesthesiologists, trained in performing such procedures and with their speciality background, are familiar with chronic pain medications and their side effects will have the knowledge and skills to be team members managing the chronic pain patient.

 Minus: The focus of anesthesiologists is on procedures, and other co-morbidities are not managed. They are team members.

Physiatrists have a scope of practice that could lend itself to treating chronic pain. Their speciality focuses on musculoskeletal disorders, and their training programs include chronic pain management. Thus, they are team members of the chronic pain management team.

Minus: The training of physiatrists does not focus on managing all the patient’s co-morbidities. The training programs vary significantly on exposure to chronic pain management, with most focusing on rehabilitation.

Physical Therapists have established themselves as team member of the chronic pain management team. The need for evaluation and providing recommendations for activity is paramount.

As a chronic pain management team member, physical Therapists evaluate and recommend activity and provide direction for exercise and activity levels.

Minus: Their recommendations do not include medication therapy which is usually needed as an adjunct to exercise.

Chiropractors get their patients as referrals from a medical practitioner (allopathic or osteopathic). Chronic pain patients usually have several medical problems, so they consult a medical practitioner before receiving chiropractic care. However, chiropractors have a role in musculoskeletal movement and manipulation. Therefore, chiropractors would be team members but not the lead in chronic pain management.

Minus: Chronic pain is a disease and needs to be treated as a disease entity. The treatments by a chiropractor are more of a short-term nature and have a limited role in chronic pain. Chronic pain has moved past any long-term effects of manipulation.

Orthopedic Surgeons are usually members of the chronic pain management team but would not be the team leader. An orthopedic surgeon should assess most patients with chronic pain. Misaligned bones and previous surgeries create difficulties in chronic pain management.

Minus: There are no specific negatives. As mentioned, they would not be the team leader.

Rheumatologists, among other diseases, treat arthritis patients, who usually complain of chronic pain. Therefore, rheumatologists’ treatment of some of their patients can be part of the treatment plan for any chronic pain patient.

Minus: Rheumatologists are not the team leader for many chronic pain patients.

Neurologists evaluate the patient with chronic pain and assess if it is the primary neurologic cause or if the neurologic system has been secondarily affected by the chronic pain. Neurologists do most of the tests to evaluate the integrity of the nervous system.

Minus: Neurologists focus on one aspect of chronic pain disease. They are team members.

Conclusion

In conclusion, every team member mentioned above has a significant role in caring for a chronic pain patient. The chronic pain management team will have very little success in treating a patient who does not assume an active role in their care. The patient should be at least the honorary team leader of this multidisciplinary team. They will be aware of their consults’ role in treating their pain. Each mode of treatment is to be measured by a log of pain scores and activity levels. Changes in treatment will also be measured and graded. As a team leader, the patient would now be part of the solution, and over time, the patient could be listed as the primary team leader. 

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