What do Pain Management Doctors Actually Do?

Dr. Ara Deukmedjian, MD is fighting a losing battle to dispel the myths about pain management doctors. Many patients aren't aware of what a pain specialist does. This confusion is not uncommon.

If you or a loved one is experiencing any of the following symptoms outlined in this article, it's time to get a FREE Consultation and MRI Review with Deuk Spine Institute. We will help relieve your pain and get you back to living your life without limitations!

Dr. Ara Deukmedjian is the lead and World Renowned neuro-spine surgeon at the Deuk Spine Institute. He regularly receives referrals from patients suffering from pain who don't want to go to a doctor who prescribes painkillers. He must instead explain that he can offer other methods to reduce pain. In this article, he will cover common topics that patients need to know in order for the Deuk Spine Institute to help them better understand the role of a pain management physician and how they can help.

Anesthesiologists were responsible for everything, from pain management procedures to prescription pain management, many years ago. It is important to understand the distinctions between anesthesiology specialties and pain management when choosing a provider. Anesthesiology has traditionally been able to provide pain management. This was possible many years ago because anesthesiologists had a good understanding of medications, especially local anesthetics and pain medicine, as well as different types and types of nerve procedures (epidurals). This is where pain management's history began.

There are currently two types of pain management physicians: one who specializes in surgical pain management and the other who specializes only in medical pain management.

This group of doctors is skilled in advanced pain management techniques, such as spine injections, nerve blocks, and spine implants. The majority of interventional pain management specialists have completed a five-year anesthesiology residency, followed by a one-year pain management fellowship.

A group of physicians known as PMNRs (physiatry), can also be accepted into a fellowship in pain management via their specialty. Pain management can also be a specialty for neurologists.

These doctors treat patients with chronic conditions that require opioids or long-term medication. Medical pain management specialists can be any doctor, from a family physician to an internist or psychiatrist. A patient with chronic pain due to methadone would see a medical specialist for pain management and not an interventional doctor.

It is important to consult a medical pain management specialist when trying to navigate the new laws and regulations regarding pain medication. They will ensure that you are taking the correct dose at the right time, to offset any risk of addiction or dependence.

Although you don't necessarily need to be referred for a pain specialist visit, it is common for them to come after your primary care physician (PCP), and another specialist such as a neurosurgeon, or orthopedic surgeon.

Your PCP might order X-rays or prescription anti-inflammatory medication. Or, they may send you to physical therapy. If those options don't work, your PCP will refer you to a surgeon for further examination. If you are deemed a good candidate for surgery, you will be referred to a pain specialist. Sometimes, a PCP can have successfully managed a condition for many years using conservative treatment. If the condition becomes chronic, they will refer you to a pain specialist.

Although there are many ailments that pain specialists can treat, the most common problems are spine disorders. These include herniated discs in your cervical (neck), or lumbar (back). A hernia repair may be required to remove a nerve block from your groin. Or, a neurologist may refer you to a specialist to treat chronic headaches. Dr. Ara Deukmedjian believes that no matter what your condition, a pain specialist can work with other doctors to create a multidisciplinary plan for you. This could include physical therapy, appropriate medication, or surgery.

Dr. Ara Deukmedjian, MD recommends researching names to find out if your pain is becoming unbearable. Ask your PCP about your concerns and they will determine if a specialist is necessary. They will be able to confirm that you are on the right track. It's important to make sure that your pain management physician has fellowship training. There's so much technology available and so many advancements that only fellowship-trained physicians have. It is important to prepare for your appointment once you have found a doctor. Keep a journal of your pain to record your symptoms. Keep track of your pain by noting where it is and what it feels like. Also, note if it gets worse or better with certain positions.

Also, keep records. In case your imaging has not arrived by the first appointment, bring a hard copy. You should also list any prescriptions or over-the-counter medications you are taking. Tell your doctor what your goals are at your next appointment. If you have back pain that is causing you to be unable to play golf three days a week, tell your doctor. You may find a solution that will give you some relief, so you can continue to enjoy your hobbies. If your provider allows, you can bring a friend or family member along. It can be stressful to go to your first appointment. Family members can be there to help with any concerns and answer questions.

Since the 1990s, the way pain management specialists treat patients has changed. This is largely due to an opioid epidemic and an increase in addiction and death rates. According to the U.S. Department of Health and Human Services, 47.600 Americans died of opioid overdoses in 2018. In the 2000s we discovered we had an addiction epidemic and overdoses. Since then the pendulum has shifted to this multidisciplinary approach. Deuk Spine Institute stresses the need to identify a multidisciplinary method to address acute pain issues. This could include physical therapy or non-opioids and adjunct medicines.

Florida's House Bill 21 (HB21) was implemented on July 1, 2018. It restricts the prescription of opioids for acute pain to a minimum 3-day period unless other conditions are stated. Prescribers may extend a supply to 7 days if it is medically necessary and documented an exception. Patients with:

• Cancer
• End-of-life illness
• Provides relief for symptoms of an incurable, progressive disease or injury (chronic Non-malignant Pain).
• palliative care, or
• Traumatic injuries can be severe

The bill also established a statewide prescription drug monitoring program (PDMP), which requires action by both providers and pharmacists. PDMP requires that pharmacists report a detailed list to the PDMP before filling prescriptions for controlled substances. The pharmacist must also consult the database before dispensing controlled substances. Failing to do this will result in multiple citations and a misdemeanor crime.

Several studies have been done to assess the effectiveness of the HB21 Bill. Researchers at the University of Florida (UF), published a study entitled " Changes In Opioid Usage After Florida's Restriction Act for Acute Pain Prescriptions" in February 2020. The study examined prescriptions for opioids from January 2015 to March 2019, from one health plan that covered more than 45,000 employees.

The study concluded that the implementation and maintenance of the HB21 Bill were associated with decreased opioid consumption and changes in prescribing decisions. According to the University of Florida Health: "UF researchers reported The law resulted in a 16% drop in the number per month of opioid users, which continues to decline each month. The average supply days fell from 5.4 days to three days before the law was implemented to a much lower level of 3 days."

The field of pain management continues to evolve with new product innovations. Dr. Ara Deukmedjian outlines two new treatments for patients suffering from chronic spine problems. Neurostimulation is a technique that stimulates the nerves in the spinal cord. It can reduce back pain and nerve pain. After a major spine surgery or herniated disc, neurostimulation can be used to relieve pain and weakness. This device is placed in your spine and it changes how the brain sends messages back to the spine. This improves chronic pain. It's been a game changer for patients, especially those who had major surgeries and weren't able to cope with them.

Patients suffering from spinal narrowing have also been helped by the interspinous spacer. The metal spacer, which is small and fits between the vertebrae, opens the spinal canal to relieve pressure. Although injection therapy is an option, the success rates are not very high — less than half of those who try to fail. Therapeutic options can help to reduce symptoms. Regenerative medicine aims to prevent disc disease and other degenerative spinal conditions.

The Deuk Spine Institute encourages and welcomes you to contact us today regarding any questions or concerns you may have about your current situation... 

​​If you or someone you love is experiencing any of the preceding symptoms outlined in this article, it's time to get a FREE Consultation and MRI Review with the Deuk Spine Institute. We can help relieve your pain and get you back to living life without limitations!