What exactly IS pain management?

[DrGiraffe]

This might be a dumb question but what's the difference between this pain management and the anesthesia kind?

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[PMR 4 MSK]

In theory, no difference. After fellowship training, both should be competent to perform and prescribe a wide variety of treatments, including medication and PT prescription, injections and implants. In practice, it's your background bias and interests.

PM&R comes from a background of functionally-based medicine, looking at how the patient functions, and what the impairment is that is causing pain or disability.

Anesthesia comes from the background of administering specific chemical agents or targeting specific pathways in pain processing and consciousness.

 

[SSdoc33]

wish i knew....

 

[ampaphb]

The ability and willingness to talk and listen to the patient's complaints, and then spend the time to perform a thorough physical exam.

In my experience, anesthesiologists are much more likely to read the MRI report, and then honor the requesting physician's request blindly, without investing the appropriate time necessary to reach their own diagnostic conclusions.

 

[shantster]

The ability and willingness to talk and listen to the patient's complaints, and then spend the time to perform a thorough physical exam.

In my experience, anesthesiologists are much more likely to read the MRI report, and then honor the requesting physicians request blindly, without investing the appropriate time necessary to reach their own diagnostic conclusions.

Very very true. I did a pain elective two months ago and the anesthesia based clinic was a bit painful as a student. There was no real learning since it was set up where patient came, changed into gown, and then put in queue for injection. If it was a repeat, the only question was "did it help last time." If it was a new with orders, then it was a little question of where the pain was and when it started with "Dr. ___ wants you to get this injection, we'll do it." I learned everything I needed from that in a day or two.

Then I spent time with a Neurologist pain doctor who was more in tune with what the PM&R docs do and did a lot more pain rehab focused management. She had a lot of fibromyalgia patients and a 6 week group course with PT, OT, Psych, lectures to learn about the disease and effective coping strategies. The ones that put the time into it had great results. That was more useful since she did all her own evaluations and made her own plans, referring to the interventionalists as necessary.

The sports rotation I'm on now has a few physicians that will only refer their patients for spine care necessitating injections to PM&R because they want them to go to someone that will do their own evaluation and work with them for things other than just injecting. All the patients seem much more comfortable going there even if it's a longer wait after that is explained to them.

 

[mid|ine]

Pain docs from every background vary greatly in how they run their practice. I have an anesthesia background and every patient gets a comprehensive H&P. I make and follow my own care plans (not just whats on a script - unless its a purely diagnostic request ie L4-5, L5-S1 discography) based on my assessment of the patient.

Anesthesiologists do get less time interviewing patients and doing physicals in residency. However they have a lot more experience with procedures then PM&R or neurologists. None of them are perfect backgrounds, and Algos would say Pain needs its own residency and I would agree.