PAIN MANAGEMENT

UCSF Doctors Academy

Health Pathway Workshop

Statistics About Pain Management:

• Chronic pain is common in the U.S., with anywhere from 11% to 40% of the adult population reporting daily pain.
• Approximately one-third of patients experiencing pain receive a pain medication.
• While the number of prescriptions for pain management have declined in recent years, opioid misuse remains a significant public health crisis.
• Roughly 21-29% of patients who are prescribed opioids for chronic pain will misuse them.
• The solutions to this public health crisis include continued emphasis on improving chronic pain care, increasing research into pain and pain management, improving training for physicians who manage chronic pain, and increased public awareness.

What is Chronic Pain?

Chronic, persistent or long-term pain is pain that continues for longer than 3 months. It is usually defined as pain that persists beyond the normal time that tissues take to heal following an injury.

Pain persists in response to being overly sensitive to a perceived threat of harm to your body, despite the absence of tissue damage

How Physical therapy helps:

Helps people with chronic pain develop the skills they need to manage and take control of their condition, increase their activity and improve their quality of life. 

Exercise therapy is included in all guidelines for the treatment of chronic pain

-ask your physical therapist, the exercise expert

Prevalence of Chronic Pain in the U.S.

• If you’re not directly impacted by chronic pain, chances are you know someone who is. Advances in medication and treatment make it easy to overlook how many people suffer every day.
• More than 1 in 5 adults in the U.S. experience chronic pain.
• Approximately 8% of adults have high-impact chronic pain.
• Most (84%) of high-impact chronic pain patients are unable to work outside of the home.
• Chronic pain is the No. 1 cause of disability and disease burden globally.

Pain Management Physicians

• Physicians who specialize in the evaluation, diagnosis, and treatment of pain – have advanced training that qualifies them as your best source of treatment if you are experiencing any type of pain due to illness or injury.
• They have a high level of training and experience in diagnosing and treating different types of acute and chronic pain
• Most pain management doctors devote their time and expertise to helping chronic pain patients whose needs can sometimes be hard to diagnose and take months or years to treat using multiple therapies.

Skills and Techniques Used

Pain management can be simple or complex, depending on the cause of the pain

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When the pain does not go away, it can require a wide variety of skills and techniques to treat the pain

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These skills and techniques can include:

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• Interventional procedures
• Medication management
• Physical therapy or chiropractic therapy
• Psychological counseling and support
• Acupuncture and other alternative therapies
• Referral to other medical specialists

https://www.saskatoonhealthregion.ca/painmanagement

The Role of the Pain Management Physician

• They diagnose the specific cause of your pain and the underlying conditions that lead to it
• Once diagnosed, they find the therapy that works best for you based on their specialized training and the latest research.
• They use a wide range of nonsurgical, interventional treatments – along with complementary therapies – as a way of reducing the amount of medication you need to take or to avoid the need for surgery.
• These may include massage, a weight loss regimen, acupuncture, exercise, yoga, meditation, physical therapy, dietary changes, or chiropractic care.
• Prescribe pain-killing medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or antidepressants. Depending on the severity of your specific condition, they may also recommend epidural steroid injections, nerve blocks, joint injections, radiofrequency ablation, spinal cord stimulation, or neuromodulation.
• If none of these methods are effective in alleviating your pain, surgery may be an option of last resort.
• They coordinate treatment between multiple doctors and healthcare professionals.

First Type of Pain Management Doctor:

Physiatrist (phys·​iat·​rist | fi-zē-ˈa-trist) –

Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. Unlike other medical specialties that focus on a medical “cure,” the goals of the physiatrist are to maximize patients’ independence in activities of daily living and improve quality of life.  

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Completed training in the specialty of Physical Medicine and Rehabilitation (PM&R)

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May be subspecialty certified in

• Brain Injury Medicine
• Hospice and Palliative Medicine
• Neuromuscular Medicine
• Pain Medicine
• Pediatric Rehabilitation Medicine
• Spinal Cord Injury Medicine
• Sports Medicine

Specifics of PM&R physicians:

• Treat patients of all ages
• Focus treatment on function
• Determine and lead a treatment/prevention plan
• Have a broad medical expertise that allows them to treat disabling conditions throughout a person’s lifetime
• Diagnose and treat pain as a result of an injury, illness, or disabling condition
• Lead a team of medical professionals, which may include physical therapists, occupational therapists, and physician extenders to optimize patient care
• Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons, and many others.
• Treat the whole person, not just the problem area 

Various Treatments Used by Physiatrists - �Depending on the injury, illness, or disabling condition, some PM&R physicians may treat their patients using the following procedures/services:

Education Required to become a Physiatrist

Average Salary

Average Physiatrist salary in Fresno ranges from $231K - $285K as of June 2023 with the high being approximately $311K.

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Ranges vary depending on city, education, certificates,

additional skills and years of practice

Physiatrist in California

Second Type of Pain Management Doctor:

Chiropractor –

Chiropractors use hands-on spinal manipulation and other alternative treatments.

The theory is that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication.

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• Manipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper back support.
• Treatment is primarily used as a pain relief alternative for muscles, joints, bones, and connective tissue, such as cartilage, ligaments, and tendons. It is sometimes used in conjunction with conventional medical treatment.

Common duties include:

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• Meeting with patients to discuss symptoms
• Evaluating posture and spine to identify any issues
• Developing an in-office treatment plan
• Suggesting stretches, exercises, sleep techniques and diet choices
• Using techniques such as acupuncture or massage therapy
• Referring patients to doctors for additional treatment as needed

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What do Chiropractors treat?

• Low back pain
• Neck pain
• Tension headaches
• (cause pain in the back of your head and neck)
• Migraines
• Whiplash
• (neck sprain causing stiffness, pain, muscles spasms and swelling)
• Sacroiliac pain
• (S1 joint - large joint at the bottom of your spine, may feel pain in your buttock or the back of your thigh)
• Shoulder pain
• (stiff and painful shoulder – known as frozen shoulder)
• Knee pain
• (wear and tear on the knee joint causes knee osteoarthritis)
• Joint pain and stiffness from arthritis

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Common Treatments Used by Chiropractors

Education and Salary

• 4-year college degree
• A degree in biology, exercise science, kinesiology or a similar subject helps show admissions officers that you have a foundational knowledge of science and can memorize large amounts of information
• Attend Chiropractic School
• 4 years to obtain Doctor of Chiropractic or D.C. degree
• Obtain a License
• Pass a 4-part series of National Board of Chiropractic exams
• Part I – during your 2^nd year of medical school
• Part II – during your 3^rd year
• Part III & Part IV – 6-9 months after you graduate
• Upon completion, you can apply for your state license

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Certifications in many chiropractic specialties are available, including occupational health, acupuncture, radiology, clinical nutrition, neurology, developmental disorders, pediatrics, forensics and sports medicine.

Most require 300 to 400 hours of additional training and make you more appealing to patients and fellow health care professionals.

Salary ranges can vary widely depending on the city and other important factors, including education, certifications, additional skills, the number of years you have spent in your profession, and type of practice

Chiropractic salary ranges in California

Average salary in Fresno ranges from $137K - $223K

As of June 2023

Additional Specialists/Physicians in Pain Management Include:

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Primary Care Physicians – can begin treatment with patients then refer out as needed if pain persists

Oncology Doctors - Pain is a highly prevalent symptom in patients with cancer. Adequate pain relief can be achieved in 70 to 90 percent of patients when well-accepted treatment guidelines for cancer pain are followed

Physical Therapists – uses exercise, therapy, education, and teamwork with their patients to help alleviate pain and access how their patients’ pain responds to treatment and what needs to be altered

Anesthesiologist - dedicated to the relief of pain and total care of the surgical patient before, during and after surgery

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Pain medicine is a multidisciplinary team effort often involving the patient's primary care physician or other treating doctor, and specialists in radiology, psychiatry, psychology, oncology, nursing, physical therapy, complementary alternative medicine, and other fields.

Evaluation

Link: https://tiny.ucsf.edu/DASpeaker2324

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Health Professions Workshop (HPW)

Title: Pain Management

Speaker: 

Date:

Pain Management Videos

• PM&R: Our Voices, Our Vision (8:12) https://youtu.be/MiPANopAar4?t=5Vision of the Future for PM&R (2:09) https://www.youtube.com/watch?v=36ApAnuPeGk&feature=emb_title
• What is a Physiatrist? And what types of treatments do they offer? (2:28) https://www.youtube.com/watch?v=2Xzt5kSwyp8
• Your Guide to Chiropractic Care for Back Pain (3:45) https://youtu.be/u1be59VkXuc
• Various Chiropractic Educational Videos - https://www.stanfordchiropractic.com/educational-videos.html

Activity Idea:

Creating an Infographic

• Choose a chronic condition to research
• Describe the condition
• What causes it?
• What are the symptoms?
• Explain the condition and provide self-help coping skills, stretches and/or exercises that one can do at home to alleviate or lessen the pain
• Provide information on treatment options (if applicable)
• Be creative, engaging, and use colorful images

References

• https://fight.org/chronic-pain-what-is-it/
• https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry#:~:text=Physical%20Medicine%20and%20Rehabilitation%20(PM%26R,ligaments%2C%20muscles%2C%20and%20tendons.
• https://www.medicinenet.com/pain_management/article.htm#introduction_to_pain_management
• https://www.asbestos.com/cancer/chronic-pain-statistics/
• https://yourpainreliefcenters.com/news/primary-care-vs-pain-specialist-benefits-of-pain-management
• https://www.psadocs.com/what-does-a-pain-management-doctor-do/
• https://www.webmd.com/pain-management/guide/chiropractic-pain-relief
• https://www.salary.com/research/salary/benchmark/chiropractor-salary/ca