Wanted: Chronic Pain Doctors

The ideal chronic pain physician is the one who satisfies all your needs and wants with respect to your chronic pain. However, doctors are trained to manage problems, not satisfy needs and wants. Therefore you need to see that there are two sides to looking for a chronic pain doctor.

Please understand that the following recommendations are based on my personal opinion and should not be taken as some sort of standard to be met by anyone who manages pain. Instead, view the recommendations as pointing to qualities that I personally believe are important in doctors who manage chronic pain.

One side of picking a doctor is determining their qualifications. Because there is no officially recognized specialty in chronic pain, you will need to do your homework or at least be prepared to ask some questions. Is the doctor a family practice trained physician or a medical/surgical specialist? What experience, training or certifications does the doctor have in pain management?

In my opinion the doctor should have a basic understanding of the current state of medical knowledge of chronic pain. This requires at least some familiarity with contemporary medical research whether through reading or attending conferences, seminars and workshops. Another desirable quality is knowledge concerning the pharmacology of pain.  There are several different kinds of medications used in chronic pain (and not just opioids) all of which may have side effects. Some may interact with each other and/or regular medications.

I feel a chronic pain doctor has to know that there are pharmacological, physical, psychological and surgical treatments for pain – and at least be able to advise you how to find out more about some specialized treatment’s relevance to your problem. If a doctor offers a particular kind of treatment (e.g. psychotherapy or nerve blocks) you should find out what training or experience she/he has. All doctors, not just chronic pain physicians, should be able to advise you of potential risks and benefits of any treatment they offer and also be able to manage complications of such treatment.

The other side of looking for a chronic pain doctor is knowing what you need or want from the doctor. I don’t just mean what treatment you found on the Internet or what drug you think you should be taking.  Do you want attention and someone to talk to? Then you need someone who is a good listener and whose practice is structured to give time for talking. A doctor who mainly offers a specialized kind of treatment such as surgery or nerve blocks may not have the time or training to act as a psychotherapist. Avoid disappointment by being clear to yourself about why you are seeing a particular doctor: is it for specific advice for a specific problem or are you looking for a longer-term therapeutic relationship. If it is the latter, you will need to work as hard as the doctor to make the relationship work.

There is no ideal chronic pain doctor. There are few if any physicians who alone can provide physical, psychological, pharmacological and other specialized treatment. Recognize this when you search for treatment. You may want to reread Using Doctors before your next appointment to help you start getting better treatment. That has been the point of this whole series.

A final word on finding a good doctor: several years ago I was invited to speak about chronic pain management to a group of doctors in training to become family physicians. I emphasized that establishing a good therapeutic relationship was perhaps the most important thing they could do for their chronic pain patients. I said that the key to this was being kind to the patient.

I believe kindness is a valuable asset in any medical practice. Look for it.

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