How to Choose a Pain Physician

Many patients suffer from chronic pain due to a variety of causes such as degenerative disc disease, cancer, post herpetic neuralgia, etc.  When the level of expertise exceeds that of the Family Practice or Internal Medicine Physician, how does the patient decide where to go for treatment and what should they look for in a Pain Physician?

Many different physicians practice pain medicine.  Some have formal training and some do not.  Some are board certified and some are not.  Since Pain Medicine now known as Pain Management is a relatively new specialty, many practitioners were “grandfathered” meaning they were practicing in the field of pain before formal fellowships were widespread and allowed to take board certification examinations without completing formal training.  At the present time four specialties of medicine offer fellowship training and certification in pain management.  Fellowship training can be thought of as subspecialty training and occurs after one has completed their initial training in their respective field called residency.  The first specialty of medicine to offer certification in pain management was the American Board of Anesthesiology.  Since that time, the American Board of Physical Medicine and Rehabilitation and the American Board of Psychiatry and Neurology have offered certification.  Therefore a Board Certified Pain Physician can be an Anesthesiologist, Physiatrist, Psychiatrist or Neurologist.  This means they have passed a written test demonstrating a fundamental proficiency in the basic science of the field of pain medicine.   It is important to realize that these are the only boards recognized by the American Board of Medical Specialties (ABMS), which is the umbrella organization for the 24 medical boards recognized in the United States.  There are over 180 other self designated boards that have not sought or qualified for membership to the ABMS.  Those physicians who state they are “Board Eligible” are physicians who have met the criteria established to take the Board Certification examination but have not yet taken or possibly have not passed yet.

Fellowship training is also essential to the pain practitioner’s credentials.  A fellowship is a period of training dedicated to receiving a formal curriculum and allows the physician to work under the supervision of physicians while learning the specialty.  This formalized training is under constant review and scrutiny by the American Council of Graduate Medical Education which supervises all medical training programs in the country.  A physician who has completed fellowship training is required to complete a minimum number of procedures to demonstrate competency and is exposed to the latest state of the art technologies.  Many fellowship programs require their fellows to complete research during their training which adds to their expertise as a physician.

Now in all fairness, three other medical specialties, Neurosurgeons, Orthopedic Spine Surgeons and Interventional Radiologists, need to be discussed.  Because Neurosurgeons and Orthopedic Surgeons by virtue of their training operate on the spine, many of them practice interventional pain procedures, especially implantation of devices.  However, many choose to let others perform their pain procedures in order to focus more on surgical techniques.  Interventional Radiologists are trained to perform a variety of techniques, some of which are pain procedures; however their physician/patient relationship is limited unless they choose to limit their practice to pain.
While it is important to determine your physician is qualified to treat your condition, there are other aspects you need to explore when looking for a pain physician.  What is the physician’s bedside manner, does the physician answer all of your questions, and does the physician examine you, what are the alternatives to the physician’s recommended treatment plan?  Often, a patient is referred by a friend or acquaintance and word of mouth certainly goes a long way in making a favorable impression.  However, if you are new to town, you may not know anyone to ask.  A good resource for physician referral is the local Medical Society, such as the Collier County Medical Society, Inc.  These agencies serve as advocates for physicians in the promotion of public health, ensure high standards in medical education and ethics, and enhance the quality and availability of healthcare.  Of course, your primary care physician can also refer you to a pain specialist, who they are familiar with.

When seeking out a pain physician, do not be afraid to ask the basic questions:  1) Is the physician fellowship trained, 2) Is the physician board certified, 3) Where did the physician train?  By seeking out a fellowship trained, board certified Pain Management Physician, you will be assured your physician has been through formalized training and demonstrated a core knowledge on a standardized examination.