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Are pain management Doctors at the top of the food chain?

It seems to me that no matter which type of specialist you see, you always end up in the hands of a pain management doctor. They are the one's who decide whether or not you get injections or what type of treatment you need, right? Are pain management doctors more qualified than orthopedist, orthopedic surgeons , neurologist, neurosurgeons? Are Pain management Doctors trained in reading x-rays ct-scans and mri's ?


  • It isn't a case of who sits where in the food chain. It's more about understanding the roles of the different doctors.

    I started out with my pain management specialist and he tried a range of different treatments in the hope that I could avoid surgery. He is very skilled in reading images and inderstanding the spine and nerves. He has to be in order to do some of the procedures that he does eg: radiofrequency ablation, inserting spinal cord stimulators etc. In my case, the more conservative treatments didn't do a great deal for me due to the level of instability in my spine and SIJ so he referred me to a neurosurgeon.

    My neurosurgeon identified the need for fusion surgery to stabilise my spine. He was very clear from the outset that, while the surgery was necessary, he would not guarantee that the pain would be fixed. In fact he said that if there was an improvement in the pain that it would be a bonus.

    The role of the neurosurgeon or orthopaedic surgeon is to maintain functionality where possible.

    Pain, however, comes from so many different sources that repairing the mechanics often does little to control the pain. This is where the pain management specialist comes in. His / her job is to find a way to make the pain bearable so that you can have some hope of living a better life.

    My neurosurgeon and my pain management specialist work together to keep me as mobile as possible and as pain free as possible. They are part of my overall team which also includes my GP, physiotherapist, occupational therapist, psychologist, physical therapist etc. Each have their own part to play. Understanding who does what helps me understand who to call on for what purpose. Eg: if I am having trouble moving my leg I will see my physiotherapist and possibly make an appointment with my neurosurgeon. If my pain is not under control I will see my GP and my pain management specialist. If I'm not coping with the pain I might call on my psychologist for help, and if I am having mobility issues because I have lost conditioning then I will spend time with my physical therapist focussing on strengthening muscles etc.
  • edited 11/22/2015 - 5:37 PM
    Your response really helped me understand the different roles between specialist. I was referred to a pain management specialist by a orthopedist and a neurosurgeon.

    I have constant pressure in the back of my head and progressively pulsates when I do almost anything shooting a pain down my neck down through my left arm.

    I have had this pain for many years now, but has become unbearable this year. I only recently within the last few months started seeking medical help

    My MRI reveals neural foramina narrowing from C3 to C7 being greater on the left side and moderately significant at C6-C7. My current diagnosis is spondylosis.

    I have been in several accidents throughout my life including flipping a cement truck 10 years ago where an unsecure toolbox in the cab of the truck struck me in the back of the head resulting in a few staples.

    I always seemed to think I was fine, but all the accidents are catching up, and the pain is becoming unbearable. I hope the pain management specialist can help.
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  • gfishggfish Pittsburgh PAPosts: 197
    My pain doctor is good. If you are old and have arthritis, a knee or hip replacement. Something that is common. As to the spine with mine. Its a hit or miss with the drugs. when I first saw mine and showed him my back. He was like WOW! that a huge scar! Right then and there i knew he has never dealt with issues like mine. I think a PCP is just as good.
    Greg fisher
  • Medical, you talk about how your past accidents are catching up to you. I just wanted to share what happened in my case.

    In 2008, I was having some arm and upper back pain issues so I went to the doctor. After imaging, trying PT, etc, three desiccated discs in my neck (C4/5,5/6,6/7) and had to have a 3-level cervical surgery. Two years later, serious problems and pain at L4/5, had fusion surgery. Two more years later, again serious problems and pain at L3/4, had fusion surgery. Today, three years after my last surgery and I'm working through more pain at the L1/2 and 2/3 levels and will need surgery #4 when my spine becomes unstable.

    With all this, in talking to my surgeon and going through my past life, we determined that my crumbling spine started when I was in a horrific head-on collision when I was 18 -- 30 years earlier! Had I known I had spine issues from the accident, there are so many things I wouldn't have done - bungee jumping, river rafting, tai-kwon-do lessons, etc. Now I'm truly paying for not taking care of nor thinking about my spine after an accident that changed my life 30 years later.
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