Until late in the 20th century pain was poorly understood and patients expected that their surgery or recovery after injury would be miserable, even agonizing. Even cancer pain was not well managed until recent decades and suffering was a ‘normal’ part of being a patient.
More recently an explosion of knowledge in our understanding of the brain and about pain has lead to improved management techniques and better outcomes for patients.
As medical knowledge about pain and its management has grown, the specialty of pain medicine has developed and has been recognized in its own right since 2005 in Australia and in New Zealand since 2012.
Many pain specialists begin their career as anaesthetists due to their involvement with management of pain after surgery, although rehabilitation specialists also make up a large proportion of the approximately 450 qualified pain medicine specialists in Australia. Pain Medicine Specialists complete an extra two years training and examinations in addition to their original specialty to become a Fellow of the Faculty of Pain Medicine. (FFPMANZCA) As pain affects patients in a broad range of medical areas, doctors from specialties such as paediatrics, neurology, neurosurgery, psychiatry and general practice have also trained as pain medicine specialists in Australia.
While many simple pain issues resolve with time, patients are often referred to pain specialists when the pain problem is more complex or has the potential to impact on long-term recovery.
Pain medicine specialists understand pain physiology, or how pain works in the body and the benefits and side effects of medications and other treatments for pain. They are trained to take a whole patient approach; assessing not only the pain but the impact it has on the patient and their life so that treatment can be individualized to a patient’s situation and goals.
Pain is often patients’ greatest fear about surgery. Today while major surgery is not pain free, advances in surgical and medical care usually enable pain to be reduced to a tolerable level.
Many patients having surgery today are already taking pain medications, making their pain management after surgery more difficult. A pain specialist is knowledgeable about the options for these patients and can be consulted before surgery or in the postoperative phase.
Today patients are often discharged while they are still taking pain medication. Pain specialists can provide information to patients about medication and other non-drug techniques for pain management as well as how and when to stop taking pain medication after surgery.
Sensitivities or side effects of pain medication, tolerance due to long-term medication use or difficulty ceasing pain medication are example of problems pain specialists can help with. They are also expert in management of drugs for nerve pain that need careful titration.
Working with patients with persistent pain or complex pain often requires a team approach. Pain specialists regularly communicate with other doctors and health care providers.
For in hospital care pain specialists often provide a consultation service for patients with complex pain problems. They also work with nursing staff, pharmacists, and allied health staff and support ongoing education about pain management and development of safe practices in various hospital areas.
Patients seen as outpatients may see a pain medicine specialist for assessment, prescribing medication, performing pain relieving procedures, or education and counseling of patients and families. Often the specialist is involved in coordinating a team that includes physiotherapists, psychologists, occupational therapists, social workers and nurses who bring specific skills and techniques to help manage complex pain problems.