Opinion
Pain medicine physicians and pain management programmes
23rd Feb 2017
Pain medicine is a relatively new medical speciality that can be used to assess personal injury cases where pain is a major contributing component to impairment and disability. This article outlines the specialist training, examination and expertise that distinguishes pain medicine physicians from other medical specialists and the difference between a pain medicine physician and pain management programmes (PMPs).
Pain Medicine Physicians
Australia was the first western country to recognise pain medicine as a medical speciality. In 1998, the Australian and New Zealand College of Anaesthetists established the Faculty of Pain Medicine and in 1999 the first fellowship examinations were conducted. Pain medicine physicians are now recognised by the post nominals FFPMNAZCA (Fellowship Faculty of Pain Medicine Australian and New Zealand College of Anaesthetists). In 2005, the Australian Medical Council recognised pain medicine as a medical specialty.
Before undergoing two years of training in multidisciplinary pain medicine, physicians must have already completed specialist training in another related discipline such as anaesthesia, psychiatry, internal medicine or surgery. It is therefore common for a pain medicine physician to be a psychiatrist, anaesthetist or surgeon in addition to being a pain medicine physician.
Pain medicine physicians have a detailed knowledge of the physiology, psychology, pathology and pharmacology of pain and are usually the clinical leaders of multidisciplinary PMPs. They are able to assess and coordinate the physical, psychological and rehabilitation needs of individuals who experience complex pain. Some pain medicine physicians further specialise in interventional (surgical) approaches to pain relief such as injections, nerve blocks and advanced pain therapies such as neuromodulation and intraspinal drug delivery systems. Some such physicians specialise in persisting paediatric and adolescent pain conditions.
Pain Management Programmes
PMP, sometimes referred to as cognitive behavioural therapy (CBT), are education programmes focused on individuals who are experiencing impairment and disability from persisting pain. They are usually group-based and run by a team of allied health professionals such as psychologists, occupational therapists and physiotherapists. PMPs assist individuals to overcome excess reliance upon health providers by teaching self-management techniques to promote independence. A pain medicine physician will usually conduct an assessment of an individual to determine their suitability for a PMP.
Who should be referred to a Pain Medicine Physician?
Pain medicine physicians are well equipped to provide overall perspective and explanation of pain causation and quantum in individuals who do not conform to a straightforward model of disease, and to those whose presentation has become complicated by the development of secondary sequelae such as depression, anxiety, physical deconditioning and multiple analgesic drug use. Previously, non-surgical spinal pain, complex regional pain syndrome, neuropathic pain syndromes, analgesic drug dependency and pain complicated with psychological and behavioural amplification were treated by neurologists, rehabilitation physicians and psychiatrists. It is now routine for these conditions and more to be assessed and treated by pain medicine physicians.
Conditions commonly treated by Pain Medicine Physicians
- Complex Regional Pain Syndrome
- Central pain sensitisation (wind-up)
- Spinal injury pain
- Phantom pain
- Chest pain from mesothelioma
- Nerve damage pain
- Combined pain and psychiatric disorder
- Fibromyalgia
- Chronic fatigue
- Spinal pain and whiplash
- Analgesic substance abuse
- Referred pain
- Nerve blocks
- Arthritic pain
- Neuromodulation
- Fear avoidance and abnormal illness behaviours
- Spinal drug reservoirs
- Drug therapy for pain
- Organic and non-organic pain
Dr Marc Walden is a registered pain medicine physician, specialist anaesthetist, independent medical examiner and the principal of Greenslopes Medicolegal.
This is the first article in a series of three. His next article will discuss the often controversial and difficult diagnosis of Complex Regional Pain Syndrome. His third article will discuss pain and psychological issues.
The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).
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