Pain can be dreadful. It can be incapacitating and frustrating. It can be a formidable obstacle towards daily activities in one’s way of life.

Pain has become one of the most significant healthcare crises in the United States, with nearly 50% of Americans citing pain as their primary complaint.

According to a World Health Organization study, psychological illnesses such as depression and anxiety are four times more likely to be present in people with persistent pain. 

But fret no more. Pain management opens an avenue for an improved quality of life. However, it is a complex and tedious process that requires accuracy and expertise. 

Every patient experience is unique. People have varied perceptions and thresholds of pain. Hence, pain management should be carefully tailored to each patient for it to serve its purpose.

Programs on pain management are not new, and multiple pain management clinics offer various programs for pain. These clinics have become a haven for people whose quality of life is affected. And, it seems, for those who suffer primarily because of chronic pain. 

And that is why direct primary care is particularly important! Direct primary care gives you access to a primary care healthcare provider who probably knows you better than you know yourself. Direct primary care encourages long-term relationships between clinicians and patients such that there is a holistic approach in patient care, on top of continuity in terms of management. 

With this kind of relationship in mind, direct primary care can help manage chronic pain, which probably cannot be addressed by a simple 10 to 15-minute walk-in consult at just any clinic. 

Your primary care healthcare provider first rules out all other possible causes of your pain using diagnostics and imaging, which may be part of your membership. The primary care healthcare provider also maximizes pain management available at his fingertips.  If needed, he will refer you to a pain management clinic to facilitate further therapeutic options.  The primary care healthcare provider will start with a first-line management (e.g., oral medications) before assessing if you are really in dire need of a pain specialist.

If you are interested in knowing more about direct primary care, you may call our WellLifeABQ hotlines at 505 585 2345.

Nonetheless, if chronic pain is one of your persisting problems today, here are some facts on pain and pain management you might find helpful and educate yourself before you visit your primary care healthcare provider. 

Pain is perceived when the brain interprets signals from the peripheral nervous system regarding an “injury” in the body.

Pain is a complex process involving neurotransmitters and various chemicals in the human body.  You perceive pain as a threat to the body when specialized nerves, called nociceptors, are initiated by a specific adverse chemical, thermal or mechanical stimulus. 

The activation of nociceptors may be direct (e.g., trauma) or indirect (e.g., via biochemical mediators released from damaged tissues). These mediators may trigger a domino effect by augmenting the pain response by upregulating more pain receptors. Examples of these mediators are prostaglandins, bradykinins, serotonin, histamine, and arachidonic acid. 

The severity of the perceived pain depends on (1) how many nociceptors are activated, (2) how long the stimulus was perceived, and (3) the number of mediators released.

These nociceptors send signals from the peripheral nervous system towards the spinal cord’s spinothalamic tract. Neurotransmitters then relay the pain signals from the spinothalamic tract onto the brain. The brain then recognizes the signal and localizes the pain. 

There is no such thing as a “higher pain tolerance.”

As much as we want to believe there are varying degrees of pain tolerance, studies have pointed out the differences are more on the “experience” of pain than “tolerance” towards pain.

The same kind of stimulus can evoke different responses from person to person. A study using MRI showed the network of the brainstem and spinal cord regions contribute to an individual’s specific response and are responsible for variations in pain sensitivity. Another study used MRI in tracking morphological and functional brain alterations in response to chronic pain. This tracking paved to the discovery that everyone can feel pain, but not everyone experiences pain the way others do. The same stimuli can elicit different responses per individual. 

Pain is directly classified as acute or chronic.

Acute pain occurs suddenly, often described as sharp, and usually stems from direct tissue damage. It’s called nociceptive pain or “pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. It does not last longer than six months.

On the other hand, chronic pain is a sensitizing pain lasting more than three months. It can be nociceptive, neuropathic, or central – and it can be all three. Chronic pain is a multifaceted sensory and emotional experience affected by a person’s psychological state.

Pain management is an actual branch of medicine.

Pain management is the branch of medicine that deals primarily with patients who suffer from chronic pain. It aims to give them a better quality of life and ease the suffering associated with experiencing chronic pain.

Otherwise known as Algiatry, pain management is a discipline within the field of medicine that  deals specifically with the “prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain.”

A typical pain management team is multidisciplinary.

The typical pain management team is composed of the following:

• medical practitioners or healthcare providers 
• pharmacists
• clinical psychologists
• physiotherapists
• occupational therapists
• healthcare provider assistants
• nurses
• dentists

Pain management is a holistic approach to curing chronic pain. It involves physical, behavioral, and psychological therapies towards pain, such that the outcome is long-lasting and affecting a better quality of life. 

A pain medicine specialist may be an anesthesiologist, physiatrist, or any board-certified medical or osteopathic healthcare provider. They are also known as interventional pain management specialists. 

Pain medicine specialists (or pain management healthcare providers) implement a broad-based approach to treating pain disorders. This approach includes assessment of pain as an indication of disease, to pain as the primary disease.

The pain specialist serves as a consultant to other healthcare providers if there are co-managing healthcare providers involved. His objective is to provide the best care to the patient and alleviate the patient’s suffering.  The pain management specialist, as the attending healthcare provider, may request or perform the following:

• Directly care for the patient
• Prescribe medications
• Prescribe (or perform) rehabilitative services
• Prescribe (or complete) pain-relieving procedures
• Counsel patients and families
• Create and direct a multidisciplinary team
• Coordinate care with other healthcare providers

The pain medicine specialist also formulates comprehensive therapeutic plans that consider a patient’s culture and special needs. 

Evaluation involves the usual medical approach to all other illnesses: a review of prior medical history, a review of previous laboratories, imaging and electrodiagnostic studies (if any), and a comprehensive assessment on behavioral, social and occupational issues. An interview and a thorough physical examination by the pain medicine specialist are also a must.

Pain management involves a diverse therapeutic approach.

Direct primary care plays a huge role in the management of illnesses, including pain management.  Identifying the problem often starts with a primary care healthcare provider, who rules out other causes of pain that might merit immediate medical attention or perhaps a trip to the emergency room. 

Once the primary care healthcare provider establishes the cause of pain,  he often discharges a patient and prescribes pain medications and physical therapy. 

However, suppose pain medications and physical therapy fail. In that case, this failure may warrant more advanced pain management and hence a referral from the primary care healthcare provider to the pain management healthcare provider or pain medicine specialist.

Pain management specialists train to address pain in the following stepwise manner

1. Medications are considered the first line of therapy. Anti-inflammatories, muscle relaxants, and anti-depressants fall under this category, including injections done on purpose to numb pain such as in nerve blocks.
   
   Transcutaneous electrical nerve stimulators (TENS) commonly employed in rehab medicine also fall under this category. TENS use skin pads to deliver low-voltage electrical current to areas of concern, numbing pain in the process.
   
   
2. The second line of management involves advanced procedures or a mix of medications plus advanced procedures.
   
   Radiofrequency (RFA) is one advanced procedure that involves the application of heat or chemical agents to stop a nerve from transmitting signals to the brain. This kind of therapy is usually done for chronic pain problems.Another procedure, viscosupplementation, also falls under this category. Viscosupplementation involves the injection of lubricant fluid into joints to relieve pain.
   
   
3. The third line of management involves a more invasive procedure – implantation of a pain pump or spinal cord stimulator. This implantation directly relieves pain at the spinal cord level, inhibiting it from sending signals to the brain related to pain.
   
   Another therapeutic option falling under this category is stem cell therapy or implantation.

A pain management clinic is a health facility that diagnoses or manages chronic pain.

Pain clinics are actual health facilities focused on the diagnosis and management of chronic pain.

So, does pain management really work? Research has it that people who turn to comprehensive pain management live a better quality of life with less emotional distress. Daily tasks also become bearable and easier with proper pain management. 

If you think pain management will work wonders for you, you can consult us, your primary care provider, for advice on the next steps to take. 

WellLife ABQ can help you! Book an appointment with our clinic today and during your consultation, share your past and present medical history. Include as well every concern you have in mind. You will be oriented on what therapeutic options are available for your specific case, and we will do our best to exhaust readily available options for your specific care. You will be referred to a pain management clinic once necessary. The ultimate goal is to help you bounce back and live pain-free using a non-invasive approach.

Contact our WellLifeABQ hotline at 505 585 2345. Let us start creating a holistic pain management plan that is tailor-fitted for you today!