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When to See a Pain Management Doctor

When your pain is too much to bear, a specialist visit offers relief you won't find on pharmacy shelves.

There’s a plethora of pain remedies out there. Over-the-counter pills, creams, patches, heat pads, cold packs — you name it. For most bouts with pain, these do just fine. With a little time and a trip to your local pharmacy, you have everything you need to heal.

But if you’ve cycled through your options and there’s still no relief in sight, it’s time to see a physician.

The road to relief starts at Primary Care.

You read that right. Your first visit should be with your primary care provider.

“Everyone’s willing to try a patch, cream, Tylenol or ibuprofen. Often, they’re not as willing to see a doctor,” says Jun Xu, MD, PhD, a West Des Moines pain management physician. “If it’s been more than four weeks, it’s likely you need a provider to look into what is going on.”

While you may be prescribed some over-the-counter options, your primary care doctor has many more treatment tools at their disposal. Prescription medications and physical therapy are common for most pain conditions.

“Your provider will go down a diagnostic path to figure out exactly what the reason is. We like patients to try these treatments for about six to eight weeks,” Dr. Xu says. “These conditions are sometimes because of a muscle or ligament tear. They happen quite often when you stretch your neck or back.”

Prolonged pain requires a specialist.

Two to three months is typically plenty of time for a muscle or ligament to heal. So when pain lasts beyond that mark with little improvement from treatment, it’s likely coming from a different part of your body: the nerves.

Nerve-related pain, or neuropathic pain, is caused by damage or disease within your spinal cord, brain or the nerves that spread throughout your body. Neuropathic pain is usually chronic and can flare up with no known cause, accident or injury.

“Neuropathic pain is concerning. It’s chronic. Most people will know it’s something more serious than a twisted muscle,” Dr. Xu says.

You know it because you feel it. The pain doesn’t just stay in one spot. It radiates to other parts of your body, following the web of peripheral nerves.

“That means not only neck pain, but pain down to the arms, hands and fingers. Not only back pain, but pain in the buttocks, thigh or calf,” Dr. Xu says. “It depends on where that nerve travels. It can feel like pins and needles, numbness, tingling, burning pain, electric-shooting pain or sensitivity to touch.”

Neuropathic pain requires what he calls a “second step” of pain treatment. After 4-6 weeks of conservative treatment without relief, it’s time to step up to more advanced nerve pain medications. It’s also typically time for more advanced imaging study such as MRI to try and find the source of the nerve pain.

Your primary care provider may order these tests and treatments or refer you to a pain management specialist at this point.

Pain management offers more options.

When you visit a pain management physician, you can expect a continuation of this conservative approach. There’s a wide range of treatments between over-the-counter medications and opioids. Your pain specialist will work with you to develop a plan to minimize or manage your pain symptoms, based on your personal preferences and your body’s response.

“There’s a full spectrum of treatment. We come up with a plan together based on the severity of your symptoms and your preference for invasive or aggressive treatments,” Dr. Xu says.

Some people want to avoid the side effects of medications. Others fear needles or want to steer clear of the operating room. In most cases, it takes a multi-modal treatment plan to find the relief you’re striving for. And the plan is individualized based on your unique pain experience. Your pain treatment may include:

  • Epidurals – Steroid injections into the epidural space around your spinal cord can help provide lasting relief from neuropathic pain. Epidurals are also commonly used for herniated disks.
  • Neuromodulation – Electrical stimulation of the spine can alter nerve activity, blocking the pain signals from firing. The success rate for neuromodulation is nearly 80%, Dr. Xu says, so it’s highly effective for nerve pain.
  • Prescription pain medicine – Under the observation of a pain management professional, prescription narcotics are useful against both short-term and long-term pain conditions, or as a bridge to other treatment options. Pain specialists follow strict dosing guidelines to help you find relief with the lowest dose and side effects.

“We want you to maintain your daily function and quality of life. We want you to enjoy life with your family, kids and grandkids,” Dr. Xu says. “We have a full spectrum of treatments. When something’s not successful, we’ll work with you to find something your body is responsive to.”

Red flag pain symptoms warrant a visit sooner.

If burning pain and the feeling of electricity shooting through your body doesn’t sound serious enough, there are still other pain symptoms that Dr. Xu says are warning signs for more severe conditions. If you experience pain plus these other symptoms, it’s a red flag:

  • Profound weakness in your arms or legs
  • Numbness in your private area (known as “saddle anesthesia”)
  • Bowel or bladder incontinence
  • Fever or chills accompanying pain in the back

“These are the red flags where we want you to contact a pain specialist or your primary care provider immediately,” Dr. Xu says. “We want to make sure there is no infection, no spinal cord compression or no metastatic cancer. It’s more urgent. We want to deal with it as soon as possible.”

Of course, there’s always a sense of urgency when pain is affecting your daily function or quality of life. Whether you have red flag symptoms or not, you can make an appointment with a pain management professional — no referral necessary.

“The majority of cases are not in the red flag category. Most are neuropathic pain,” Dr. Xu says. “And you don’t have to wait a certain length of time or have to see your primary care doctor first to get a referral. You can make an appointment any time your pain has reached a level that’s concerning.”

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