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Understanding Pain Management Options

Exploring the differences between Pain Medicine and Physiatry
By Lena Shahbandar, MD, Paul Manganelli, MD

Your pain medicine and physiatry doctors are solely focused on the evaluation, treatment and prevention of pain in order to help your body get back to a healthy and pain-free state. While both specialties aim to identify and treat your pain, there are some important differences between them. Dr. Paul Manganelli, Pain Medicine, and Dr. Lena Shahbandar, Physiatry, outline key similarities and differences between the two pain specialties to assist you in making informed decisions about your care.

What is Pain Medicine?

Pain medicine is a medical specialty dedicated to the prevention, evaluation and treatment of pain. Pain physicians offer a variety of options to treat the full spectrum of pain disorders. Your DuPage Medical Group pain doctor will assist in finding the cause or causes to your pain and then work with you to formulate a personalized treatment plan.

When Should I See a Pain Medicine Specialist? 

If you have experienced pain for more than three months or your pain has not improved while under the care of your primary or specialty physician, you should consider an evaluation by a pain management specialist. Below are just a few of the conditions that your DMG pain physicians assist patients with every day:

  • Acute or chronic arm or leg pain
  • Acute pain
  • Arthritis
  • Back and neck pain
  • Cancer pain
  • Chronic pain
  • Diabetic peripheral neuropathy
  • Headache/occipital neuralgia
  • Joint pain both before and after joint replacements
  • Neuropathic pain
  • Neuropathy associated with chemotherapy
  • Oral facial pain
  • Pain associated with addiction
  • Pain associated with spinal compression fractures
  • Pelvic pain
  • Persistent post-op foot and ankle pain
  • Persistent post-op pain
  • Sacroiliac joint pain
  • Sciatica

Treatments Provided by a Pain Medicine Physician

During your visit with your pain medicine physician, you’ll receive an evaluation to determine the cause or causes of your pain. Evaluations will include a review of your health history, a physical exam and a review of any tests or imaging you may have previously completed. Based on your evaluation, your physician may recommend one or a combination of treatment options to reduce your pain and improve your function. Depending on the source and severity of your pain, possible treatment options may include:

  • Nerve blocks or nerve ablations – medication is injected into your body to numb a nerve or group of nerves to reduce pain. Ablations can often last for a year or longer.
  • Oral medications – medications taken by mouth to control pain (anti-inflammatory, acetaminophen, opioids, etc.).
  • Topical medications – ointment, cream or patch applied to your skin to manage pain.
  • Steroid injections – shots administered (often with ultrasound or X-ray guidance) directly into joints or next to nerves to treat painful inflammatory conditions. Epidural steroid injections are a common example.
  • Spinal cord and peripheral nerve stimulation - miniaturized electrodes are implanted to block pain signals, often providing profound and long-term pain relief from patients suffering from very challenging chronic pain conditions.
  • Kyphoplasty – cement is injected into painful spinal vertebral fractures to strengthen the bone and quickly reduce or eliminate the pain.
  • Minimally invasive spinal decompression devices – small implantable devices that may help manage leg pain associated with spinal stenosis when surgery is not the best option.

The bottom line is that with so many ways to treat pain, you should consider an evaluation by a pain medicine specialist before resigning yourself to living with chronic disabling pain.

 What is Physiatry?

Physiatrists, also known as rehabilitation physicians, specialize in non-operative physical medicine for musculoskeletal conditions (muscles, bones and associated nerves, ligaments, tendons and other structures) in order to restore function, mobility and quality of life. You could think of a physiatry as primary care for the musculoskeletal and nervous system.

The biggest difference between pain medicine and physiatry, however, is in their approach. Though physiatrists can administer medications or medical procedures, they look at your overall health and well being, focusing on the big picture to determine causes of pain and best course of treatment to restore and enhance your functional ability. This can include development of care plans that address your physical, emotional and medical needs, and collaborate with other specialty teams such as physical or occupational therapists.

 When Should I See a Physiatrist?

If you are experiencing chronic or acute pain and want to explore non-surgical care for your condition, a physiatrist is a great reference.  Your primary care physician can help you determine if physiatry is right for you and your condition, as well as work closely with a physiatrist to develop a non-surgical plan of care.

Physiatrists can treat both acute and chronic pain associated with nerve, muscle and bone injuries or illness, including:

  • Acute and chronic joint pain
  • Acute and chronic back pain
  • Running or other sports-related injuries
  • Degenerative joint conditions
  • Nerve entrapments
  • Overuse injuries
  • Tendonitis/Tendinopathy

Treatments Provided by a Physiatrist

In order to develop a customized treatment plan for your condition, a physiatrist will conduct a comprehensive evaluation to determine a diagnosis. Evaluations will include a thorough review of your personal and family medical history, as well as a complete physical exam. Depending on the cause or severity of your condition, further diagnostic testing such as labs, nerve conduction studies, psychological testing or X-rays and MRI scans, may also be administered.

Physiatry takes a multi-faceted approach to treatment focusing on restoring function, reducing pain and improving overall quality of life. Treatment options may include one or multiple of the following:

  • Exercise therapy
  • Physical therapy
  • Occupational therapy
  • Guides to improving overall health (such as smoking cessation or weight management)
  • Non-opiate therapies and medications
  • Psychosocial support
  • Minimally invasive injections to the joints, nerves or other painful structures
  • Alternative therapies, such as acupuncture

You don’t have to live your life with daily pain and discomfort. Our pain medicine and physiatry specialists are dedicated to finding the means necessary to identify and treat the underlying cause of your pain so that you can enjoy a balanced, healthy lifestyle. So, whether it is through medication or a focused physical therapy routine, finding the treatment approach that is right for you and your condition is the first step in achieving a pain-free life. If you are struggling to decide which pain management route is best suited for you, consult your primary care physician or visit our website to learn more.

Click here to learn more about pain medicine and physiatry or to schedule an appointment with one of our specialists today.



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