If you’re living with chronic pain, it’s very likely your GP will recommend you see a Pain Management Specialist to optimise your care. Many people are excited at the prospect of seeing a specialist doctor who can diagnose, treat and manage chronic pain, but the prospect can also be daunting. This article should hopefully help you prepare and give you an idea of what to expect at that first appointment and make the most of your time.
What is a Pain Management Specialist?
A pain management specialist is a doctor who specializes in treating chronic pain conditions. These doctors have advanced training in evaluating, diagnosing, and treating various types of pain, including back pain, joint pain, neuropathic pain, and other chronic pain syndromes.
Pain management specialists use a variety of techniques to help patients manage their pain, such as medication management, physical therapy, nerve blocks, injections and other interventional procedures. They work closely with their patients to develop individualized treatment plans that address their specific needs and goals.
In addition to treating pain, pain management specialists may also work with other healthcare providers to address the underlying conditions that are causing the pain. They may collaborate with physical therapists, psychologists, and other specialists to help patients achieve the best possible outcomes and improve their quality of life.
Preparing for your pain management appointment
Preparing for your first pain management doctor appointment can be a little overwhelming and stressful, especially if you have never seen a pain specialist before. However, with a little preparation, you can make sure you get the most of your appointment and ensure that you receive the best possible care.
Before the appointment
Gather all the information the pain management doctor will need. Including:
1. Your referral
Don’t forget to bring your referral. Many clinics will have had a copy faxed or emailed by the GP, but if not, it’s a good idea to email a copy to the clinic yourself. That way the referral is already on file, and there’s no chance you will forget it on the day. If that’s not possible, make sure you bring it with you on the day.
2. Pain Questionaire
Most pain clinics will give you a pain questionnaire to fill out before the appointment. Don’t forget to fill it out and bring it with you to the appointment, or email it back so the doctor can review your reco
3. Gather your medical records and history
Your doctor is going to want to have a copy of all your medical records, especially those that directly relate to your pain condition. This will include a list of your current diagnoses, any scans or bloodwork that you’ve had recently, and a list of all the surgeries and procedures you’ve had.
Obviously, focus on your pain condition. While your pain management doctor needs to know about your general health, including things like your blood pressure, cholesterol, allergies etc. they don’t need a blow by blow of the appendectomy you had when you were 13, but they do need to know if you had a bad reaction to the anaesthetic, for example.
4. Write Down Your Symptoms and Concerns
Before your appointment, take some time to write a list of all your symptoms and concerns, in order of importance. Include information such as when your pain started, where it is located, how severe it is, what, if anything, improves the pain, and what, if anything, makes the pain worse. What kind of pain it is, is it achey, burning, sharp, electric, buzzing, sharp, dull…try to write down a few descriptors for what your pain feels like.
Having a list ensures that you don’t forget anything during your appointment. Its very easy to get side-tracked, and I can’t count the number of times I’ve left an appointment and as I’m getting into my car, I realise I completely forgot to ask about thing X.
Make a list, and don’t leave the appointment until everything on it has been discussed and addressed to your satisfaction.
5. Write down a list of all the treatments you have already tried for your pain
Usually, by the time you are referred to a pain management doctor, you have been in chronic pain for a while, and you’ve tried a LOT of different therapies.
They might include medications, such as simple analgesics, NSAIDS, anti-depressants, anti-seizure medications, opioids or others. Try to list the names and doses of each medication you were taking, and whether the medications helped or if they caused side effects. If you’ve stopped taking a medication, try to write down why you stopped it.
A pain management doctor might want to start from the beginning and run all their own tests, and sometimes they may ask you to re-try medications that you’ve already trialled. Its helpful to have a list of medications you’ve tried, and their effects – good and bad – so you don’t have to waste time doing the same things again. For example, I was prescribed gabapentin for nerve pain, but even the lowest dose sedated me so much that I couldn’t function. My pain management doctor wanted me to try it again, but I refused, because it made my life worse, not better. My pain management doctor accepted this, but only because I had this documented.
Also include other non-medication therapies that you’ve tried, including physiotherapy, hydrotherapy, psychological therapies, and/or meditation and mindfulness courses. It’s common for pain clinics to require patients to learn about pain science, or how the brain processes pain. If you’ve already done one of these courses, be sure to mention that as well.
Bring a List of Your Medications
Make sure to bring a list of all the medications you are currently taking, and their dosages. Include any over-the-counter medications, vitamins, and supplements. This can help your doctor identify any potential drug interactions or side effects and ensure that your medications are optimised for your specific needs.
Bring a list of all your other doctors
Make a list of all the other doctors you consult regularly. Write down what their specialty is, the diagnoses they are managing, and how often you see them. Your pain management doctor might want to talk to them about your case and get more information from them.
For example, if inflammatory arthritis pain is what you are consulting your pain management doctor for, they will likely wish to speak to your rheumatologist about your history and management.
Prepare a List of Questions
Take some time out before your appointment to make a list of questions you need to ask your doctor. Even when you’re very sure you won’t forget these questions, appointments often head out on unexpected tangents, and its very easy to forget that one important question! A list of questions will ensure you cover everything that’s important to you, and help you make informed decisions about your care.
Remember, the pain management doctor is a specialist in managing pain, but you are the specialist in YOUR pain and your body. You want to develop a good working relationship, a partnership, with your doctor, who will offer you treatment options based on their education and experience. The final decision on treatment pathways should always rest with the you, the patient.
To make those decisions you need to be able to ask as many questions as you need, and your doctor should be happy to make the time to answer. If you feel rushed, or unsure about something, don’t be afraid to speak up and say you need more information.
Some questions you may want to ask include:
- What is causing my pain? As in, what is the diagnosis? E.g. Is it a mechanical problem? A nerve problem? a disease process?
- What are my treatment options?
- What are the benefits and risks of each treatment option?
- How long will it take for the treatment to work?
- What happens if I choose NO treatment? How is my condition likely to progress?
- What can I do to manage my pain at home?
- Are there any complimentary therapies that may help?
- Is it OK to exercise? What type of exercise is best?
- What should I do if my pain gets worse after starting treatment? Or I experience side effects from a medication? Who do I contact?
I have a journal that I carry with me. Whenever a question pops into my head, I write it in my journal, and then I make a master list of all these questions before my next doctor’s appointment.
Your doctor will review you medical history, scans bloodwork, medication list and current therapies. And they will also ask you a lot of questions on the first visit to get to know you and understand you better.
Questions your pain doctor will likely ask you
Some of the questions your pain doctor may ask may feel very personal, and you might not think they are relevant. Try to be as open and honest as you can. Either way, it’s good to be prepared for these questions and think about the answers ahead of time. Common things your pain doctor will ask about may include :
They will ask about your day-to-day life, if you work, what your interests are., whether you are active or what forms of exercise you are able to do. They may also ask about cannabis and/or alcohol use. Try to be as honest as possible, so that your doctor can provide a safe treatment plan.
Doctors will often ask what your goals are (something beyond “get rid of my pain!”). They might phrase it as “How would your life change, if you woke up tomorrow without pain?” Or “What would you be doing with your life if you did not have chronic pain?”
Your answers might be things like : “I want to ride horses again” or “I want to return to my career” or “I want to be able to play with my kids”. Having a tangible, defined goal to work towards helps your doctor understand more about your life, and measure progress.
Your doctor will ask about your relationships and friendships. They will want to know if you have good social supports, and whether you have people you can rely on.
Your mental health
Anxiety and/or depression are very common in people living with chronic pain. Hardly surprising! Your doctor will want to know how you manage your mental health, how anxiety and depression are impacting your life and pain levels, and whether you need additional supports and treatment in these areas. Mental health can have a very large impact on chronic pain, just as chronic pain can affect mental health. It’s a bit chicken-and-egg, but your doctor asking about your mental health does NOT mean that they believe your pain is ‘all in your head’. Pain doctors often refer patients to psychologists to help with strategies to manage pain and to live well despite pain.
On the day:
Bring a Support Person
If you feel anxious or overwhelmed about your appointment, consider bringing a support person with you. This could be a friend or family member who can offer emotional support, but its also very helpful to have someone there to help you remember important details, or they may have questions that haven’t occurred to you.
Be Honest and Open
It’s essential to be honest and open with your pain management doctor about your symptoms, concerns, medical history and lifestyle. This can help your doctor develop a personalised treatment plan that is tailored to your specific needs and goals.
Also, at the outset, list a summary of the issues you wish to discuss, in order of importance. For example, say something like “I’m here to discuss my arthritis pain, which affects most of my joints, but is worst in my knees. But I also suffer from peripheral neuropathy and endometriosis.“
That way the doctor knows from the outset that you have multiple issues to discuss, and they can devote enough time to each. It’s important that your doctor has a good overview of your general health, and then will focus specifically on your pain or pain conditions.
Wear Comfortable Clothing
Make sure to wear comfortable clothing to your appointment, especially if you will be undergoing any physical examinations. Loose-fitting clothing can make it easier for your doctor to examine you and can help you feel more relaxed during the appointment.
Bring a pen and paper and ask the doctor if it’s OK if you take notes. If they are going over important details, ask them to pause so you can write them down.
It’s not uncommon for the doctor to refer to other health care providers, either in the same clinic, or at another practice. You may be referred to physiotherapy, a psychologist, an acupuncturist, or for hydrotherapy or an exercise physiologist who specialises in chronic pain.
It can be a LOT to take in, and a lot to remember.
Personally, I make quick notes on my phone in a text file that I copy to a document later, or even make quick voice recordings that I can play back after the appointment to jog my memory. Do whatever works for you, and helps you remember the details.
In conclusion, preparing for your first pain management doctor appointment can seem daunting, but it doesn’t have to be. By following some simple tips, and doing some preparation, you can make the most of your appointment and ensure that you receive the best possible care. Never be afraid to ask questions, remember your pain management doctor is there to help you. It is part of their job to explain everything, and answer your questions and concerns.
Most of all remember your doctor is giving you their opinion, based on their many years of education and experience, but the choice of which treatment option is always yours.