Give guidance on proper diagnosis

Treatments must be carefully selected

Education on pain is multifaceted, according to David Kloth, MD, national spokesman, board member, and past president of the American Society of Interventional Pain Physicians (ASIPP), headquartered in Paducah, KY.

He advises educators to teach consumers that early diagnosis and treatment is essential for preventing acute pain from becoming chronic pain and from the affected areas losing functionality.

Also, medical expertise in properly diagnosing and treating pain is important. He adds that pain specialists not only know how to properly treat pain, but also diagnose the cause of the problem. "As with any problem, if you don't make the right diagnosis, it does not go away," explains Kloth.

After taking a comprehensive patient history, doing an examination, and reviewing tests that have been ordered, a pain specialist determines the cause of the problem. Diagnostic steps might be an injection that selectively blocks a nerve to prove that is the cause of the pain, says Kloth.

Patients should make sure they have all the facts before considering surgery, he adds. While surgery should be done for very specific and correct indications, not all surgeries to treat pain are going to be successful, says Kloth. He advises that patients with back, neck, and spinal problems try appropriate, conservative management first to see if that corrects the problem. This may be physical therapy, medication management, injections, or chiropractic treatment. Every patient is different, he adds.

Kloth says that the vast majority of pain management treatments are totally reversible, and if they don't work, they have not caused any harm or long-term problems, except with surgery where scar tissue can form.

Pain management is not a shot in the dark, says Kloth. While a chiropractor or acupuncturist may be beneficial, a pain specialist will determine if such treatments are appropriate and advise patients which to explore based on their particular condition.

Patients should use the following criteria to find the right pain specialist, according to the ASIPP:

— Make sure the physician has a track record in interventional pain management.

— Ideally, the physician should be practicing pain management full time.

— Training is important. Find out where the physician did his/her residency and what their specialty was. Also, ask if he or she did a fellowship in pain management.

— Find out if the physician holds a certificate in pain management from a board, such as the American Board of Medical Specialties (, or the American Board of Interventional Pain Physicians (

— Ask if the physician has credentials at a local hospital or surgery center to practice interventional pain management.

— Use peer recommendations. Patients can ask their personal physician to refer them to a physician who specializes in pain management.


• The American Society of Interventional Pain Physicians, 81 Lakeview Drive, Paducah, KY 42001. Telephone: (270) 554-9412.