Pain management is a branch of medicine that deals with the alleviation of chronic pain. It involves knowledge of painkillers and other pharmaceuticals, psychology, physiotherapy and occupational therapy by a combination physicians, physician assistants, pharmacists, nurses and specialist nurses. It may also involve psychiatrists, other mental health professionals and massage therapists. Pain management physicians generally come from anesthesiology, neurology and psychiatry.
Although medicine's understanding of pain in relation to a pathology is well understood, it is less well understood why, in some cases, pain persists well after the underlying pathology has been successfully treated. When pain persists, the focus of the medical team is not on diagnosis and treatment, but on ongoing support for the patient. This is particularly true when the pain cannot be traced to any known pathology. In modern practice pain relieving drugs are combined with mental health support and physical intervention rather than just relying on drugs alone.
Pain management starts by identifying the characteristics of the underlying pain, such as its severity, location, and any factors that may make it worse. The physician starts a treatment plan based on both the risks and rewards of proceeding with any given plan. For example, the use of narcotics may relieve the pain, but cause dependency on the drug. Other painkillers, such as NSAIDs, are less likely to cause dependence, but are also less likely to be completely effective and also have side effects, particularly with long term use. In addition, pain management can mask new problems when they develop.
Physicians now prefer a physical approach to pain management, such as physiotherapy or electrical stimulation of nerves. However, these treatments require the cooperation and commitment of the patient and can be time consuming.
Behavioral therapy has shown a great deal of usefulness, particularly in helping patients form and stick to an appropriate treatment plan.
Recently, the overuse of opioids has been severely criticized, largely due to the increasing number of deaths from overdose of the more common drugs used for severe pain. However, new restrictions on the use of opioids has resulted in under-treatment of severe chronic pain.