Pain management is a new specialty in medicine and doctors who specialize in this may also call themselves pain management specialists. This is a multidisciplinary specialty meaning that many fields of medicine must converge to help better understand and manage pain.

Doctors differentiate between acute pain and chronic pain. People with acute pain usually know what caused it. Acute pain is often brought on by a specific event (recent surgery, illness, injury) and the pain usually goes away in an appropriate amount of time. Acute pain can usually be managed medically, that is, doctors and nurses have effective (although not always perfect) ways to help you cope with it.

When a doctor helps you to deal with acute pain, the physician will almost always try to fix the underlying cause of the pain. For instance, if you have a toothache, the best course of action may be to pull the tooth first, then help you deal with the pain as you heal.

Chronic pain is something different. Chronic pain is defined as pain that lasts longer than six months. With chronic pain, the underlying cause of the pain may not be something that can be fixed. For some people with chronic pain, the underlying cause is not even known.

Pain specialists have found out that chronic pain cannot be treated the same way as acute pain. Chronic pain is more complicated. Some people who have had chronic pain for a very long time may also experience depression and discouragement which, in turn, make it harder to treat the pain.

For many people with severe pain (whether acute or chronic) and people with chronic pain, it may take more than one type of therapy to bring relief. There are actually many things that can be done to help manage pain and it is unusual for one to work by itself. Pain can be treated using:

Pain specialists know that all pain is either nociceptive or neuropathic. These are big words but the concept is simple. Nociceptive pain is pain that comes from tissue damage. For example, pain from cancer cells is often nociceptive. Tumors can grow and block blood flow to organs of the body and also cause nociceptive pain.

People with nociceptive pain sometimes describe it as sharp pains, aches, or throbbing pain.

The other kind of pain is neuropathic pain. This kind of pain comes from nerve damage. If a cancer tumor presses on a nerve, cancer can also cause neuropathic pain. Diabetes and multiple sclerosis can inflame nerves and cause neuropathic pain.

Neuropathic pain is often described as a burning pain or sometimes a sensation of heaviness or numbness.

Pain is actually a signal. Your skin and body organs have cells called receptors which can send electrical impulses through the body’s nervous system to the spine. From the spine, these electrical signals are transmitted to the brain. It is not until the signal gets interpreted by the brain that the body feels pain.

If you are suddenly injured, for example, by cutting yourself, the site of injury immediately sends out electrical impulses to the spinal column to signal pain. The spine sends these signals to the brain that registers pain and helps you figure out what has happened. In this example, let’s say you apply pressure to stop the bleeding, bandage the wound, and the pain subsides. There may be a bit of tenderness as the cut heals, but in a few days, the pain is gone. That’s acute pain.

In that example, you can see that pain is useful because it alerts us to problems and helps us to take steps to prevent further injury. When the problem is solved, the pain diminishes and eventually goes away.

Chronic pain no longer helps us. It may occur because there is a medical condition that cannot be addressed, which causes the body to keep transmitting pain signals. This may be the case if you had back surgery that did not work out. Chronic headaches are another type of constant condition which sends out a steady stream of pain signals. Conditions that inflame the nerves or ongoing diseases like cancer, osteoporosis, and nerve damage can keep a person in chronic pain. In some cases, chronic pain can occur because of an injury that has already healed.

Sometimes, even pain specialists cannot find out what is causing chronic pain in that signals may be transmitted for no obvious reason.

If you or a loved one has chronic pain, you know how difficult it can make life. People with chronic pain may miss work, become socially isolated, suffer from depression, and have to limit their activities. In fact, the International Association for the Study of Pain says that pain costs the U.S. more than heart disease and cancer combined in terms of medical cost and lost work days!

There are many ways to approach pain and if you have had a lot of pain or are in chronic pain, chances are you are familiar with some of the “first line” approaches. These include drugs (both over-the-counter pain relievers and prescription drugs) and physical therapy.

These are often effective at first, but people in chronic pain may find that these things become less and less effective with time.

Since pain is caused by signals that the body sends out to the spine and from there to the brain, scientists started to look at very interesting new ways to help manage pain. What if you could block those signals from getting to the brain? These scientists reasoned that chronic pain might cause certain body parts to always send out pain signals, but if those signals could somehow be blocked or intercepted, the person would feel less pain or possibly even no pain.

This led to the invention of the neurostimulator (which is a nerve stimulator). A neurostimulator is a small, battery-powered device that is implanted within the body. An insulated wire from the device sends very low-voltage electrical stimulation to the spinal cord.

Many people with chronic pain have found great relief with neurostimulation. It does require an operation to implant the device and the wire. The device must be replaced periodically (after several years). As with any therapy, neurostimulation does not work for some people and not all people with chronic pain are candidates for this kind of therapy. In addition, some people find that a neurostimulator blocks some pain, but does not relieve it 100%.

An even newer device is called the “intrathecal drug pump.” Like the neurostimulator, it’s an implantable device that is placed in the body during surgery. The pump has a little tube or catheter that leads to the spine in a part of the body near the base of the spinal cord that doctors know as the “intrathecal space.” The pain specialist fills the pump with a pain medication, typically morphine or a similar drug.

The intrathecal drug pump then sends a very small amount of pain-killing drug out to the spine.

All opioid drugs (narcotics like morphine) block pain because they interfere with the body’s transmission system. The body signals pain and transmits the signals through cells known as receptors (receptors are cells that “receive” incoming signals). By jamming the receptors, pain killers make it impossible for pain signals to travel to the brain.

Of course, morphine and other pain-killing drugs are probably familiar to people with chronic pain. Perhaps you or your loved one with chronic pain has taken them orally or received them through an IV system during a hospital visit.

There are a couple of reasons why intrathecal drug pumps work better for some people with chronic pain than taking drugs intravenously or orally.

Because an intrathecal pump delivers the drug exactly to the portion of the spine where the pain signals travel, people with chronic pain can get pain relief with much less drug than they would have to take if they took the drug by another means. In such cases, the patient has to literally ingest the drug into the entire body to get the drug to the spinal cord area. An intrathecal drug pump puts the drug exactly where it is needed and nowhere else.

As a matter of fact, a patient with an intrathecal drug pump may find relief with a hundredth of the oral dosage of the same pain killer—or even less!

Intrathecal drug delivery systems also provide a steady flow of the needed drug, which frees you to go about your day and not have to worry about taking shots or pills. Because the system is implanted in the body, there are no pumps or mechanisms to wear or carry around.

Of course, there are risks with just about any medical therapy and intrathecal drug pumps are no exception. Surgery is required to implant the pump, and surgery always carries with it certain risks. Ask your physician about these risks.

Intrathecal pumps have been used for over two decades. There are tens of thousands of people around the world right now with an intrathecal drug pump.

If you are in chronic pain or severe pain, please discuss this with your physician and ask him or her to refer you to a pain specialist. Many people feel like complaining about pain is a sign of weakness, but there are some good reasons to find a pain specialist:

While you should speak frankly to your physician about pain (and ask for a referral to a pain management specialist if you do not get one), you must also bear in mind that every person is unique. Your health is impacted by numerous conditions. You may or may not be a good candidate for certain therapies. While you should definitely seek help and learn about your options, remember that not every therapy works well for every patient.