Q+A: From Back Pain to Arthritis

May 11 -- How do you find a reputable pain clinic? Are you a good candidate for a pain specialist? Here is a selection of your questions about pain management with answers from Dr. Carol A. Warfield, chair of the department of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School.

Paula in New Orleans asks: How do you feel about patients with chronic pain going to the emergency room for narcotics? Do you feel that a patient with chronic pain should only be given narcotics by a physician who knows the patient and is a pain specialist? Thank you.

Answer: Any patient should feel comfortable going to an emergency room for what they feel is a medical emergency. However, patients with chronic pain often find that bouts of severe pain are better handled by making a plan in advance with your primary care doctor. This person knows you and your pain problem much better and can thereby better tailor your treatment to you. Many primary care doctors prescribe narcotics to patients with chronic pain on an ongoing basis but many feel more comfortable doing this after the patient has had a second opinion from a pain specialist who can best discuss all the options available for treating pain before resorting to narcotics.

Diane in Texas asks: There have been several news reports recently regarding pain management clinics being shut down for the blatant misuse of prescription pain medication. How would you recommend evaluating a pain specialist or pain clinic to make sure that they are qualified and reputable? And how do you know if the clinic is appropriate for your ailment?

Answer: There are many fine pain clinics across the country in many settings. Unfortunately there is no good and widely accepted standard used to accredit these clinics. If you have concerns, my advice would be to call the teaching hospital affiliated with a medical school in your area. They generally have clinics which treat all types of pain and may be able to recommend local private pain clinics in your area which might be most appropriate for your type of pain.

Mary in Kentucky asks: I take Dilaudid for chronic pain. I was hospitalized a year ago for shoulder surgery and the hospital staff seemed very judgmental about my medication, it was as if I was some drug abuser. I will never go to that hospital again. I never dreamed I would end up with debilitating pain and my experience with doctors and nurses tells me they need more education and sensitivity, are medical and nursing schools getting any better at addressing this issue?

Answer: Medical and nursing schools are putting much more emphasis on education in pain management than they did in the past. In fact, the Joint Commission on the Accreditation of Healthcare Organizations which is the major group which accredits hospitals has made it mandatory that nurses document pain scores in hospitalized patients just as they document blood pressure, temperature, rate of breathing and pulse. Unfortunately there are still many medical personnel who do not understand that strong painkillers like Dilaudid are sometimes necessary to treat chronic pain.