A COMPLEX EQUATION: TREATING NEUROPATHIC PAIN OFTEN INVOLVES A HOST OF SPECIALISTS

By Rebecca McKinsey

Because of the complex nature of neuropathic pain, and its many causes, a wide variety of providers and specialists may be involved in managing this type of pain—including some you might not expect.

“While sometimes, nerve pain can occur suddenly as a result of an injury or surgery, a lot of times, nerve pain can come on gradually,” says Helen Blake, MD, an interventional pain physician who is board certified in anesthesiology and pain management and practices with St. Louis Spine and Orthopedic Surgery Center.

Gradual onset of neuropathic pain can be caused by the thickening of soft tissues, or external factors such as irritating and compressive clothing or repetitive motions.

“Because these conditions come on gradually and masquerade as a lot of different things, that contributes to the probability of delaying treatment of nerve pain,” Blake says.

Individuals with neuropathic pain often start treating it by seeing a primary care physician, who may prescribe medication or offer a referral to a specialist, including:

—Interventional pain doctors and pain management doctors, who help individuals craft an individualized pain management plan

—Physical therapists and occupational therapists, who help rehabilitate pain

—Neurologists and neurosurgeons, who address conditions involving the brain, spinal cord, and peripheral nerves

—Peripheral nerve surgeons, often plastic surgeons or orthopedic surgeons with a subspecialty in treating nerves, who provide various types of nerve repair

—Osteopathic doctors or physiatrists, who treat neuropathic pain as it pertains to an individual’s health as a whole (nurses often play a large role in treatment of pain as well)

—Rheumatologists, who treat neuropathic pain as a symptom of autoimmune and inflammatory diseases

—Chiropractors, acupuncturists, acupressurists, or massage therapists, who offer a variety of complementary treatments

—Dietitians, who can work with individuals to craft a nutrition plan to best support their needs

—Mental health practitioners, who use methods such as neurofeedback or biofeedback, or help people manage the toll that chronic pain can take.

Neuropathic pain’s complexity often necessitates a multi-faceted treatment approach, says Peter Abaci, MD, a pain specialist with IPM Medical Group, a California practice that focuses on the management of chronic pain.

“Some of these therapies, whether massage treatments or other modalities, are not going to necessarily change the disease process,” he says. “But if they provide some level of subjective relief, if it allows the person to function better with daily activities, if it helps you get through things a little better, then great—it’s another tool to help support your quality of life.”    

“Because these conditions come on gradually and masquerade as a lot of different things, that contributes to the probability of delaying treatment of nerve pain.”