3 questions for a pain specialist

This is the person that'll get you off the DL and back on the active roster.

When athletes get hurt, their initial thought is often to enlist the services of an orthopedist. But that shouldn't always be the first line of defense. Another option—and in conjunction with a joints doctor—is seeing a pain specialist. So for the latest installment of our "3 Questions for a Doctor" series, we spoke with Febin Melepura, M.D., a New York-based physician who's double board certified in pain management and anesthesiology, to find out more about the field.

What are the most common injuries you see and how do you treat them?

<p>The most common injury I see at the office is low back injury, followed by neck injury, then shoulder and knee. Low back pain is an extremely common problem that affects at least 80 percent of all individuals at some point in their lives, and is the fifth most common reason for all physician visits in the United States. A <strong><a href=http://www.healthdata.org/sites/default/files/files/policy_report/2016/PolicyReport_IHME_GBD-Norway_2016.pdf target=_blank>Norwegian study</a></strong> suggests that at least 30 percent of the population had experienced neck pain within the last year. About 40 percent of those patients had pain lasting more than six months. The first line of treatment for acute injury is the application of heat or cold therapy and over-the-counter anti-inflammatory medications. The next step is physical therapy, occupational therapy, <a href=http://emedicine.medscape.com/article/325107-overview target=_blank><strong>transcutaneous electrical stimulation</strong></a>, and/or <a href=[ContentPath:I]/sitecore/content/sites/FurtherMore/Home/Articles/2016/05/new-forms-of-acupuncture><strong>acupuncture</strong></a>. I determine if further diagnostics evaluation is needed, for example, an X-ray or MRI. If the pain persists, there are a series of simple office-based interventions that I can do to treat the pain, depending on the injury. These treatments cure what is causing the pain while restoring the body’s function.

What in your field is most exciting to you now?

<p>The field of pain management has been around for centuries, but it has now become a distinct specialty. The future of the field is promising because we are better at understanding pain. Not only do we now appreciate its complexity, but we've made strides in understanding the physiologic changes that occur in the body and how we can treat it. There have also been developments in new medications and therapeutic interventions, as well as minimally invasive surgical techniques. There are also exciting advancements in regenerative medicine which uses stems cells from the person's own body to rebuild injured tendons and ligaments.

How has your field changed?

<p>We have a better understanding of what happens to the body when it's perceiving pain. We now know that the central and peripheral nervous system is a dynamic complex system that modulates itself when there is tissue damage. Although most of these modulations are transient, some may persist and lead to chronic pain states even if the tissue damage is resolved. There are also new and improved interventions that help patients with their underlying cause of pain. In modern pain management, interventions have become more precise and targeted. There are more minimally invasive surgical techniques that help patients regain their functionality more quickly. Additionally, we now use spinal cord stimulators to help chronic pain patients from suffering. The device changes how they perceive pain by altering how the nervous system sends painful signals to the brain. With more research being done, we are finding more painful ailments to treat with this device.