Pain management has always been a part of neurosurgery, and all neurosurgeons are trained to diagnose and manage many different types of pain. However, some complex and chronic types of pain require the help of a physician with special pain management training.
In a recent article for AANS Neurosurgeon, the quarterly journal of the American Association of Neurological Surgeons, Dr. Christopher Winfree, a neurosurgeon at Columbia University Medical Center/NewYork-Presbyterian Hospital who specializes in pain management, explained the advantages of sending patients to a pain specialist.
The journal posed the question, “Opioid prescriptions: What is a neurosurgeon’s responsibility?” Dr. Winfree and a fellow neurosurgeon, Dr. Sharona Ben-Haim, discussed the pros and cons of complex pain management in a point-counterpoint format.
Taking the “point” side, Dr. Ben-Haim argued that general neurosurgical training is enough to treat all cases of pain, even the most complex, including prescribing opioid medications when needed. As some subspecialties of neurosurgery have become more complicated and extensive, pain management has also become more complicated. Dr. Ben-Haim argued, however, that the neurosurgeon is still in the best position to understand the patient’s pain needs and fit them into the overall picture.
Taking the “counterpoint” side, Dr. Winfree argued that although neurosurgeons are trained to diagnose and treat pain, they may sometimes better serve their complex and chronic pain patients by calling in a dedicated pain management physician.
He explained, for example, that the management of a patient with complex and chronic pain, particularly one who has been on opioid medication for many years, “can be difficult, time consuming and fraught with complications. Most neurosurgeons cannot properly commit to the comprehensive management of these patients,” he went on, because most neurosurgeons do not have the advanced training in pain management that many of these cases require. Adding a pain specialist to the team broadens the patient’s treatment possibilities.
Dr. Winfree stressed that neurosurgeons should be prepared to treat routine postoperative pain and to prescribe opioids for short-term use as necessary. But when a patient’s needs become more complex or require long-term opioids, the neurosurgeon should consider calling in a pain specialist.
Although bringing in a pain specialist does mean adding another doctor to the mix, Dr. Winfree pointed out that in most cases patients with complex, chronic problems are already under the care of different subspecialists, such as an infectious disease specialist or a critical care specialist, as well as their neurosurgeon. “The management of pain in these patients is no different from the management of any other organ system,” he said. “It should be handled by the most appropriate specialist available, which is generally a pain management physician.”
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