“When to see a neurologist and when to see a pain management specialist for your nerve pain?”

Who should you see for your pain?

Medical specialties can be confusing at times, and even intimidating to the hurting patient who is just trying to find the right doctor for their symptoms. While the responsibility of a sound referral always falls on your primary care provider (PCP), it is still helpful to understand the different roles different physicians play in your management, so you know what to expect in the interview with them, and what you will achieve by the end of it. Dr. Awss Zidan is a board-certified neurologist and a pain management specialist, and can best explain the difference.

Where is your pain coming from? Dr. Awss Zidan explains:

First, let us dive into “pain” as a symptom. Pain is the unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Pain can arise from a musculoskeletal structure like the joints in our spine, from nerve injury like what is seen in diabetes (i.e. diabetic neuropathy), or from a combination of both like a disc herniation compressing the sciatic nerve. Pain can also arise from our inner organs, such as abdominal pain, or from a dysfunction of our nerves or brain pain centers, such as migraine attacks.

A neurologist or a pain management specialist?

Neurologists are physicians who successfully completed neurology residency, during which they learnt how to diagnose and treat a variety of brain, spinal cord, nerves and muscles diseases. They are the better equipped physicians in identifying the reasons for pain when it stems from nerve damage (i.e. neuropathy and sciatica) or from nerve or brain dysfunction (i.e. complex regional pain syndrome CRPS, headache…etc). They, however, may have limited tools in treating some of the causes of the pain. Most of these tools consist of anti-neuropathic medications.

Pain management specialists are physicians who completed pain management fellowship after their residency. They are typically anesthesia-trained physicians, or physical medicine and rehabilitation (PM&R) trained. They are proceduralists who are equipped to manage and treat the symptom of pain. They do so either by a combination of the different pain medications, or by procedures that alter the sensation of pain, either by injection the damaged tissue by steroids, by numbing/destroying the nerves transmitting the pain, or by altering their function.

Neurology and pain management are complimentary specialties:

 If you or your PCP suspect that your pain is stemming from a neural cause, then it may be helpful to see both specialists. The neurologist will work on identifying the reason behind your pain, explain to you the cause, and perhaps offer insights on what to expect from the treatment course. A pain management specialist can work with you in making a plan to eliminate or reduce some of the pain you are having.

Beware, too many cooks spoil the broth:

Dr. Awss Zidan warns that having different specialists can have its disadvantages; he has seen his fair share of patients who were treated for their headache by pain management physicians who performed procedures or prescribed medications that interacted with the treatment plan of the neurologist. He has also seen neurologists who, due to lack of training in the field of pain, failed to identify that the pain source is musculoskeletal and not neurologic, negatively affecting the treatment plan for their patients.

When in doubt, look for one who can do both:

There are a growing number of neurologists who are undergoing pain management fellowship, and hence becoming well rounded in identifying the cause of pain, and offering a symptomatic treatment for it. Dr. Awss Zidan is such a physician. You may want to seek one of these physicians in cases where you are not comfortable with having too many specialists, or when you feel the communication between the two of them is not as ideal as you want. More importantly, they can be a great resource when your pain condition falls on the line between the two specialties, such as having a headache due to neck arthritis and pain, or having neuropathy with incapacitating pain that anti-neuropathic medications cannot alleviate it.

More tips, tricks and updates on headache and pain? subscribe here to receive our newsletter in your email