Which Health Professional Should I See?

If you are experiencing pain or have an injury, there are many options for health professionals to treat your painful condition. So who should you see first? Going to your family doctor is usually the best first step, and he/she will direct you with initial treatments and referrals. However, sometimes you can go straight to another health professional or ask your doctor for a referral to someone on this list. I selected these few to emphasize because many patients have asked me about these options.

1. Physical Therapist: joint pain, new injury, old injury, chronic pain, weakness, balance/walking issues, shoulder pain, elbow pain, neck pain, mid back pain, low back pain, sciatica, pelvic pain, hip pain, knee pain, ankle/foot issues, gross motor delays in babies or children, muscle pain/strain, neurological injury (such as a stroke) 

2. Occupational Therapist: pain/injury of any part of the arm/hand, difficulty with fine motor tasks, hand/arm weakness, difficulty performing usual daily tasks, neurological injury (such as a stroke), developmental delay in babies or children

3. Chiropractor: new episode of spine pain, car accident, whiplash, chronic back pain, some areas of joint pain, alignment issues, low back/pelvis pain, sciatica

4. Massage Therapist: fibromyalgia, chronic pain, tight muscles, stress

MD Specialists for some common painful conditions:

1. Neurologist: nerve problems (numbness, tingling), neuropathies, neurological conditions (stroke, TIA, MS), unexplained weakness

2. Pain Management: chronic pain, need for injections (such as Cortisone), back pain

3. Orthopedist: specific for each joint. For example, find a shoulder specialist/surgeon if you have shoulder pain.

4. Neurosurgeon: new or chronic spine pain that may radiate away from the spine into the arm(s) or leg(s)

Always remember that you can choose your own health professional just like you select your pharmacy. Even if your doctor refers you to a specific therapist or specialist, you can request a referral to someone of your choice.

Will My Pain Respond To Medication?

CHEMICAL PAIN:
If your pain has a chemical component, it is more likely to improve with medication. This type of pain occurs when chemicals are released in the injured body part, and it includes inflammation. One way to know if your pain is chemical is if it is CONSTANT. This means you have pain throughout every day and it never goes away, no matter what position you are in. It may increase and decrease some, but it is always present. Chemical pain is not changeable with movement.  Typically chemical pain occurs in response to a traumatic injury or repetitive stress on that tissue over an extended period of time. If you have swelling from a new injury, your pain clearly has a chemical component. This type of pain may last for a short or long time, depending on the cause. 

MECHANICAL PAIN:
The other type of pain you may have is mechanical pain. Mechanical pain improves and worsens depending on your movements and positions. If sitting down eliminates your pain, your pain is more mechanical and likely is not chemical.  You fit into the mechanical pain category if you can identify specific activities that remove your pain, such as standing up, walking around, lying down, or stretching. Similarly, you know the specific activities that initiate your pain, such as standing, walking for 5 minutes, bending down, reaching a certain way, or lifting an object. For mechanical pain, moving a joint one way makes it feel worse yet moving it the opposite way decreases the pain. With time, as you find the symptoms improving, your overall joint movement also improves. If you have mechanical pain, it is less likely to respond to chemical treatment (medicine).

PHYSICAL THERAPY VS. PAIN MEDICINE:
It is possible for constant pain to be chemical or mechanical. But if your pain is not constant, you can rule out the chemical component! In that case, find a good Physical Therapist near you! If you suspect both components of pain, you may benefit from both medicine and Physical Therapy.

A new injury will have a chemical/inflammatory component for several days-weeks but as the healing process occurs, the constant pain will decrease so that it is no longer constant. Then the pain will occur mostly with movement of that tissue. If it is stressed excessively during that time (too much exercise or movement), it may cause more inflammation. It is important to follow your healthcare provider's instructions after a new injury. If you do not know when/how to start moving the body part after an injury, you would benefit from Physical Therapy.

Remember that these are not the only components of pain. Be sure to consult your physician about your pain so he/she can assess and diagnose the problem and refer you wherever is most appropriate for treatment.


Source: McKenzie R, May S. The Human Extremities: Mechanical Diagnosis & Therapy. 2000: Spinal Publications New Zealand Ltd, pages 61-72.