We have always encouraged a step-care model for treating our patients in pain. Start with the least expensive, least invasive procedures before trying the more expensive, complicated, and invasive procedures.  So when you first experience pain, your primary care physician, or PCP, would be your first stop.

The Institute of Medicine (IOM) made the following key recommendations[1]:

  1. Use non-steroidal anti-inflammatory medications (NSAIDs) and acetaminophen (Tylenol) as first line pain medication.
  2. Referral from primary care physicians (PCPs) to specialists for back pain was not recommended. Referral  to physical therapists was recommended.
  3. Use of imaging, such as MRI, CT scan, or x-ray, were not recommended.

This may be easier said than done.

A recent article explored the interaction between patient and doctor about pain complaints. Patients were concerned that their pain wasn’t being taken seriously, and they feared that their doctors didn’t believe how much pain they were experiencing. Physicians claimed difficulty with time constraints, stating that they also had to discuss other health issues in one short visit. They also claimed that sometimes they did “doubt the reality of their patients’ pain.” [2]  The authors conclude that “some communication strategies may provide opportunities to mitigate tensions and strengthen the [patient-] primary care relationship.”

The American Academy of Pain Medicine and the American Board of Pain Medicine are exploring ways for PCPs to be educated and supported to understand and comfortably treat the patient with chronic pain. You, the patient, can help by organizing and writing down your thoughts before going to see your doctor. Everyone benefits with improved communication skills from all parties involved.



[1] Mafi, John N., MD, McCarthy, Ellen P, PhD., Davis, Roger B, ScD., Landon, Bruce E, MD, MBA, MSc. “Worsening Trends in the Management and Treatment of Back Pain.” JAMA Intern Med 173 (2013): 1573-1581.

[2] Bergman, Alicia A., PhD, Marianne S. Matthias, PhD, Jessica M. Coffing, MPH, and Erin E. Krebs, MD, MPH. “Contrasting Tensions Between Patients and PCPs in Chronic Pain Management: A Qualitative Study.” Pain Medicine 14 (2013): 1689-697.


Filed under: pain management

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