hcpsPart 1

Responses to What’s Your Pain IQ, revealed a gem; over a quarter missed which healthcare providers treated pain. It is often confusing about who could, should and does treat pain. In order to provide comprehensive, patient-centered, multi-modal pain care—many healthcare professionals are involved. There is not just one type of pain specialist, just as there is not just one type of pain treatment which is most effective. This article is dedicated to all those special men and women who help ease the agony, improve the function and enhance the daily living of their patients with pain. Each of these providers can plan a critical role in someone’s’ pain care.

What is the difference between a family doctor, a general practitioner and an internist?

  • Family physician (FP)- is a medical doctor (MD) or doctor of osteopathic medicine (DO) who has completed a residency in family medicine. They provide medical care to the entire family, from birth to death and some choose to deliver babies as well. A family practice physician (FP) diagnoses and provides treatment to the individual, regardless of the medical problem. FPs may conduct minor surgeries within their clinic setting.
  • Internal medicine (Internist) – is a medical doctor (MD) or doctor of osteopathic medicine (DO) who has completed a residency in internal medicine and only cares for adults (usually age 18 and older). According to the American College of Physicians (ACP), theyapply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.”
  • General practitioner (Generalist) – is a medical doctor (MD) or doctor of osteopathic medicine (DO) who, according to the American Academy of General Physicians (AAGP), chooses not to limit their practice to any particular area of medicine or specialty. These physicians will generally see any patient who desires to see them and if the medical problem is more complicated than these physicians can handle, then these physicians will refer the patient to a specialist for specialty care. They treat acute and chronic illnesses; he/she provides preventive health care and health education. Some GPs conduct minor surgeries within their clinic setting.

Therefore, your primary care physician/provider (PCP) could be an FP, Internist or Generalist.

What is the difference between a psychiatrist, psychologist and a physiatrist?

While the first two study the brain, emotions, feelings and thoughts, there is a distinct difference between the two fields of study. The third specializes in physical medicine and rehabilitation.

  • Psychiatrist- is a medical doctor with training in psychology who specializes in the diagnosis, treatment, and prevention of mental health disorders and emotional problems.  A psychiatrist has extensive medical training and understands the body’s functions and complex relationships between medical illness and emotional illness which makes them well qualified to distinguish between psychological and physical causes of both mental and physical distress. Psychiatrists often treat patients suffering from depression related to chronic pain as they can provide counseling, behavioral therapy and can prescribe medications, such as antidepressants.
  • Psychologist- has either a master’s degree (MA) or doctorate (Ph.D.) in psychology. They may also have other qualifications, including board certification and additional training in a type of therapy. A clinical psychologist works at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals. They specialize in diagnosing and treating diseases of the brain, emotional disturbance, and behavior problems by using talk therapy. Some psychologists complete further training that focuses specifically on the treatment of chronic pain. Psychologists can help people with stress relief, as well as coping with chronic back or neck pain. They can also treat depression, which is fairly common for patients suffering from chronic pain. A psychologist is not licensed to write prescriptions.
  • Physiatrist- is a medical doctor (MD) or doctor of osteopathic medicine (DO) who specializes in a wide variety of conservative treatments for the musculoskeletal system; they do not perform general surgery buy may performed interventional services, such as specialized injections (epidural steroid injections, selective nerve root blocks) and minimally invasive procedures. Physiatrists diagnose and treat both acute pain and chronic pain and musculoskeletal disorders. They can order and interpret all types of spine imaging (X-ray, CT, and MRI), perform specialized nerve tests (EMG) to find the location and severity of nerve damage and may practice osteopathic manipulations. Physiatrists have varying degrees of specialization and often practice as part of integrated spine centers. They commonly treat back pain, neck pain, work or sports-related injuries, fibromyalgia, myofascial pain, arthritis, tendonitis, spinal cord injuries. Typical treatments may include, exercise, stretching, heat/ice, TENS units, prescription medications and massage therapy. Their primary focus is to help individuals regain or maintain as much function as possible and help with coordination of that care.

What is the difference between a neurologist and a neurosurgeon?

  • Neurologist – is a medical doctor (MD) or doctor of osteopathic medicine (DO) who is specializing in the nervous system. Neurologists deal with problems like seizures, strokes, epilepsy, Parkinson’s disease, headaches, tremor, Alzheimer’s, multiple sclerosis and various forms of pain and peripheral nerve problems like numbness and burning. Neurologists are trained to perform a detailed examination of all the important neurological structures in the body which includes the nerves of the head, neck and spine to all areas served; the muscular strength and movement, sensation, balance testing, ambulation, and reflex testing. This examination can be helpful in distinguishing a primary neurological problem (e.g. multiple sclerosis) from a musculoskeletal disorder. Neurologists use many types of medication to treat nervous system problems; many specialize in headache. A neurologist may refer a patient to a surgeon for a surgical evaluation, but does not perform surgery.
  • Neurosurgeon – is a medical doctor (MD) or doctor of osteopathic medicine (DO) who focuses on the surgical treatment of patients with neurological conditions; they are trained in the diagnosis and treatment of disorders of the brain, spine, spinal cord, nerves, spinal & brain blood vessels and the skull. Though they are commonly thought of as brain surgeons, most perform surgeries on the spine. In larger medical facilities, there may be a select number of neurosurgeons who specialize in brain surgery while others specialize on surgery of the spine. In smaller cities and hospitals, neurosurgeons will often handle both conditions.

What is the difference between an orthopedic surgeon and an osteopath?

One way the two professions are linked is they both work with the musculoskeletal system.

  • Orthopedic Surgeon (Orthopedist) is a medical doctor (MD) or doctor of osteopathic medicine (DO) who focuses on the workings of the musculoskeletal system. Orthopedic surgeons are trained to diagnosis and treat spinal disorders, arthritis, sports injuries, trauma, and fractures. If you have a fracture of a long bone, need a joint replaced, or experience trauma that impacts a bone, you will most likely need an orthopedic surgeon. Orthopedic surgeons can choose to practice general orthopedics or specialize in certain areas of the body (for example, foot, hand, shoulder, spine, hip, or knee), or in a specialized area of orthopedic care (for example, sports medicine or trauma medicine). There are orthopedists that may specialize in several areas and may collaborate with other specialists, such as neurosurgeons, rheumatologists, or physiatrists in caring for patients.
  • Osteopath is doctor of osteopathic medicine (DO). Osteopathy – is a system of health care medicine is based on a philosophy that combines current medical practice with the needs of the individual as a patient. Practitioners take the whole-person approach and deal with both the physical and mental needs of their patients; they are taught that illness and physical trauma affects the body’s ability to move and the flow of fluids inside the tissues as well as the structure and texture of the tissue. They may use a technique called osteopathic manipulative treatment (OMT) to treat illness and injury. Osteopaths can prescribe medicine and other conventional treatments. They can perform different tasks depending on their specialty and are often found in the areas of internal medicine, obstetrics and gynecology, pediatrics and primary care. Osteopaths in family practice and obstetrics deliver babies, while pediatric osteopaths provide well-child care and school physicals.

There are other healthcare professionals who treat pain, either as part of their ongoing practice or as specialists holding certifications as a sub-specialty in pain medicine, pain management and/or palliative care.

  • Rheumatologist– is a medical doctor (MD) or doctor of osteopathic medicine (DO) who specializes in a wide variety of chronic musculoskeletal diseases, including osteoarthritis, rheumatoid arthritis, musculoskeletal pain disorders (involving joints, muscles and bones), fibromyalgia, certain autoimmune diseases, osteoporosis, and tendonitis. Many types of rheumatic diseases are difficult to identify, and rheumatologists are trained to accurately diagnose musculoskeletal disorders so that appropriate treatment can begin early. Many are board certified by the American Board of Internal Medicine.
  • Anesthesiologist– is a medical doctor (MD) or doctor of osteopathic medicine (DO) who is best known as the one who administers anesthesia during surgery. Yet, an anesthesiologist also provides medical care and consultations in other situations in addition to the operating room, since by definition anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery. This may include medical evaluation before surgery, consulting with the surgical team, providing pain control and support of life functions during surgery, and supervising care after surgery and medically discharging the patient from recovery. Some anesthesiologists complete pain fellowships and provide interventional pain treatments like injection therapy (such as epidural steroid injections), implantable devices (like spinal cord stimulators) and other minimally invasive procedures for pain. They may practice in a variety of settings, such as an inpatient and/or outpatient pain management clinic or an integrated pain center. If you live with pain and are planning to have surgery, it is a good idea to meet with your anesthesiologist in advance, so together, your pain needs can be addressed before, during and after surgery.
  • Endocrinologist– is a medical doctor (MD) or doctor of osteopathic medicine (DO) who is in the subspecialty practice of internal medicine. Endocrinology deals with diseases resulting from the dysfunction of one or more of the hormonal systems in the body. The most common conditions that come to the attention of an endocrinologist are diabetes, obesity, thyroid and parathyroid dysfunction and disorders of sexual and reproductive function.
  • Chiropractor– is NOT a medical doctor (MD) or doctor of osteopathic medicine (DO). According to the American Chiropractic Association (ACA), “chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.  Chiropractic care is used most often to treat neuromuscular and/or musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.” Practitioners might be referred to as chiropractic physicians or doctors of chiropractic. They use integrative medicine in their practices like, therapies using water, light, ultrasound, massage, acupuncture and heat. They provide guidance about nutrition, exercise, lifestyles and stress management. Chiropractors do not perform surgery nor prescribe medications and can practice only in the U.S. where they are licensed.

What is the difference between and physical therapist and an occupational therapist?

  • Physical therapist or Physiotherapist (PT)– are not doctors; they are skilled healthcare professionals who become state licensed practitioners after obtaining specialized training  which requires a bachelor’s degree from an accredited 4-year college or university; it is not common for a PT to continue on and obtain a doctorate (PhD). A referral from medical specialists like orthopedic surgeons, physiatrists, neurosurgeons is commonly required. Physical therapist’s encourages their patients to use their own muscles to further increase flexibility and range of motion before finally advancing to other exercises improving strength, balance, coordination, and endurance. To relieve pain and reduce swelling, physical therapy often includes the use of modalities, or passive physical therapy, such as electrical stimulation, hot packs or cold compresses, and ultrasound. When necessary, therapists teach patients to use assistive and adaptive devices (such as crutches) and frequently teach patients exercises to do at home to expedite their recovery. Some physical therapists treat a wide range of ailments; others specialize in areas such as orthopedics, sports medicine, or neurology. According to the American Physical Therapy Association (APTA), PT’s provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.
  • Occupational therapists (OT)– are not doctors; they are skilled healthcare professionals who become state licensed practitioners after obtaining specialized training which requires a master’s degree in occupational therapy. OT works with specific therapy programs to improve the patient’s abilities to carry out normal daily activities. The evaluation of work and home environments and recommendations on necessary adaptation helps the patient achieve maximum benefits. The OT will also make recommendations for adaptive equipment and will provide training in the use of the adaptive equipment to help and replace lost function. They also provide guidance to family members and attendants in the safe and effective methods of caring for individuals.

Is there overlap between an OT and PT? The two professions have differences in their focus, yet there is a crossover between them. The OT therapist is often involved in helping to educate people on how to prevent and avoid injuries and the healing process, just like a PT.  Physical therapists in turn help patients improve their ability to do daily activities through education and training. While there is crossover between the two, they both play very important roles and are specialized in their areas of expertise. In many situations, both PT and OT professionals will be involved in someone’s rehabilitation.

There are others who contribute greatly to the pain care of others. Watch for Do You Know the Difference? Part 2 which will be posted in our next issue of the Pain Communicator. We will discuss the various integrative medicine practitioners from acupuncturist, massage therapists, yoga instructors and many more.

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