Medical Specialties with Expertise in Pain Medicine

Pain medicine is a multidisciplinary field focused on the diagnosis, treatment, and management of acute and chronic pain. Because pain can stem from a wide range of underlying conditions, including neurological, musculoskeletal, surgical, and psychological, multiple medical specialties contribute expertise to pain medicine. These specialties often collaborate to provide comprehensive care to patients suffering from pain that impacts their quality of life.

Among the medical specialties involved in pain medicine, anesthesiology occupies a central role, particularly for interventional procedures and the management of chronic pain. Many anesthesiologists pursue additional fellowship training in pain medicine, through which they gain experience in nerve blocks, spinal injections, epidural procedures, and neuromodulation techniques such as spinal cord stimulation. Their background in pharmacology and physiology also makes them well equipped to manage complex medication regimens and to assess the systemic effects of pain treatments ^1–3.

Neurologists play an important role in pain medicine, especially in diagnosing and treating pain related to the nervous system. Conditions such as migraines, neuropathy, multiple sclerosis, and central pain syndromes fall within their domain. Neurologists often assess patients with unexplained pain or symptoms that suggest nerve involvement and may use diagnostic tools such as electromyography or nerve conduction studies. Their understanding of brain and spinal cord function helps them contribute to the development of long-term management strategies for neurological pain disorders ^4–7.

Specialists in physical medicine and rehabilitation, also known as physiatrists, are very involved in the management of musculoskeletal pain, sports injuries, and post-surgical pain syndromes. They focus on restoring function and mobility through non-surgical means when possible, using tools like joint injections and nerve conduction assessments. These physicians are especially skilled at managing chronic pain conditions such as fibromyalgia or complex regional pain syndrome, for which rehabilitation and multidisciplinary care are essential ^8–10.

Pain is also a psychological experience. Psychiatrists and psychologists provide expertise in the emotional and behavioral aspects of pain, particularly in cases where anxiety, depression, or trauma play a role in pain perception. Cognitive behavioral therapy (CBT), biofeedback, and mindfulness-based approaches are frequently used by mental health professionals to help patients develop coping strategies and reduce the emotional burden of chronic pain. In some cases, psychiatrists also manage medications for comorbid psychiatric conditions that can exacerbate pain ^11–14.

Surgical specialists like orthopedic surgeons and neurosurgeons become involved in pain medicine when structural issues are the root cause of pain, such as spinal stenosis, herniated discs, or joint degeneration. While their primary role is operative, these specialists also contribute to pain management through diagnostic imaging, pre- and post-operative care, and occasionally procedures aimed to relieve pressure on nerves or joints ^15–19.

Rheumatologists specialize in autoimmune and inflammatory disorders that often result in chronic pain. Their expertise in diagnosing and managing systemic inflammation is crucial to preventing long-term joint damage and reducing pain in patients with complex immune-mediated conditions ^20–22.

Pain medicine is supported by a diverse array of medical specialties, each offering unique skills and perspectives. The most effective pain management often results from a multidisciplinary approach, where different experts contribute to a unified plan tailored to the patient’s physical, emotional, and functional needs.

References

1. Pain Medicine. https://www.asahq.org/advocating-for-you/pain-medicine.

2. de Barros, G. A. M., Kraychete, D. C., Lineburger, E. B. & Módolo, N. S. P. Anesthesiology and pain medicine. Braz J Anesthesiol 72, 549–552 (2022). DOI: 10.1016/j.bjane.2022.07.007

3. Pain Management – Pain Types & Treatments| Made for This Moment. Made For This Moment | Anesthesia, Pain Management & Surgery https://madeforthismoment.asahq.org/pain-management/.

4. Schuster, N. M. & Hascalovici, J. R. Emerging Subspecialties in Neurology: Pain medicine. Neurology 91, 1025–1028 (2018). DOI: 10.1212/WNL.0000000000006580

5. Ho, K. W. D. & Jones, R. Opinion and Special Articles: Pain medicine. Neurology 91, 483–486 (2018). DOI: 10.1212/WNL.0000000000006130

6. Electromyography (EMG). Cleveland Clinic https://my.clevelandclinic.org/health/diagnostics/4825-emg-electromyography.

7. Nerve Conduction Studies. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nerve-conduction-studies (2024).

8. About Physical Medicine & Rehabilitation. www.aapmr.org https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation.

9. Overview of Physical Medicine and Rehabilitation (PM&R). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/overview-of-physical-medicine-and-rehabilitation (2020).

10. Lee, J.-Y. et al. Comparison of complex regional pain syndrome and fibromyalgia. Medicine (Baltimore) 98, e14452 (2019). DOI: 10.1097/MD.0000000000014452

11. Goesling, J., Lin, L. A. & Clauw, D. J. Psychiatry and Pain Management: at the Intersection of Chronic Pain and Mental Health. Curr Psychiatry Rep 20, 12 (2018). DOI: 10.1007/s11920-018-0872-4

12. Griffith, L. J. Why Psychotherapy Helps the Patient in Chronic Pain. Psychiatry (Edgmont) 5, 20–27 (2008).

13. Lim, J.-A. et al. Cognitive-behavioral therapy for patients with chronic pain. Medicine (Baltimore) 97, e10867 (2018). DOI: 10.1097/MD.0000000000010867

14. Zeidan, F. & Vago, D. Mindfulness meditation–based pain relief: a mechanistic account. Ann N Y Acad Sci 1373, 114–127 (2016). DOI: 10.1111/nyas.13153

15. Orthopedic Doctors Vs Interventional Pain Management Specialists. https://goholistiq.com/orthopedic-doctors-vs-interventional-pain-management-specialists/ (2024).

16. Bouri, F. et al. Orthopedic Professionals’ Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals. Healthcare (Basel) 6, 98 (2018). DOI: 10.3390/healthcare6030098

17. How Neurosurgeons Treat Chronic Pain. AANS https://www.aans.org/patients/conditions-treatments/chronic-pain/.

18. Neurosurgery Pain Management | Mount Sinai – New York. Mount Sinai Health System https://www.mountsinai.org/care/neurosurgery/services/pain-management.

19. Re-thinking pain management—why orthopedic surgeons have a role to play in battling the opioid crisis. https://www.aofoundation.org/spine/about-aospine/blog/2023_07-re-thinking-pain-management.

20. Fitzcharles, M.-A. & Shir, Y. Management of Chronic Pain in the Rheumatic Diseases with Insights for the Clinician. Ther Adv Musculoskelet Dis 3, 179–190 (2011). DOI: 10.1177/1759720X11408999

21. What Is a Rheumatologist? Cleveland Clinic https://my.clevelandclinic.org/health/articles/22335-rheumatologist.

22. Tehrani, M., Aguiar, M. & Katz, J. D. Narcotics in Rheumatology. Health Serv Insights 6, 39–45 (2013). DOI: 10.4137/HSI.S10461