The Roanoker - July/August 2018 - 67

As a specialty,
pain management has evolved from a hospital-based
function performed mostly by anesthesiologists to
predominantly outpatient treatment with providers
having a variety of training backgrounds. This was
partially driven by the rise of the palliative care model,
for patients with a limited life expectancy.
After a conversation with your primary care provider,
a referral to the appropriate pain medicine specialist
is expected to increase the success rate and reduce
the sub-specialty runaround. Physical medicine and
rehabilitation (PM&R) physicians, also known as
physiatrists, are experts in musculoskeletal conditions,
much like an orthopaedist, but they do not do surgery.
These physicians, as well as neurologists, may be
trained in providing pain management interventions
such as physical therapy, medications, orthoses, nerve
blocks and implants. Mental health providers may also
be part of a pain management team, both for helping
patients cope with chronic pain and also to help with
drug addiction issues.
Dr. Monty Baylor, a partner at Blue Ridge Pain
Management, associate professor at Edward Via College
of Osteopathic Medicine and an attending physician
at HCA Lewis-Gale Hospital, reminds us that "each
patient is different and a holistic approach is needed."
Baylor emphasizes that he is not just treating a
symptom, but rather the whole person. When he does
an assessment of needs, he looks for physical changes
that can be made by medical interventions such as nerve
blocks, but also the overall function of the patient in
their current lifestyle. While some patients might never

be pain-free, he can help improve quality of life and
restore function in many cases.
Baylor suggests that his treatment paradigm is like
a buffet table. While he has a vast array of options
for patients, including medications, physical therapy,
cognitive behavioral therapy, nutritional counseling and
surgical intervention, not every patient needs to eat from
the entire buffet. To identify the patient's problem and
how pain is being generated, he has a comprehensive
program of testing, risk stratification and compliance
monitoring that includes pill counts, urine tests and
psychological screening. If a patient does not honor
his or her agreement with him, he does not attempt to
"make them feel subhuman," as he put it. For example, if
they use an illicit drug and it shows up on a urine screen,
they may no longer be prescribed controlled drugs, but
may still be offered other methods of treatment.
Baylor advocates that patients and referring
physicians learn about the background of their pain
management specialist. He is wary of physicians who
claim they are pain management physicians, as the law
allows many diverse backgrounds to legally advertise
and practice under the specialty.
The downside, especially in rural areas, is that many
of these non-board-certified providers end up running
so-called "pill mills." Some of these
practices offer plans of a monthly
fee paid in cash, and no insurance
is billed. Opioids may be the only
treatment offered, without such
adjuncts as physical therapy and

Dr. Monty Baylor
COURTESY OF BLUE RIDGE PAIN MANAGEMENT

TheRoanoker.com

JULY/AUGUST 2018

67


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The Roanoker - July/August 2018 - Intro
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