Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: What kind of doctor is best for me?
An area that comes up in question with patients is often “What kind of doctor’s best for me?” and that’s not an easy question because the traditional area of trigeminal neuralgia was neurology. That’s who the patients got referred to. And when the condition was either recognized as trigeminal neuralgia or just simply a face pain, it often went to primary care, and then ENT, dental and then often it got finally recognized well maybe you should see a neurologist. In neurology, my training growing up in the 80’s and 70’s was often the only place that dealt with trigeminal neuralgia. And if there was a consideration for a posterior fossa decompression surgery, it went to the neurosurgery group who then often referred it back for medication management. That’s changing a little bit. It has to do with who is doing medication management and under what situation. Neurology has always been see the patient, examine the patient, and since we deal with epilepsy, and Alzheimer’s, and MS and all these conditions that are very medication management oriented, we are very used to doing that.
One of the things I’m seeing changing is as we get into some of the more controversial and complex medications such as long-acting narcotics or potent narcotics, there’s a whole issue of should you use it or not and we can talk about that but the question now becomes “Who’s going to prescribe those, monitor them, and follow them?” A lot of neurologists don’t like using the narcotics. You have to have a different set of training, a different set of bookkeeping and recordkeeping. So they’ll often send patients to what’s known as a pain clinic.
Pain clinics are generally more oriented toward nerve blocks. And yes they use the more complex narcotic medications but patients come in and they’re often confused “Well, who should I see?” I always feel that you have to consider trigeminal neuralgia as first and foremost medication management is the old mainstay, it’s the time honored treatment. And the advent of using other things such as the nerve blocks which are done in pain centers has to be a part of it but patients have to determine what’s the best for them. If they’re just doing blocks and they’re not getting medication management, they’re probably not getting the best treatment they can get for them. If they’re just doing medication and they’re not really considering any of the Botox or nerve blocks, maybe they need to start a format.
In this day and age, what I’ve seen is you may have to kind of have a team approach and it may not be a team in one place. The patient may have to create his own team approach and help to kind of orchestrate the information exchange.