Interview with Dr. Steven Passik – Question #5

Question #5: Can you tell me what a pain specialist is and what training should be required for a pain doctor?


Dr. Lynn Webster [Dr. Webster]: Hello, this is Dr. Lynn Webster. Thank you for listening to the Pain Topics series of interviews on Today I am back with Dr. Steven Passik to continue our discussion. Dr. Passik is a clinical psychologist and vice president of clinical research and advocacy at Millennium Health. Thank you for joining me, Dr. Passik. Today, I’d like to ask if you can you tell me what a pain specialist is and what training should be required for a pain doctor?

Dr. Steve Passik [Dr. Passik]: Well, I think, clearly – first of all, it would have differ amongst the different professions involved in treating pain.  Like I don’t think every physical therapist is automatically a chronic pain equipped physical therapist.  I don’t think that of every psychologist.  You can call yourself pain psychologist with no training other than any other clinical psychologist has. But I know you’re asking largely with regard to pain physicians here, and I think these are all questions with the obvious parts.  You have to know how to make a diagnosis.  You have to have the specialized neurology, the anesthesiology, you have to know how to do it and then you have to be equipped with and be able to do or recognize the indications for particular treatments that you don’t you do.  So, you have to be – this is not just straight neurology and it’s not the one hour of pharmacology.  You have to have specialized training in the drugs, you have to have specialized training in pain, and pain diagnosis.  I mean the kind of people that run around saying someone has low back pain as if low back is a diagnosis.  It’s just unbelievable to me because there are 50 different syndromes that could be in that category and the sophisticated docs are the ones who know the difference amongst them and that’s just one pain location that I’m talking about.  I also think that you have to have training in addictions to go along with it and finally, I really believe that you have to have the psychological kinds of training that it’s not the kind of thing that when you’re a resident and you go and do your psych rotation and you’re in the psychiatric hospital dealing with bipolar and very severe depression and schizophrenia, I think there’s a kind of psychology here that’s extraordinarily important and it has a lot of more to do with how do you mobilize people to make changes in their life and lifestyle when they are downtrodden and/or completely resistant in making those changes.  And I mean I can speak to myself as a psychologist.  It’s not like I got all kinds of training in how to move a reluctant person from point A to point B.  I got a lot of theories and I learned techniques but I think you really have to be an expert in human motivation.  I often joked when I give lectures that like, if ran a medical residency program and it was time for you to do your psych rotation, I would take you down to use car a lot and have you watch like a master of moving a reluctant person to action.  But I think this is what’s largely missing in a lot of medical training I think because whether you’re treating high blood pressure or diabetes or chronic pain, lots of people are going to have to give up a lot of things that are tied up in immediate gratification and reward that they don’t necessarily want to give up if they’re gonna live better and longer, and ultimately cost the healthcare system less.  And I don’t think that a lot of physicians have the time or the training to really be a change agent in the life of their patient and that’s the kind of training that they need in addition to the pain knowledge that they need to have and the addiction knowledge that they have to have.

Dr. Webster:  So, the incentives are going to have to change, though, for that to occur?

Dr. Passik:  Yeah. Well right, because again, I just identified a whole slew of interventions and discussions that’s basically talking to people and thinking about them which, again, is on the low rung of the ladder when it comes to how we pay for medical care.

Dr. Webster: Of course all physicians treat people in pain, but we may need to reexamine who is considered a pain specialist. That’s something that maybe we can discuss at a future time.

Thank you for participating in today’s interview, Dr. Passik, and I want to thank the listeners for tuning in to Pain Topics on Please come back tomorrow for the sixth and final question with Dr. Passik. If you aren’t already, please follow me on Twitter @LynnRWebsterMD. Also, stay tuned to my blog for more information about my upcoming book and documentary, titled The Painful Truth, to be released this fall. Thank you and have a great day.

Steven D. Passik, Ph.D.
Vice President of Clinical Research and Advocacy, Millennium Health

Steven D. Passik, PhD, is vice president of clinical research and advocacy at Millennium Health. Before coming to Millennium, Dr. Passik was professor of psychiatry and anesthesiology at Vanderbilt University Medical Center in Nashville, Tenn. He was section co-editor for the opioid pain and addiction section of Pain Medicine, served on the editorial board of the Journal of Pain and Symptom Management and has been a reviewer for many peer reviewed journals, including The Clinical Journal of Pain. Dr. Passik was editor in chief of the National Cancer Institute’s PDQ Supportive Care Editorial Board. He was named a fellow of Division 28 of the American Psychological Association (Psychopharmacology & Substance Abuse) and awarded a Mayday Fund Fellowship in Pain and Society. An author of more than 200 journal articles, 60 book chapters, and 59 abstracts, he speaks nationally and internationally on pain, addiction and the pain/addiction interface. Dr. Passik received his doctorate in clinical psychology from the New School for Social Research, New York, and was a chief fellow, Psychiatry Service at Memorial Sloan-Kettering Cancer Center in New York.

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