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A pain management specialist

Pain management must be done systematically according to the type of pain and its severity level in order to obtain optimal results. Therefore it is necessary to have an expert in pain management, who is equipped with a variety of pain management knowledge. In Indonesia there is no specific profession or license to become a pain management specialist. In this article the author tries to explain what is pain management specialist from various references abroad.


INTRODUCTION
Pain is an unpleasant subjective sensory related to tissue damage 1,2 . In general, it is categorized into two, namely acute and chronic pains 3 . The acute pain is the one that lasts from a few seconds to less than six months; it comes suddenly and is generally associated with physical injury, and usually decreases with the healing 4 . The chronic pain is constant or intermittent pain that persists over a period of time; it lasts for six months or more, the pain in cancer is one example of this kind 5 .
Pain is recorded as the most reasons that drive the patients to the hospital. It is estimated the prevalence of chronic pain is 20.6% of the world population. The total number of pain prevalence has never been studied in Indonesia, but it is estimated that the cancer pain is experienced by around 12.7 million people (5% of the population), rheumatic pain occurs in 23.6-31.3%, and lower back pain is suffered by as much as 40% of the population 6,7 .
When a patient feels the pain, he or she cannot enjoy their life. The discomfort will increase the stress response so that it affects psychological conditions, emotions, and quality of life. Each patient responds to the pain differently, ranging from grimacing, crying, to screaming and many others [8][9][10] .
Pain management aims to reduce or eliminate the pain with minimal side effects. So far the pain management is still mostly done by doctors and nurses, through pharmacological and non-pharmacological approaches 11 . Pharmacological therapy is usually done by a doctor by administering analgesic drugs as a pain killer. While nonpharmacological therapy is usually done independently by nurses without being dependent on other medical staff, such as giving stimulation and cutaneous massage, ice and heat therapy, distraction, guided imagination, deep breathing relaxation techniques and so on depending on the ability of individual nurses as well as existing facilities 12,13 .
The pain management sometimes is done between the patients. They help each other to reduce the pain they have, eventhough they may have different kinds of diseases.
This fact shows that pain management performed by health workers to them is inadequate. An epidemiological study examining pain management among the cancer patients found that half of cancer patients did not get an adequate pain treatment 14 .
The impresence of a specialist in the field of pain management is considered to be one of the factors. A specialist in the field is expected to deal with the problem systematically based on the disease and the patients' needs.

WHAT IS PAIN MANAGEMENT SPECIALIST?
A pain management specialist is a physician who has special expertise in studying, diagnosing, and treating all types of pain. A physician can be a doctor, nurse, or other health profession who is equipped with special training and is certified to deal with pain 15 .

QUALIFICATIONS TO BECOME A SPECIALIST PAIN MANAGEMENT
A pain management specialist is required to have a minimum of undergraduate education in health or medicine. After completing the education, the person who wants to become a pain management specialist must attend training and practice and he or she should pass an exam to get a pain specialist certificate 15,16 .

AUTHORITY OF A PAIN MANAGEMENT SPECIALIST
A pain management specialist must be given authority in both pharmacology and non pharmacology as the measures in dealing with pain problems among the patients 17,18 .

THE ABILITY TO HAVE FOR A PAIN MANAGEMENT SPECIALIST
A pain management specialist must have the ability to assess the causes of pain, diagnose them including their type and severity, provide appropriate interventions to reduce or eliminate pain with minimal side effects based on the evidences based practice. He or she must be equipped with knowledge of various treatments to reduce pain such as knowledge of various analgesic drugs, their functions and mechanisms of action, the use of implantable devices (for example pumps, stimulators), physical therapy, and complementary methods (for example biofeedback, relaxation, hypnosis, meditation, acupuncture, cognitive behavioral therapy) 18,19 .

PAIN MANAGEMENT SUB SPECIALITS
A pain management specialist may have special management abilities in certain fields, for example, he specializes in the treatment of acute pain (for example post-operative pain), specialists in handling cancer pain, arthritis, headaches (eg migraine, etc.), back and neck pain, neuropathic pain, addiction pain and etc 16 .

PAIN MANAGEMENT SPECIALIST AND PAIN CLINIC
It is a health care facility that focuses on the diagnosis and management of chronic pain. A pain management expert, is expected to open an independent practice service that specializes in dealing with chronic pain. This is acually a good opportunity, because it is still rare to find 20,21 .