Next to the common cold, back pain is the second most common reason for people to visit a primary care physician. Physicians specializing in pain management have seen patients accessing their services at an increasing rate for a multitude of pain-related problems. The elderly are afflicted with wear- and tear-related issues to their joints and spines. Younger patients also seek their services for sports-related injuries and other recreationally or occupationally related injuries.

As pain management has become a recognized specialty in the field of medicine, primary care physicians and providers are more readily referring patients for chronic pain issues. “Pain management is getting more recognized,” says Dr. Ashar Afzal, who, along with Dr. Frank Hawkins, provides full-time pain management through the Allen Hospital Center for Pain Medicine, located at 3630 W. 4th St. in Waterloo. “I think there’s a lot more research into the mechanisms, biology and pharmacology of how to effectively manage pain,” Dr. Afzal adds.

Pain is defined by the International Association for the Study of Pain as an unpleasant sensation associated with actual or perceived physical or psychological trauma. Dr. Afzal explains that pain is not always linked together with something that has happened physically, but with how a person perceives pain. 10 to 15 years ago, pain was actually recognized as the “fifth” vital sign, along with temperature, pulse, blood pressure and respirations.

“People have different psychological structures,” Dr. Afzal comments. “People perceive pain differently and manage pain differently. Pain and depression are very closely linked. We try to assess this as a contributing factor to their pain complaint. We then incorporate the use of antidepressant medications to primarily manage their chronic pain but potentially to have the added benefit of helping with their underlying depression.”

Dr. Hawkins says treating pain — either acute or chronic — begins with a thorough evaluation, and conducting a history of the pain location and its intensity, characteristics and possible precipitating events. A physical examination is performed to determine from where the pain may be originating. Diagnostic studies are then utilized, if available, to help confirm the diagnosis of the source of the pain.

“If we can determine the nature of what is causing the pain, then we can decide if the patient may need the assistance of physical therapy, chiropractic care, a psychological evaluation, injections, or medications. We might incorporate over-the-counter medications or prescription medications to help in their recovery,” Dr. Hawkins adds. “The ultimate objective is to help reduce their pain to allow them to recover and be more functional with less pain. We take patients from evaluation, to treatment, to hopefully positive outcomes,” says Dr. Hawkins.

With advancements in pharmacology that allow the medications to better target the pain receptors, Dr. Hawkins and Dr. Afzal incorporate the latest advancements in medication delivery. These medications may be delivered orally, topically, trans-dermally and spinally via pump technology. They also provide injection therapy to the spine and joints. Additional services include spinal cord stimulation and certain spine fracture management procedures.

Drs. Afzal and Hawkins were both trained as anesthesiologists. Dr. Afzal completed a fellowship in pain medicine at the University of Iowa Hospitals and Clinics and is board-certified in anesthesiology with a subspecialty certification in pain medicine. Dr. Hawkins became interested in pain management after completing his residency training in anesthesiology over 23 years ago. He incorporated this discipline into his clinical practice beginning in 1993. He is board-certified in anesthesiology and certified by the American Board of Pain Medicine.

Dr. Afzal joined Cedar Valley Medical Specialists (CVMS) in 2002, and he, along with two other physicians, started the pain management practice for CVMS. Dr. Hawkins joined CVMS in 2004 and began practicing pain management along with Dr. Afzal in 2007. As the practice grew, it was no longer feasible to provide both anesthesiology services and pain management. They began practicing full-time pain management approximately four years ago.

Both physicians express the advantages of practicing under the umbrella of a medical group such as CVMS and the relationship that they have with UnityPoint Health-Allen Hospital. Allen Hospital provides the support staff to allow the clinic to run efficiently. This includes the clerical staff, radiology technicians, medical assistants and nurses that provide exceptional care to the clinic's patients.

“We have the resources in regard to a referral network within CVMS and UnityPoint Health where we can have confidence that we are sending our patients to colleagues who we respect and who we are certain will provide the best care to our patients,” notes Dr. Hawkins. “Being under this umbrella of these organizations allows us to provide our patients with the quality care they deserve.”

“CVMS also gives us an identity,” Dr. Afzal adds. “Cedar Valley Medical Specialists is a recognized name in the community and statewide. We are affiliated with an organization that has a highly trained network of physicians. We can rely on the resources it has, whether it be orthopedics, physical therapy, radiology or any other department that we may call upon to help us care for our patients.”