A distinction needs to be made between a referral to palliative care and a referral to a pain specialist. It is important to remember that a palliative care program uses a team approach, usually consisting of palliative care-specialist physicians, nurses and social workers. Other disciplines that may be part of a palliative care team are nurse practitioners, physician assistants, psychiatrists, psychologists, nutritionists and case managers. The medical staff of the palliative care team are trained, and often licensed, in assessing and treating physical pain throughout the course of illness. At this point in time, receiving palliative care is not contingent on insurance and the palliative medical team cannot bill insurance for the services.

There are some hospital and clinics that have separate pain management specialists who are not part of or associated with palliative care. As with the palliative care medical team, these are also specialists who have been trained and licensed in pain management. Often these pain specialists are anesthesiologists if they are physicians or nurse anesthetists if they are nurses. These specialists can, for the most part, bill for their pain management expertise.

Some hospital-based palliative care programs are now joined with pain programs. The result is a singular program referred to as “Pain and Palliative Care”. The combining of these two programs into one program accomplishes a few things. It allows the palliative care team to utilize their pain management expertise in a broader patient population and gives them the opportunity to bill for their pain management services, thus subsidizing the palliative care program.

Your father might have received a referral to either an individual pain specialist or a Pain and Palliative Care program. Either way, it is important that your father follow-up with the referral for his own physical and emotional well-being. Pain associated with cancer is complicated because the causes of pain can be variable and change from day to day. As for his resistance, it might be helpful for you to explain that pain management is an important part of his overall treatment program. You can also explore his concerns and provide information that might help clarify. For more information, please read our publications:

• Opening the Doors to Effective Pain Management
• Controlling Cancer Pain