Anesthesiologist’s vs Physiatrist’s Approach to Pain Medicine: Exploring the Overlap Through a Medical Student Lens

by Coleman Yamakoshi

“I want to be a doctor who takes away the pain.” Which specialty comes to mind when you hear that? Before medical school, I believed that alleviating pain was the essence of every doctor’s role. But after three years of training and one year to go, I’ve come to realize that while nearly all physicians encounter pain, some specialties are uniquely equipped and specially oriented to address it.

Pain medicine is a prominent fellowship and a shared destination across several different residency paths. These different residency routes reflect how different fields conceptualize and address pain. Anesthesiology and Physical Medicine & Rehabilitation (PM&R) are two such specialties. One often works behind the scenes in operating rooms; the other frequently leads multidisciplinary teams in rehab hospitals or outpatient clinics. But both are deeply committed to improving quality of life, and both see pain as a critical barrier to overcome.

Pain is everywhere in the hospital – whether the sharp radiating pain of sciatica, the gnawing pain of a peptic ulcer, or the overwhelming pains of childbirth – pain can disrupt the comfort, function, and even identity of a patient. That is where the role of both anesthesiologist as well as physiatrists come into play, albeit through different vantage points. Anesthesiologists are adept in providing care for acute and chronic pain. They often are the initial responders to pain, intervening through epidural injections, nerve blocks, or neuromodulation. Physiatrists approach pain by targeting its impact on movement and function, crafting strengthening plans, coordinating with physical and occupational therapy, and managing pharmacological regimens that open the path to restoration.

My school offered a two week elective rotation in clinical anesthesiology that gave me a snapshot of the procedural skills, work environment, and goals of anesthesia. I saw the precision of utilizing ultrasound-guided nerve blocks to prepare a patient for surgery and set them up for a less painful and quicker recovery. Epidural injection, whether for a pregnant woman or an elderly man dealing with a persistent radiculopathy, provided almost instantaneous relief. The pace of their day was quick, moving from one procedure to the next throughout the hospital as they administered the treatments that would allow a patient to get by at least one more day. Their plans were made on their feet, deciding things like the best route to administer the nerve block and what pharmacologic agent to use. Their work creates windows of relief and opportunity for definitive intervention. 
Physiatrists deal with pain on a regular basis as well. Rather than focusing on decreasing pain, however, they strive to increase function. Pain is viewed not as a pathology to be palliated, but a barrier to be navigated. They are much more interested in the patient’s history of functionality, as well as their current ability to accomplish the tasks of daily living. Do you enjoy living a very active lifestyle? Do you play with your grandchildren? What are the physical demands of your work? This function-first perspective allowed them to set a goal and create tailored steps to achieve that level of functionality.

The overlap between anesthesiologists’ and physiatrists’ approach to pain plays out clearly in interdisciplinary pain clinics. They often work side-by-side in these pain clinics, managing the most complex, chronic, or treatment-resistant pain. Both specialties employ interventional procedures such as epidural steroid injections, radiofrequency ablations, and spinal cord stimulation, pillars of modern pain management; however, they may differ in how they prioritize and integrate these techniques. Anesthesiologists readily employ pharmacologic and procedural interventions in order to achieve prompt symptom relief. Physiatrists, while also trained in these procedures, tend to emphasize integrating these techniques into their broader goals of rehabilitation and regain of function. They will often revert to therapies as transcutaneous electrical nerve stimulation (TENS), dry needling, or manual therapy to relieve pain. Both philosophies have their place, giving patients a broader set of tools to guide their care.

Another unifying factor in both specialties is their heavy use of procedural imaging, namely ultrasound to guide their intervention. Ultrasound provided a way to administer nerve blocks as well as perform ultrasound guided line placement. Likewise, ultrasound use is a staple in PM&R, used in not just nerve blocks, but also joint injections, tendon evaluations, and spasticity management. Each specialty is exemplary in their use of technology to enhance anatomical clarity and deliver more precise care.

At their core, anesthesiology and PM&R share the same mission: to restore comfort and function. Anesthesiologists excel in urgent, high-stakes environments—acting swiftly and calmly to interrupt pain at its peak, whether acute or chronic; they often lay the groundwork for recovery. Physiatrists build upon that foundation, excelling in paving the road to a functional recovery by crafting sustainable and often nonsurgical strategies that improve quality of life. One relieves pain so that healing or surgery can begin; the other relieves pain so that the journey to recovery is unimpeded.

Pain medicine is the place where these two specialties converge. Whether through the acute lens or chronic, both strive to restore the function and dignity to the lives interrupted by pain.  It’s the intersection where technical skill meets a holistic understanding of the patient, and where pain relief is not the endpoint, but the gateway to recovery.