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When Did They Appear? Apparently, the treatment of chronic pain is a relatively new field, since fully 43% of all pain clinics responding to Marketdata's first 1992 mail survey were founded during the 1984-86 period, with another 21% started during the 1970s. The oldest clinic was founded in 1960. Of some of the more well-known programs, the Pain Control & Rehabilitation Institute of Georgia moved into private practice in 1985, and the New York Pain Treatment Program at Lenox Hill Hospital was founded in 1984. How Many? Currently, Currently, there are approximately 366 "accredited" pain management programs, clinics and pain centers in the country (vs. an estimated 384 in 2003, 410 in 1997 and 439 in 1995). A total of 101 are now accredited by the Commission on Accreditation of Rehabilitation Facilities (C.A.R.F.), which has developed standards for multidisciplinary programs along with the American Pain Society. This figure is down from 208 in 1999. CARF-affiliated programs are staffed by a multi-disciplinary team.Another 50 “facilities” are accredited by the American Academy of Pain Management (vs. 80 in 2001). Another 215 programs are estimated to be housed in JCAHOaccredited hospitals. It’s important to note that the hospital itself is accredited by JCAHO--not the pain program. Another 700 or so “pill mills” and/or non-accredited programs exist, usually smaller in size in terms of the depth and expertise of their staffs.
It would appear that the number of AAPM accredited programs has fallen from 2003. This is true, but with an explanation. Programs are re-accredited every three years by this organization, for $2,000. Some programs, being small, decide not to re-accredit due to the cost. However, in the case of CARF, their figures fell from 148 programs to 101 today, partly due to a consolidation of categories. Programs classified as “acute”, “cancer”, and "chronic” were consolidated into one new category: interdisciplinary.
In addition to these chronic pain programs and centers, there are a reported 4,119 anesthesiologists nationwide who are certified in pain therapy. This is up 45% from a 2,834 in 2003, according to American Board of Anesthesiology. Anesthesiologists practice in most cases as solo practitioners.
Marketdata estimated that 8% of ALL anesthesiologists in the nation were active in pain management in 1997, and we believe this share rose to 10.6% by 2003. Considering recent trends, this number should have risen to 12% currently. Marketdata estimates that there are now 32,500 active, practicing anesthesiologists in the United States.
Based on interviews with anesthesiologists and the trade groups and boards representing them, it appears that the percentage becoming involved in pain therapy or treatment has risen slightly since 2003.
Marketdata estimated in 2003 that 10.6%, or 2,915 were involved in pain management. Today in 2010, that figure is estimated to be 12% of the active 32,500 practicing anesthesiologists, or 3,900.
Marketdata therefore estimates that there are 9,066 pain programs, clinics, centers and/or specialists now active in the field. This is up substantially from 2003 and reflects the fact that with this study we’ve included an estimate of doctors other than anesthesiologists that have recently entered the field and who are administering nerve blocks and injections to patients. Added to this figure, there are an undetermined number of chiropractors, stress and biofeedback centers, massage therapists, physical therapists, dentists, and radiologists. HMOs/PPOs, and acupuncturists who also treat pain patients and who frequently call themselves pain "clinics". Obviously, the terminology in the field is a little loose, and is the source of some of the image problems pain facilities face. Pain clinic experts and directors interviewed by Marketdata estimate that two-thirds of all pain clinics are private, freestanding operations, with one-third being hospital or university-based. In the past, experts interviewed by Marketdata feet that the share of freestanding clinics would rise, since they may be more cost-effective than large and sometimes bureaucratic institutions. Cost effectiveness is a key concern today with third-party payors. However, we’re not sure about this. What we’re hearing today is that the independent clinics have a tougher time surviving, since they are dependent upon payment by their patients’ insurers, many of which are reluctant to reimburse for programs. Pain programs based in hospitals or universities, on the other hand, can draw upon other staff at the hospital and share their overhead and operating costs—a distinct advantage. They also may be better equipped to track outcome data. Thus, we may see a shift to more hospital and university-based programs in the future, if the reimbursement situation doesn’t improve. Accredited Programs & Clinics C.A.R.F stands for the Commission on Accreditation of Rehabilitation Facilities. It is an organization based in Tucson, Arizona, which accredits only pain clinics with a multidisciplinary approach. Currently, there are 101 programs accredited by CARF. Sole practitioners in pain therapy far outnumber the larger, multidisciplinary clinics, which may be freestanding or affiliated with a hospital or university (by about 10 to 1). However, there are many reputable programs which are not accredited. Many simply cannot afford the cost. Others decide that they don’t need it since it’s not mandated by law or required for reimbursement. The American Academy of Pain Management currently is the only multidisciplinary body offering certification in pain management. The problem, to some degree, is defining exactly what constitutes chronic pain, and what constitutes a "clinic". Surely, a 1-person operation (a chiropractor or biofeedback specialist) is not a "clinic". Basic criteria for CARF accreditation are:
CARF also has a model to measure outcomes and objectives, and accredited pain clinics are audited by a "surveyor" who asks to see this data. CARF certification is a guarantee that the operation of a clinic that is certified meets the standards of excellence set by authorities in the field. It does not guarantee an individual's performance. It's pointed out that organization size is not a guarantee of quality. Some hospitals and institutions are so bureaucratic that they cannot extract the data needed by CARF surveyors. Data is frequently scattered among so many different departments of the hospital or university that it cannot be collected together. Following are the CARF classifications. Note: See the Pain Associations link for information on C.A.R.F.
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