Summary

Until recently, the medical community has neglected the treatment of pain.  Certain chronic pains such as migraines and gastrointestinal disorders have been shown in many patients to be related to psychological problems such as stress.  Pain clinic doctors will look for lifestyle factors as well, such as alcoholism, a bad career or marriage, or childhood traumas. There is said to be a "huge gap between what is known about pain management, and what actually gets applied in practice."

With cancer pain, experts say that they have the tools to control the pain, but many times these are not used, due to patient and practitioner fears of addiction, lack of special training in pain among physicians, and the need for a multidisciplinary approach which cuts across medical boundaries.

Multidisciplinary or “interdisciplinary” pain centers often see patients with chronic pain only after they have endured several years of pain, failed surgery and left work—in many cases on compensation.  Patients whose low-back pain persists for more than eight weeks are at high risk of developing a chronic condition.

Typical Goals of A Pain Treatment Program…

• Reduce patient's level of pain, achieve effective use of pain control techniques, when possible.

• Resolve/lessen psychosocial and family problems resulting from chronic pain.

• Eliminate/reduce usage of medication and substance abuse associated with chronic  pain.

• Involve patient in a physical reconditioning program, providing instruction in postural control, appropriate body mechanics, work simplification and stress management.

• Obtain surgery when appropriate.

• Help patient set realistic lifestyle and job-related goals.

• Reduce patient's feelings of being alone and being depressed.

• Develop and follow a discharge plan for the patient.

Inpatient programs are longer in duration, and much more expensive.  Marketdata's proprietary November-December 1994 survey of pain clinic directors found an average cost of $12,416 for an inpatient treatment program, compared to $8,100 for an outpatient program. (Data not collected for 1997,1999, 2001, or 2003).

Pain clinic directors interviewed by Marketdata estimate that the inpatient/outpatient mix can vary substantially from clinic to clinic, but a typical ratio today is about 85% outpatient and 15% inpatient. Some estimated that inpatients only represent 5-10%. The trend should be toward less inpatients because detoxification that used to be used is not needed as much as in the past.

A number of hospitals have opened outpatient facilities that focus exclusively on treating pain.  The treatment of pain has changed dramatically in recent years as new technology, drugs, and treatment protocols have been introduced.  C. David Tollison, director of the Pain Therapy Center of Greenville (South Carolina), says that, using the new approaches, medical personnel try to eliminate pain, not reduce it.  Today’s pain clinics range from those in which an anesthesiologist offers a limited range of medical interventions to large centers with a full-time staff of therapists and specialists. 

According to the Pain Control and Rehabilitation Institute of Georgia, most chronic pain patients can be treated on an outpatient basis. There, the typical outpatient visits the clinic 2-3 times per week. A complete pain rehab program requires about 15 days of treatment. At this institute, inpatient treatment is recommended for patients who.. 1) have a serious illness other than the pain problem which requires close medical supervision,

2) are dependent on drugs and need detoxification, or 3) have serious physical and emotional problems requiring around-the-clock supervision.

Based on Marketdata Enterprises' proprietary August-October 2003 survey of pain program directors, 77% of pain programs use a multidisciplinary approach, and 55% utilize psychotherapy. A total of 71% of all programs surveyed use physical therapy, 82% use nerve blocks, 84% use trigger point injections, and 73% of programs utilize long-term narcotic painkilling medications. These are currently the most popular treatment methods. 

List of Treatment Methods

Source: Marketdata Enterprises, Inc., Chronic Pain Management Programs: A Market Analysis