Multidisciplinary Pain Clinics

The first multidisciplinary pain clinics, developed after World War II, didn’t actually work very well.  Most of the practitioners were anesthesiologists who believed that pain could be handled by nerve blocks, a spinal block, or an ablation procedure in which the offending nerves were destroyed.  Any pain left over after these procedures were handed over to the psychiatrists, few of which actually helped people with chronic pain.

Later on, multidisciplinary team approaches included the services of a physical therapist, an occupational therapist, pain educators, vocational counselors, psychotherapists and instructors in relaxation therapy along with medical or neurological treatment.  More clinics developed techniques in dorsal column stimulation and TENS unit therapy, which helped and continue to help many patients.

Recent advances in pain management call for a comprehensive history of the patient’ pain issues, a review of all diagnostic tests, a complete physical and neuromuscular exam, including posture and spinal mechanics, special testing such as CT scans and MRI scans, and a team of pain specialists, including physical therapists, psychotherapists, doctors, nurses and the inclusion of a detailed form regarding the quality of pain and other stressors in the person’s life.

If a surgical approach is not necessary, the patient undergoes education about pain along with its interrelatedness to psychosocial stressors, physical interventions such as acupuncture and massage, nerve blocks, TENS units which override the pain with electrical stimulation, soft tissue mobilization exercise, nutritional approaches and pharmacological approaches to their pain.

The techniques that seem to work the best in a multidisciplinary clinic are a  positive attitude, the belief in oneself, conscious control of one’ s sensations, and spiritual attunement.  The different types of pain clinics available have different emphases. Some include mostly nerve blocks, TENS units or physical therapy.  All of these techniques work well in the treatment of chronic pain.

Most patients in a pain clinic suffer from back pain, headaches or post-operative pain.  Others suffer from degenerative pain or other posttraumatic pain.  Patients had been incapacitated by their pain from 1-7 years.

The success rate of such clinics is good.  About 5-7 percent of all patients fail to complete a program in pain management from a reputable chronic pain clinic.  One percent is sent home because they openly resist treatment.  Others drop out because they don’t believe in the modalities used by the pain clinic.

Of 94 percent of patients who complete the program, 35 percent of them are able to return to work, while 70 percent report improvement by 50-100 percent six months after treatment.  Those that didn’t improve often didn’t follow the exercises recommended by the pain clinic.  Twenty five percent used the TENS unit for at least six months.  Intensity of pain was reduced by 70 percent on average.  Mood improved in 90 percent of participants.  Drug costs were decreased by 85 percent.  Hospitalizations were reduced by 90 percent.  Most pain clinics charge between $5000 and $35,000, much less than the prior expenses of the patient before being seen at the pain clinic.

Estimates stated that if only 8 percent of patients returned to work, the economy would break even and in most cases, 35 percent of patients returned to work, making the use of a multidisciplinary clinic very cost effective.

Outpatient and inpatient clinics are accredited by the Commission for Accreditation of Rehabilitation of Facilities or CARF.  Pain clinics are divided into inpatient facilities, outpatient facilities and combinations of inpatient and outpatient facilities.  Unfortunately, in the age of HMOs, PPOs and Manage Care Systems, many of the best modalities for the reduction of pain, such as acupuncture, biofeedback, TENS units and neuromuscular re-education techniques are poorly covered, making it difficult for painful patients to get the appropriate care covered under their insurance plan.  

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