CHAPTER 45 PAIN CLINICS Nelson Hendler, MD, MS, Charles E. Argoff, MD 1. What is a multidisciplinary pain treatment center? A multidisciplinary pain treatment center is made up of various medical disciplines and ancillary personnel to assist with the diagnosis and management of patients with chronic and persistent pain. Centers can be organized as an outpatient, inpatient, or combined setting, and they may be freestanding or hospital-based. They are usually characterized as multidisciplinary chronic pain treatment centers (those using numerous clinicians and a broad spectrum of modalities to treat any number of syndromes), monomodality centers (using only a single type of treatment, such as nerve blocks, biofeedback, or hypnosis), and syndrome-specific clinics (treating only one disorder). In a truly multidisciplinary center, both the diagnostic component and the treatment component are multidisciplinary. 2. How should a multidisciplinary pain treatment center be organized? The central element of a multidisciplinary pain treatment center’s organization is the establishment of a common philosophy among the various physicians and other health care personnel involved. This philosophy addresses (1) the use of pharmacologic agents, (2) the interpretation of various diagnostic studies, (3) attitudes toward the role of psychiatry, physical therapy, and adjunctive treatments, and (4) the goal of the chronic pain treatment center—i.e., rehabilitation, reduction of pain, and restoration of function. 3. What are the essential elements of a multidisciplinary pain treatment center? A well-run multidisciplinary pain treatment center requires that a single health care provider function as the leader of the team. This person assumes responsibility for coordinating all of the medical efforts, laboratory studies, ancillary therapies, and medications and should be available during all hours that the center is open, to provide continuity of care. Any health care provider with expertise in pain management can be the team leader for a specific patient, though it is usually more practical for the leader to be a physician. Members of the team may be from any and all disciplines. The most common cadre is an admixture of anesthesiologists, neurologists, psychiatrists, psychologists, physiatrists, neurosurgeons, orthopedic surgeons, and nurses. In centers treating orofacial pain, dentists are indispensable. Social workers and nonmedical personnel round out the team. The exact composition of the team is less important than the philosophy of working as a team toward the functional rehabilitation of patients in pain. 4. Is there evidence that multidisciplinary treatment plans are better than general good care? Yes. Although the data are hard to analyze, a number of studies have shown that multidisciplinary pain centers can be cost-effective for patients with low back pain, chronic abdominal pain, and a number of musculoskeletal pain disorders. 5. What is the role of a psychiatrist in a multidisciplinary chronic pain treatment center? The multidisciplinary chronic pain treatment center’s psychiatrist(s) can assist in the identification of psychiatric conditions that may initiate or perpetuate pain conditions. The psychiatrist should have a good working knowledge of psychopharmacology; he or she should be knowledgeable about drug interactions and dependence or addiction. A psychiatrist should either run or supervise group psychotherapy sessions and biofeedback, as well as family counseling sessions. Appropriately directed psychiatric treatment can help in withdrawal of potentially harmful medications, development of appropriate coping skills, and identification of factors that tend to perpetuate a chronic pain syndrome. 6. What is the role of an interventional pain specialist in a multidisciplinary pain treatment center? An interventional pain specialist can be an invaluable member of the multidisciplinary team. He or she can provide both diagnostic and therapeutic blocks. An interventional pain specialist also can provide greater insight into drug interactions and novel means of drug delivery. Additionally, an interventional pain specialist working in conjunction with the neurosurgeon and the orthopedic surgeon of the team can provide a continuity of care, ranging from diagnostics through the anesthesia needed for surgery. The interventional pain specialist typically also has a background in anesthesiology, physical medicine and rehabilitation, or neurology. 7. What is the role of the neurosurgeon? The neurosurgeon can provide diagnostic and surgical skills not available from other specialties at the multidisciplinary pain treatment center. He or she can provide both stimulatory and ablative procedures for pain relief. 8. What is the role of the psychologist? The psychologist at the multidisciplinary center can provide skills usually not offered by a psychiatrist in the area of administration and interpretation of psychological testing and neuropsychological testing, and assessment of cognitive functioning. Working alone or in conjunction with the psychiatrist, the psychologist provides group therapy, supportive psychotherapy, family counseling, and individual counseling. Additionally, he or she can coordinate the activities of the social workers and help to deal with the multiple social issues usually associated with chronic pain. Many psychologists have special training in cognitive-behavioral techniques and biofeedback. 9. What is the role of a rehabilitation specialist? A physiatrist can provide valuable input in the area of rehabilitation, both occupational and vocational, at the pain treatment center. He or she may supervise the occupational therapist and vocational rehabilitation specialist. The physiatrist can manage the physical therapist and select appropriate physical testing and rehabilitation efforts, such as muscle strengthening and muscle retraining. A physiatrist is also of great assistance in postoperative care and rehabilitation. 10. Who should lead a multidisciplinary pain treatment center? The answer to this question is rather complex. The experience of many chronic pain treatment centers indicates that care is facilitated by a physician as leader. A physician can prescribe and regulate medications, coordinate medical testing, and serve as a medical coordinator among the various consultants. This role would be very difficult for a Ph.D., who may be knowledgeable in these areas, but unfortunately would not have the legal ability to prescribe medications and medical diagnostic studies. However, if the Ph.D. or other provider works in conjunction with a licensed physician, this problem can be minimized. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Pain Clinics Full access? Get Clinical Tree
CHAPTER 45 PAIN CLINICS Nelson Hendler, MD, MS, Charles E. Argoff, MD 1. What is a multidisciplinary pain treatment center? A multidisciplinary pain treatment center is made up of various medical disciplines and ancillary personnel to assist with the diagnosis and management of patients with chronic and persistent pain. Centers can be organized as an outpatient, inpatient, or combined setting, and they may be freestanding or hospital-based. They are usually characterized as multidisciplinary chronic pain treatment centers (those using numerous clinicians and a broad spectrum of modalities to treat any number of syndromes), monomodality centers (using only a single type of treatment, such as nerve blocks, biofeedback, or hypnosis), and syndrome-specific clinics (treating only one disorder). In a truly multidisciplinary center, both the diagnostic component and the treatment component are multidisciplinary. 2. How should a multidisciplinary pain treatment center be organized? The central element of a multidisciplinary pain treatment center’s organization is the establishment of a common philosophy among the various physicians and other health care personnel involved. This philosophy addresses (1) the use of pharmacologic agents, (2) the interpretation of various diagnostic studies, (3) attitudes toward the role of psychiatry, physical therapy, and adjunctive treatments, and (4) the goal of the chronic pain treatment center—i.e., rehabilitation, reduction of pain, and restoration of function. 3. What are the essential elements of a multidisciplinary pain treatment center? A well-run multidisciplinary pain treatment center requires that a single health care provider function as the leader of the team. This person assumes responsibility for coordinating all of the medical efforts, laboratory studies, ancillary therapies, and medications and should be available during all hours that the center is open, to provide continuity of care. Any health care provider with expertise in pain management can be the team leader for a specific patient, though it is usually more practical for the leader to be a physician. Members of the team may be from any and all disciplines. The most common cadre is an admixture of anesthesiologists, neurologists, psychiatrists, psychologists, physiatrists, neurosurgeons, orthopedic surgeons, and nurses. In centers treating orofacial pain, dentists are indispensable. Social workers and nonmedical personnel round out the team. The exact composition of the team is less important than the philosophy of working as a team toward the functional rehabilitation of patients in pain. 4. Is there evidence that multidisciplinary treatment plans are better than general good care? Yes. Although the data are hard to analyze, a number of studies have shown that multidisciplinary pain centers can be cost-effective for patients with low back pain, chronic abdominal pain, and a number of musculoskeletal pain disorders. 5. What is the role of a psychiatrist in a multidisciplinary chronic pain treatment center? The multidisciplinary chronic pain treatment center’s psychiatrist(s) can assist in the identification of psychiatric conditions that may initiate or perpetuate pain conditions. The psychiatrist should have a good working knowledge of psychopharmacology; he or she should be knowledgeable about drug interactions and dependence or addiction. A psychiatrist should either run or supervise group psychotherapy sessions and biofeedback, as well as family counseling sessions. Appropriately directed psychiatric treatment can help in withdrawal of potentially harmful medications, development of appropriate coping skills, and identification of factors that tend to perpetuate a chronic pain syndrome. 6. What is the role of an interventional pain specialist in a multidisciplinary pain treatment center? An interventional pain specialist can be an invaluable member of the multidisciplinary team. He or she can provide both diagnostic and therapeutic blocks. An interventional pain specialist also can provide greater insight into drug interactions and novel means of drug delivery. Additionally, an interventional pain specialist working in conjunction with the neurosurgeon and the orthopedic surgeon of the team can provide a continuity of care, ranging from diagnostics through the anesthesia needed for surgery. The interventional pain specialist typically also has a background in anesthesiology, physical medicine and rehabilitation, or neurology. 7. What is the role of the neurosurgeon? The neurosurgeon can provide diagnostic and surgical skills not available from other specialties at the multidisciplinary pain treatment center. He or she can provide both stimulatory and ablative procedures for pain relief. 8. What is the role of the psychologist? The psychologist at the multidisciplinary center can provide skills usually not offered by a psychiatrist in the area of administration and interpretation of psychological testing and neuropsychological testing, and assessment of cognitive functioning. Working alone or in conjunction with the psychiatrist, the psychologist provides group therapy, supportive psychotherapy, family counseling, and individual counseling. Additionally, he or she can coordinate the activities of the social workers and help to deal with the multiple social issues usually associated with chronic pain. Many psychologists have special training in cognitive-behavioral techniques and biofeedback. 9. What is the role of a rehabilitation specialist? A physiatrist can provide valuable input in the area of rehabilitation, both occupational and vocational, at the pain treatment center. He or she may supervise the occupational therapist and vocational rehabilitation specialist. The physiatrist can manage the physical therapist and select appropriate physical testing and rehabilitation efforts, such as muscle strengthening and muscle retraining. A physiatrist is also of great assistance in postoperative care and rehabilitation. 10. Who should lead a multidisciplinary pain treatment center? The answer to this question is rather complex. The experience of many chronic pain treatment centers indicates that care is facilitated by a physician as leader. A physician can prescribe and regulate medications, coordinate medical testing, and serve as a medical coordinator among the various consultants. This role would be very difficult for a Ph.D., who may be knowledgeable in these areas, but unfortunately would not have the legal ability to prescribe medications and medical diagnostic studies. However, if the Ph.D. or other provider works in conjunction with a licensed physician, this problem can be minimized. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Pain Clinics Full access? Get Clinical Tree
