Not all pain management facilities are the same

Has your doctor referred you to pain management but you’re unsure where to go and what to expect?

With all the different names like pain clinics, pain centers, pain management centers, pain treatment centers, pain institutes, pain management programs, and pain rehabilitation programs, it’s easy to get confused.
 
I’ve tried to separate the different types of treatment facilities below into broad categories based on their disciplinary approach and treatment focus with a chronic pain rehabilitation rating.
 
GOOD
Intradisciplinary interventional pain management: Pain management physicians (typically anesthesiologists) provide an individualized approach to evaluate, diagnose, and treat all different types of pain frequently focusing on the cause of pain, pain reduction or elimination, and specific pain conditions. They primarily offer passive interventional procedures such as medications, injections, spinal procedures, nerve blocks, radiofrequency ablation, Ketamine IV therapy, acupuncture, pain pumps, spinal cord stimulators, and surgery.

​Multidisciplinary pain management: Pain management specialists provide interventional treatment with access or referral to other specialties like physical therapy, psychology, neurology, surgery, orthopedics, acupuncture, nutrition, and pharmacy with treatment customized to each patient based on their condition. While these providers may work in the same facility or for the same employer, they often operate independently with their own modalities and therapeutic goals.

BETTER
Multidisciplinary pain rehabilitation: A core provider team ​from multiple disciplines (physical therapy, psychology, rehabilitation medicine, anesthesiology, nursing, and occupational therapy) with additional involvement from surgeons, neurologists, internists, physiatrists, psychiatrists, social workers, dietitians, and pharmacists use the biopsychosocial model of medicine and standardized treatment approaches to help manage pain. Featuring psychological and behavioral therapies, traditional medicine, physical reconditioning, and educational components, these multi-week programs are more comprehensive but can be combined with interventional pain therapies for specific pain conditions. Care may or may not be coordinated or integrated with shared goals.

BEST
Interdisciplinary pain rehabilitation: Features a diverse multidisciplinary team including physical and occupational therapists, psychologists, dieticians, pharmacists, nurses, and medical doctors at one location. The providers interact with each other and the person using a shared biopsychosocial approach to pain – working together toward a common and coherent goal of pain rehabilitation teaching skills to empower the person to help themselves and actively self-manage the pain with the goals of increasing daily activity; improving physical reconditioning;  decreasing healthcare utilization, and improving quality of life with some but less focus on reducing pain. Generally lasting several weeks, these programs are often hospital-based (6-8 hours per day) and group-based offering behavioral therapy, physical therapy, occupational therapy, relaxation training, medication optimization/management, as well as some sort of family education and counseling. 

Conclusions/thoughts

• A lack of common terms and definitions made it hard to categorize the types of pain management facilities as there are no clearly established guidelines for pain management that are uniformly followed by every provider. Offering different treatment goals and components, they don’t fit into nice little boxes when doing an internet search.
• International standards and classifications for pain management should be established to improve care.
• As pain transitions from acute to chronic, passive interventions are best used in a complementary role to provide short-term relief to allow the person to participate in an active self-management program.
• Due to their focus on rehabilitation instead of interventional, and therapeutic treatments and their time commitment, interdisciplinary programs can be challenging for people, especially those expecting a diagnosis, passive treatment, and/or a cure.
• Interdisciplinary pain rehabilitation programs patterned like the program I attended at The Mayo Clinic are the gold standard of comprehensive care. One of the key attributes of the Mayo program was social modeling – seeing other people with similar pain experiences be successful in developing the skills they need to succeed. Unfortunately, there’s limited availability and access to these types of programs.

 
It was my family doctor and a local surgeon who recommended I attend the 3-week outpatient Mayo Clinic Pain Rehabilitation Center instead of going through another risky surgery to try to fix the pain. The program changed my life.

Please discuss your medical situation with your healthcare team.
 
Learn more

• Is a Pain Clinic Right for You?

• How to Move Patients from Passive Management to Active Self-Management (my article)
• We Have a Chronic Pain Problem, not a Prescription Opioid Problem (my article)
• Pain rehabilitation works (my blog post)
• Interdisciplinary Rehabilitation Programs in Chronic Pain Management
• Interdisciplinary Pain Rehabilitation Programs: Approach and Implementation
• Interdisciplinary treatment for chronic pain: is it worth the money?
• A Call for Saving Interdisciplinary Pain Management
• The Demise of Multidisciplinary Pain Management Clinics?
• My Time at the Mayo Clinic Pain Rehabilitation Center (my article)
• Mayo Clinic Pain Rehabilitation Center
• Find pain rehabilitation programs around the globe (my website)