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Over the past several years there has been considerable interest in expanding the role of the pain management specialist as an integral member of the health care team. This interest has been stimulated in part by the increased availability of health care professionals with a special interest and advanced training in pain medicine and in part by the unprecedented economic pressures of our rapidly evolving health care system. These economic pressures have forced many pain management specialists to explore new avenues of revenue generation as well as to examine new strategies to help improve the efficiency and cost-effectiveness of the care they provide.

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The purpose of this chapter is to serve as a guide for the pain management specialist who may be considering setting up a pain treatment center or expanding the scope of services currently offered. Although many of the concepts presented are basic, failure to take them into consideration may lead to high levels of professional frustration and dissatisfaction, damage to the professional image of the pain management specialist, economic loss, and increased exposure to malpractice liability.

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Should Pain Management Services Be Offered?

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There is no question that there is a huge demand for quality pain management services. The Nuprin Pain Report, which to date is the only comprehensive evaluation of pain in the United States, reveals that there are four billion work days lost due to pain in America alone.1 Seventy-three percent of the patients interviewed reported one or more headaches that interfered with their ability to work; 50% of the people interviewed reported back pain, which limited their ability to work; 46% reported abdominal pain, which limited their ability to work. The Nuprin Pain Report further noted that 43% of Americans saw a physician at least one time in the year preceding the statistical analysis and, surprisingly, 29% of those patients surveyed sought the help of a physician for pain four or more times in the year proceding statistical analysis. Of great interest to our specialty is that of those patients who sought medical attention for more than an occasional pain, 58% saw their family physician; 18% saw a chiropractor; 12% sought help from their pharmacists; and 9% percent sought help from dentists or other health care professionals. Only 3% sought the advice and help of a pain management specialist. From these data, it is obvious that there are a huge number of patients who could potentially benefit from quality pain management services and, equally obvious, is that our specialty has a problem with recognition and identity.

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Interfacing Pain Management Services with Existing Services

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The first question that must be asked when considering the implementation or addition of new pain management services is how the addition of this new service will interface with existing professional activities. One must take into account the impact of such new services on existing care. The addition or expansion of ...

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