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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 ...