Pain Clinic Guidelines
In developing nations, it may not be immediately possible to amass the professional and physical resources to establish a multidisciplinary pain clinic. A single health care provider may initiate a health care facility with the goals of adding other personnel as the institution evolves. This should be encouraged by IASP even though the health care facility at its inception may not meet the desired standards.
Pain Clinics and Pain Centers require not only physical resources but also specially trained health care providers. There is no specific training program in pain management at this time, so all health care providers have entered this area from existing specialties. Fellowships in pain management are beginning to develop, and those individuals who wish to specialize in pain management should be encouraged to obtain such a period of training. Others become reasonably skilled through their work with pain patients, but the field should move toward the establishment of specific training programs in pain management and the development of a method of evaluation and certification of individual health care providers by responsible leaders.
All pain clinics should work toward the use of a single method of coding diagnoses and treatments. Although the ICD-9 system is utilized in many countries, it is not particularly good for illnesses in which pain is the major complaint. The IASP Taxonomy system is a step in the right direction, but it will need further refinement before it becomes clinically acceptable. Nonetheless, excellence in pain management will require a standardized reporting system which can be used by all types of treatment facilities throughout the world.
Finally, excellence is dependent upon education of young health care providers who may wish to enter this field. Pain Centers need to establish educational programs on all levels to accomplish this goal. These programs should attempt tointegrate with degree granting institutions in all the health sciences as well as post-graduate educational programs.
This document has been prepared by a Task Force appointed by the President of IASP, Dr. Michael J. Cousins, and chaired by the Secretary of IASP, Dr. John D. Loeser.
Members of the Task Force were:
I often hear that the best type of facility to treat my CRPS or Chronic Pain is a Pain Clinic but;
1) What exactly is a Pain Clinic?
2) What do they do there?
3) What types of Doctors do they have there?
4) What can I expect if I go there?
5) Would that be the only place I would have to go if I did go there?
6) Do they also do Physical Therapy in the same facility?
These are some of the questions we get asked at American RSDHope regarding Pain Clinics. So many patients have no idea what a Pain Clinic is because until they developed Complex Regional Pain Syndrome they never had any need to go to one. This will give you some ideas of what a Pain Clinic is. .
Typically, a pain clinic is a location where doctors offer solutions to intractable pain. Conditions that generally respond well to pain clinic services are arthritis, back pain, and cancer. In addition, migraine headaches, shingles pain, and carpal tunnel syndrome pain frequently respond favorably to pain clinic treatments. Many primary care doctors refer their patients to pain clinics when they have exhausted other methods of pain relief.
(from the WiseGeek website)
Generally, pain management that is offered at a pain clinic include a combination of therapies. These treatments include medications, physical therapy, and nerve blocks. In addition, massage therapy is often an effective treatment for pain relief, swelling and stress. Not only does the pain clinic treat acute pain, it also performs diagnostic services to determine where the pain is originating.
On the WebMD website you can read the following description of a Pain Clinic;
A pain clinic is a health care facility that focuses on the diagnosis and management of chronic pain. Some specialize in specific diagnoses or in pain related to a specific region of the body. Also called pain management clinics, pain clinics often use a multidisciplinary approach to help people take an active role in managing their pain and regaining control of their life. These programs are focused on the total person, not just the pain.
Although pain clinics differ in their focus and offerings, most involve a team of health care providers that can help you with a variety of strategies to manage your pain.
These health care providers are likely to include doctors of different specialties as well as non-physician providers specializing in the diagnosis and management of chronic pain. These providers may include psychologists, physical therapists, and complementary and alternative therapists such as acupuncturists or massage therapists. Together, they will put together a pain management plan for you.
At a pain clinic, your therapy plan will be tailored to your specific needs, circumstances, and preferences.
So as you can see, while many people like the personal touch of their local MD, the Pain Clinic offers many things that an individual physician simply cannot. Having access to all of these services in one place; where the focus is not only on the Chronic Pain but also on the patient themselves; and having the ability to see many different types of physicians who can coordinate your care into one treatment plan all under the same roof has many, many advantages not only for the patient and their families but also for the insurance companies.
(How is a CRPS Patient Diagnosed? )
By Keith Orsini,
April – 2013
Chronic arthritis pain can disrupt every aspect of life – from work performance and daily chores, to getting quality rest and even personal relationships. If you can’t get your pain under control despite treatment and healthy lifestyle habits, you may want to consider attending a pain rehabilitation program (PRP).
What is a pain clinic?
While pain clinics can help anyone with chronic pain, people with inflammatory types of arthritis and fibromyalgia may benefit the most from PRPs, says Daniel Clauw, MD, professor of anesthesiology at the University of Michigan.
There are two main types of pain clinics.
Interdisciplinary Clinics: Are one-stop shops where a team of health professionals works together to help patients by using a variety of evidence-based approaches. Programs that utilize an interdisciplinary approach are best, says Clauw, and may include physical and occupational therapists, psychologists, dietitians, nurses, doctors and other healthcare providers.
Block Clinics: Offer procedures such as injections and nerve blocks. These procedures are usually performed by an anesthesiologist, most often for specific problems such as low back or neck pain. But unless your doctor refers you to this type of provider, Clauw advises against block clinics.
What to Expect
A quick fix is not the goal – neither is the total elimination of pain. Rather, clinics aim to restore function and improve quality of life by teaching physical, emotional and mental coping skills to manage pain.
Patients typically attend sessions all or most of the day for several weeks as an outpatient. Other programs may last longer but occur on a part-time basis.
A typical day at a PRP might include:
An hour of physical therapy (PT), which focuses on improving movement.
An hour of occupational therapy (OT), which focuses on improving the ability to perform daily activities.
Several hours of pain education classes that teach how chronic pain works.
An hour of relaxation and mind/body therapy.
Other Pain Management Techniques
Patients also learn other techniques to manage pain, including guided imagery, breath training and relaxation techniques.
Clinics may also provide cognitive behavioral therapy, which teaches problem-solving skills and helps patients break the cycle of pain, stress and depression by reshaping their mental responses to pain. This type of therapy may be particularly helpful for people with fibromyalgia.
Attending a pain clinic also provides support and validation that comes from being around people who’re facing similar pain challenges. Additionally, PRPs may educate family members about pain and the best ways to support their loved ones as they manage its effects.
What about medication?
Medication isn’t automatically a part of a treatment plan. In fact, some PRPs require that patients agree to taper off opioids. “Pain medicine in a chronic pain patient can actually make pain worse,” says Jeannie Sperry, PhD, co-chair of addictions, transplant and pain at Mayo School of Medicine in Rochester, Minnesota. “It makes the brain more sensitive to pain, so people experience higher and higher levels.”
Some clinics also taper patients off sleep and anxiety medications and muscle relaxants. Many patients start taking these medications to treat the side effects of opioids, like sleep disruption, sedation, agitation, nausea and sex problems. But when patients taper off opioids, the need for other medications may diminish.
Movement is key
Movement helps reduce pain, so getting people physically active is one of the main goals of pain clinics. Staying active is especially critical for people with arthritis, says Clauw. “If they don’t keep moving their joints, they can develop contractures, the shortening and hardening of muscle and other tissues, which limit the range of motion,” he says. In addition to teaching patients about the benefits of exercise, regular PT and OT sessions at PRPs can help tremendously with pain and functional improvement.
Finding a clinic
The best PRPs tend to be associated with academic medical centers, such as those at Mayo Clinic, Cleveland Clinic and Johns Hopkins, says Sperry. They can tell you the outcomes of their programs and typically have providers associated with research institutions.
To find a clinic near you, see if your state has a branch of the American Chronic Pain Association, which may provide leads. The American Pain Society has a list on its website of “clinic centers” that have won awards from the society.
The results that come from attending a pain clinic typically last. Sperry’s clinic measures patients when they come in, when they leave, and six months later. These patients continue to have significant improvement in mood, quality of life and physical outcomes, she says.
Your First Visit to a Pain Clinic
At a typical pain clinic, an individual has access to doctors of different specialties, including physical therapists and psychologists. Image courtesy of the Indiana Polyclinic.
One Pain Warrior’s Experience at a Pain Clinic
After her primary care physician diagnosed her with chronic migraine 14 years ago, Wendy struggled to manage the pain that radiated from the corner of her right eye. “I didn’t just have pain in my head, it was in the neck, jaw, absolutely everywhere,” recalls the HR professional, who lives in the Indianapolis area.
Wendy began seeing a neurologist, who put her on high doses of the anti-seizure medications gabapentin and zonisamide for pain relief. Unfortunately, she says, “The pain got worse, and the side effects from the medication left me unable to function—I had memory loss, blurred vision, and muscle weakness, and my face was numb. I could not concentrate or think clearly.” Eventually, she was forced to leave her job.
Wendy’s neurologist gave her Botox injections, but these caused some hearing and vision loss. She also tried acupuncture and even had a pain relief device implanted in her lower back (it has since been removed). Finally, after 12 years of severe, chronic pain, Wendy was referred to the Indiana Polyclinic.
At her evaluation, Wendy was scheduled to see the clinic’s occupational therapist and pain psychologist. She also underwent various assessments, including an MRI, which her previous doctor had performed, as well as allergy and genetic testing. From the latter, “We learned that my system does not absorb medication properly and pain medications are not effective.”
Shortly thereafter, Wendy got some surprising news: “I found out I didn’t have chronic migraine, I had trigeminal neuralgia.” This disorder presents with symptoms of severe pain in the facial area, caused by the brain’s three-branched trigeminal nerve.
The new diagnosis prompted a different treatment approach. Wendy started receiving nerve blocks from the clinic’s anesthesiologist. She gets six shots of lidocaine (a local anesthetic) and an anti-inflammatory to her forehead and cheeks. “It’s five minutes of excruciating pain for four months of relief,” Wendy shares.
She also took the opportunity to work with the clinic’s pain psychologist twice a month, and the occupational therapist once a month. “They helped me learn how to live differently,” Wendy says. “From the way I exercise to the way I clean my bathroom, it was a total lifestyle change.”
The psychologist also helped Wendy to “not let the ‘What ifs’ prevent me from doing things.” Previously, “I was afraid to go anywhere and do anything. I hadn’t seen a movie in a theater in over five years because I’d think, ‘What if I get a headache?’” Thanks to her sessions with the psychologist, Wendy is once again able to enjoy outings and activities.
Occupational therapy helped Wendy identify her pain triggers, from bad weather to leaning over the bathtub, and to adjust her behavior accordingly. “Now, I take breaks when I’m mowing the lawn, and I don’t stay out too long in the heat,” she says. “It’s about learning how to get in front of the pain—being aware of how I’m doing things, and how it might affect my pain.”
Within six months of her first clinic appointment, Wendy was able to return to work. And now, “Every month I get healthier, I get stronger,” she says. She continues to see the anesthesiologist three times a year, and the OT and pain psychologist twice a year, or as needed. She also takes a daily dose of Seroquel , and the occasional Imitrex for pain. Thanks to this program, she says, “I can participate in my life, in my child’s life, and in my husband’s life.”
Wendy is a big fan of the model she encountered at the Indiana Polyclinic. “It is life-changing, they treat you from every angle.” Then, she echoes Dr. Arbuck: “But you do have to work it. It doesn’t just happen.”
Updated on: 12/16/19 View Sources
Dr. Dmitry Arbuck, interviewed for this article, is a member of the PPM editorial advisory board. He serves as president/medical director of Indiana Polyclinic. Dr. Arbuck is also a clinical assistant professor of medicine and psychiatry at Indiana University School of Medicine and a clinical associate professor of psychiatry and pain medicine at Marian Osteopathic School of Medicine, both in Indianapolis.
Pain: You Can Get Help
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Content reviewed: February 28, 2018