3. Multidisciplinary pain centers
• Major Comprehensive Pain Center
• inpatient and outpatient
• Space and beds
• Professional staff
• Full-time support staff
• Screening and selecting of patients
• Review and maintenance of records
• Consultation with multiple disciplines
• Psychological assessments
• Research activities
• Training programs
• Therapy for physical and psychosocial problems
• Periodic evaluation of treatment results
4. Multidisciplinary pain centers
• Comprehensive pain center
• 2/3 of MCPC criteria
Services of a multidisciplinary pain clinic :
1. Diagnostic
.History
.Physical exam
.Psychologic tests and interviews
.Laboratory
.Clinical laboratory
.X ray - CT- MRI- Bone scan
.Thermography-EMG- EP
8. Admission criteria for pain management
programs
• No surgically correctable pathology
• Failure to respond to conventional medical or physical
therapy approaches
• Possible psychologic component to pain syndrome
• Unable to return to gainful employment because of pain
• No active drug or alcohol abuse
• Agreeable to program’s expressed treatment principles
9. Pain management program treatment
objectives
• Increased physical function , endurance , and strength.
• Develop insight into obstacles to recovery.
• Begin realistic vocational plan.
• Foster independence from entitlement.
• Initiate long term medication use plan.
• Improve sleep patterns.
10. Staffing
• Medical director
Role of medical director
Credentials of medical director
Responsibilities of the medical director
• MD specialists
Psychiatrist , Anesthesiologist ,
Physiotherapist , Neurosurgeon ,
Orthopedic , Neurologist , Rheumatologist
• Nursing
Duties of pain clinic nurse
12. Diagnostic Facilities
• Diagnostic tests often available in pain clinic :
1. Skin temperature monitoring ( thermistors )
2. Joint range of motion (goniometer )
3. Pain tolerance and threshold ( ischemic tourniquet
test )
4. Muscle strength testing ( dynamometer )
5. Sensory testing ( cold , two point discrimination ,
vibration
6. Skin conductivity and potential (sympathogalvanic
reflex )
7. Muscle tension (surface EMG)
8. Diagnostic nerve block
13. Diagnostic facilities
Tests available outside the pain clinic
1. Plain radiographs
2. Myelography
3. CT scan
4. MRI
5. Bone scan
6. EMG and NCV
7. Sensory and motor evoked potentials
14. Criteria of treatment success
• Pain reduction
• Decreased Iatrogenic complications
• Reduction of opioid medication
• Decreased utilization of the health care system
• Increased in activity
• Return to work