This document discusses the organization and services of pain management clinics. It describes multidisciplinary pain centers as the major comprehensive type that provides inpatient and outpatient care using a team of professionals from different specialties. The services include diagnostic testing, pharmacological and non-pharmacological therapies, vocational retraining, and periodic evaluation of treatment results. Syndrome-oriented and modality-oriented clinics are also discussed, along with admission criteria, treatment objectives, staffing requirements, diagnostic facilities, and criteria for measuring treatment success.

1. PAIN CLINIC
ORGANIZATION
babak Ashrafnejad MD.

2. CLASSIFICATION OF PAIN
CENTERS
• Multidisciplinary Pain Clinic
• Syndrome Oriented Clinic
• Modality Oriented Clinic
• Others

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

5. 2. Therapeutic :
.Pharmacologic
.Cognitive (coping , biofeedback , relaxation)
.Medical modalities (nerve blocks , steroid inject ,
neurolysis , neural stimulation )
.Physical modalities (strengthening , range of
motion exersises , heat , cold , ultrasound)
.Vocational retraining

6. Syndrome oriented clinics
Headaches clinic : Neurology
Low back pain clinic : Orthopedics , Physical medicine
and rehabilitation , Neurosurgery , Anesthesiology
Cancer clinic : Oncology , Radiation therapy ,
Anesthesiology , Neurosurgery , Orthopedics
Facial pain clinic : Oral surgery , ENT , Neurology
Arthritis pain clinic : Rheumatology , Orthopedics
Spinal cord injury clinic : Neurology , Rehabilitation ,
Anesthesiology

7. Modality oriented clinics
Nerve block clinic
TENS clinic
Acupuncture clinic
Biofeedback clinic
Behavioral and cognitive management clinic

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

11. Staffing
• Office support services
Receptionist
Secretary

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