Instead, patients are typically referred to what loosely gets described as “a pain clinic.” They go and subsequently get care from the pain clinic. As they do so, they usually come to think that whatever care they get is what pain clinics do.
What patients commonly don’t know at this point is that there are multiple types of pain clinics and each type goes about treating patients in very different ways.
What are the different types of pain clinic? Roughly speaking, there are four kinds of pain clinic.
- Chronic pain rehabilitation programs that provide coordinated, daily, interdisciplinary therapies that focus on self-managing pain, returning to work, and fostering independence from the healthcare system
- Opioid management clinics that prescribe narcotic pain medications on a long-term basis and aim to reduce pain and improve function
- Interventional pain clinics that perform spinal injections, nerve-burning procedures, and implantable devices, all of which aim to alleviate pain
- Surgery clinics that perform spinal, orthopedic, and/or nerve-related surgeries, all of which aim to alleviate pain
Notice that each of these kinds of pain clinics provides different types of care – even for the same condition. Some focus on what the provider can do for the patient, particularly through performing procedures such as surgeries or injections on the patient. Some provide long-term access to certain types of pain medications. Some focus on what the patient can do to manage a chronic condition and reduce reliance on medications and procedures.
When you are first referred to a pain clinic, you might not know that there are various treatment options even for the same condition. I often tell patients that chronic pain management is not like the care that you might receive for strep throat. With strep throat, it might not ever matter what provider you see. Whoever you see, they are likely to treat you in the same way. Largely, there is conventional agreement as to how to treat strep throat. There is no such conventional agreement with the common chronic pain conditions that are treated in pain clinics. Chronic low back pain, chronic neck pain, fibromyalgia -- what have you, they are all likely to be treated differently in the different pain clinics.
So, the first thing to keep in mind when being referred to a pain clinic is that you will likely be referred to one of the four types of clinic. The second thing to keep in mind is that the care you receive is not the only type of care you can receive for the condition that you have. In other words, it’s helpful to know that you have options. If you go to a different type of clinic, you will likely be provided with a different type of care. This point naturally leads to the question of which type of care is the best care for your condition?
The question brings us to the third thing to keep in mind when being referred to a pain clinic. You should know something about the relative effectiveness of each of the different types of pain clinics. From this knowledge, you can decide to get the care that is most effective.
Given that we are talking about chronic pain, it bears reminding that there aren’t cures for chronic pain. So, when it comes to types of chronic pain clinics, effectiveness is gauged by the following criteria:
- How much a treatment reduces pain
- How much a treatment increases functioning, such as returning to work
- How much it allows for reductions in healthcare use, including how much it reduces the need for opioid, or narcotic, medications
It stands to reason that when you are referred to a pain clinic you don’t want to pursue just whatever type of pain clinic that you get referred to. Rather, you can make a more thoughtful decision about which type of pain clinic to go to. From this vantage point, it stands to reason that you want to first go to the pain clinic that has the most effective treatments, as defined above.
The following is a list of resources that you can use to see for yourself the effectiveness of various treatments. For the layperson, it might be easiest and/or most convenient to cut to the chase and focus on the Introduction and Conclusion sections of the articles. You can also print the articles off yourself and bring them to appointments with your healthcare providers. They might aid in the discussions you have about treatment recommendations. (If any of the links don’t appear to work properly, simply refresh the screen for the site that the link brings you to).
- Spine surgery: low back surgeries, neck surgeries, disc replacement, American Pain Society guidelines
- Arthroscopic knee surgery: surgery compared to placebo; compared to conservative care
- Spinal cord stimulators: review 2004, review 2005, Cochrane report
- Intrathecal drug delivery devices (aka ‘pain pumps’): review 2007
- Epidural steroid injections: review article, American Academy of Neurology report, Cochrane report
- Radiofrequency neuroablations: clinical trial 2005, clinical trial 2001, Cochrane report
- Opioid medication management: meta-analysis, review
- Chronic pain rehabilitation programs: review 2006, review 2001, American Pain Society guidelines
When getting referred to a pain clinic, it would be helpful to have reviewed the above information. With this information, it might be helpful to discuss with your provider the following questions:
- What type of pain clinic are you getting referred to?
- What other types of pain clinics might be options for you?
- How did your provider decide to refer you to one type of pain clinic over the others?
- Is the type of pain clinic that you are getting referred to consistent with your values and goals for care?
- Is the type of pain clinic to which you are getting referred consistent with established clinical guidelines of professional pain organizations?
- Is your healthcare provider knowledgeable of the established guidelines of professional pain organizations? (This issue would have to be a delicate and respectful discussion…)
- Are the goals of the pain clinic realistic for the type of pain you have? (i.e., you might ask yourself, ‘Do I have chronic pain? and, if so, is it realistic to believe that procedures can alleviate my pain?’ or 'Is it realistic to think that I can take narcotic pain medications for the rest of my life?’)
These questions may also be asked of the providers to whom you get referred. You might also want to revisit them with your referring provider later down the road, after you have been seen at the pain clinic.
In summary, you will be better prepared to discuss your care at the pain clinic if you know the following:
- There are multiple types of pain clinic
- Each pain clinic may treat you differently, even for the same condition
- You have reviewed the links above that provide information on the relative effectiveness of the various kinds of therapies and procedures that the different pain clinics pursue
- You have reviewed the above questions for yourself and have discussed them with your providers
Date of last modification: 3/4/2013
Author: Murray J. McAllister, PsyD