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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, in part by the increasing societal awareness that undertreated and untreated pain have reached epidemic proportions, and in part by the unprecedented economic pressures of our rapidly evolving health care system. These economic pressures have forced many pain management specialists and hospitals to explore new avenues of revenue generation and to examine new strategies to help improve the efficiency and cost-effectiveness of the care they provide.

The purpose of this chapter is to serve as a guide for pain management specialists 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.



There is no question that there is a huge demand for quality pain management services. The 2011 Institute of Medicine report titled Relieving Pain in America—A Blueprint for Transforming Prevention, Care, Education and Research found that approximately 100 million American adults are affected by chronic pain.1 This is more than the total number of American adults affected by cancer, heart disease, and diabetes combined.2 The report estimated that the cost of the pain to the United States is more than $635 billion each year and is rising as Baby Boomers age. A recent study of pain patients in America by the National Center for Health Statistics revealed the four most common types of pain complaints are low back pain, headache, neck pain, and facial pain3 (Fig. 101-1).

FIGURE 101-1.

Most common types of pain.

In recognition of the pain epidemic the 2010 Patient Protection and Affordable Care Act requires that the Department of health and Human Services in partnership with the Institute of Medicine provide a comprehensive assessment of the science surrounding pain, care, research, and education and provide specific recommendations to improve performance in each of these areas.

From these data, it is obvious that there are a huge number of patients who could potentially benefit from quality pain management services.


The first question that must be asked when considering the implementation or addition of new pain management services is how the addition ...

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