S-3-07-04
PAIN MANAGEMENT PAIN REHABILITATION, A MULTI-DISCIPLINARY APPROACH
Alf L. Nachemson (Goeteborg University, Goeteborg, Sweden)
Despite the commonality of low back pain in any industrialized society and the increasing number of disability days paid and increasing number of chronically disabled low back pain patients there is little evidence in the literature of any efficient programs for returning the patients to gainful employment.
Attempts to prove efficacy for traction therapy, epidural blocks, nerve blocks, acupuncture, TENS and iso-machines for these patients have largely failed. Specific rehabilitation, also multi- disciplinary, in pain centers either as in-patients or out-patients have yielded moderately impressive results. As co-ordinator of the Cochrane Collaboration for low back pain I have become discouraged when looking at the reviews submitted. We must in the future perform better studies to prove efficacy or governments and insurance companies will not pay for our treatments of chronic lbp patients. In the future we must practice evidence based medicine.
S-3-07-05
CHRONIC PAIN SYNDROME: THE PAIN CLINIC AND CENTER
Martin Grabois (Baylor College of Medicine, Houston, Texas, USA)
This presentation will review the type of pain (acute, subacute, and chronic) syndromes and appropriateness of the multidisciplinary approach for each. The concept of the pain clinic for the evaluation and treatment of chronic pain will be explained and the following models discussed: (1) modality oriented pain clinic; (2) diversed oriented pain clinic; (3) multidisciplinary pain clinic; and (4) multi- disciplinary pain center. Criteria for acceptance into multidisciplinary pain clinics and centers including major and minor criteria and exclusion criteria will be addressed. Historically, the role of the multidisciplinary approach in pain clinics will be reviewed and changes occurring in the light of managed care will be addressed.
The concept of cost effeciveness and efficacy of multidisciplinary pain clinic will be reviewed and a conceptual model of being successful in the future will be presented. There does appear to be overwhelming meta-analysis evidence that multidisciplinary pain clinics are effective but the effective treatments within these facilities has not been isolated. The winning strategies to be considered in developing or re-inventing pain clinics and centers are low price, customer satisfaction, exceptional outcome, prestige and access.
