Pain centers and clinics

Major life changes sometimes require personal guidance. Learning how to manage chronic pain is one instance where one-on-one help may make the difference. If you feel that you might benefit from more individualized care, consider visiting a facility that specializes in pain management. There, you can benefit from the knowledge of professionals who deal with chronic pain on a daily basis.

A pain clinic is a facility with one or more physicians who specialize in the treatment of painful conditions. For example, they may specialize in the treatment of back pain or headache. A pain center is a multidisciplinary group of physicians whose collective expertise allows for the management of a wide variety of pain problems. A pain center, for instance, can handle all types of pain, frequently has ongoing research programs and participates in the training of pain physicians.


Where to start


In seeking care for your pain, the first step is to obtain the correct diagnosis. You want to make sure that your pain doesn't signal an underlying disease, infection or cancer. This process usually starts with your primary care physician, who may refer you to one or more specialists. Often a number of diagnostic tests are performed and initial steps are taken to relieve your pain.

If the pain persists and initial treatments aren't bringing relief, then you may consider a pain clinic or pain center. Physicians there perform a thorough history and physical exam. Additional diagnostic tests often are performed. These tests may be noninvasive, such as an X-ray, or invasive, such as diagnostic nerve blocks. Once a diagnosis is reached, a treatment plan is proposed. Understand and consider the risks and benefits of any treatment suggested.

Hopefully the treatment will help your pain. Treatments that aren't helpful should be stopped before trying new ones. If no effective treatment can be found for your pain, there are still ways to help you cope with that situation. This process is called pain rehabilitation. Pain rehabilitation programs help you get the most out of life even if you have unrelieved chronic pain.


Pain rehabilitation programs


Pain rehabilitation programs support the belief that chronic pain affects many aspects of your life and, therefore, requires a broad treatment approach. These programs explore various ways to help you control your pain. In the process, they also help you identify factors in your life that may contribute to your pain, or make it more difficult to manage. Often, but not always, pain rehabilitation programs are associated with medical schools or large medical centers.

In many pain rehabilitation programs, pain specialists integrate behavioral and lifestyle changes with physical and occupational therapy and selective use of medications or injections. Depending on the location or cause of your pain, other therapies, such as biofeedback or transcutaneous electrical nerve stimulation (TENS), also may be incorporated into your treatment plan.

Research on pain rehabilitation programs is positive. It shows that people who take part in a program generally get more relief from their pain and have an improved outlook on life than people who receive a single form of therapy or none at all. People in pain rehabilitation programs are also more likely to return to work, generally feel less need to visit doctors or other health care providers, and typically maintain their progress over longer periods.


The pain management team


The staff members who make up pain rehabilitation programs vary. But most programs include some or all of these key professionals:

Physicians. A physician who has extensive training in the area of chronic pain typically heads up the team, providing coordination and direction. This person may be a family practitioner or have trained in one of several medical specialties, such as neurology, psychiatry, anesthesiology or physiatry (physical medicine and rehabilitation). Just one or a group of doctors may work at the center or clinic.

Psychologists. Psychologists help sort through and address the many behavioral and emotional issues that can accompany chronic pain, such as depression, anger and fear. They also help pinpoint issues that may be contributing to your pain, such as strained relations with family members or stress at work. In addition, psychologists teach important skills such as stress reduction and relaxation techniques.

Nurses. Nurses help monitor medication use or medication withdrawal. They provide information on various treatments and monitor your progress. In many programs, nurses act as case managers, serving as advocates for you and your family and acting as an intermediary to other professionals on the team. A nurse may be the team member you interact with most often.

Physical and occupational therapists. Therapists are vital to the task of rebuilding your strength, endurance and confidence in your ability to function in everyday life.

Physical therapists do this through individualized instruction for a complete fitness program. Occupational therapists bolster your independence by focusing on increasing competency in specific, day-to-day tasks. Instruction on proper body mechanics and self-care for sore muscles and stiff joints also are goals of physical and occupational therapy.

Others. Additional professionals who may be part of the pain team include:


A registered dietitian to help you eat more nutritiously and control your weight.


A social worker to help you deal with financial, work, educational or family concerns.


A vocational counselor to help you develop the skills you need to return to work or keep your job.


A recreational therapist to help you safely take part in various recreational activities.


A chaplain to assist with religious and family issues.


What to expect


Not all pain rehabilitation programs operate exactly the same, but their approach is often quite similar.

Once you've been admitted, you'll receive a thorough evaluation. This may include having staff members review your physical and psychological condition, your use of medication, your work situation and your relationship with your family. The evaluation helps staff devise a treatment plan and personal goals that address your specific problems. These goals might include helping you get off your medication, return to work, become more physically active and learn to relax.

In some programs, the therapy and attention you receive are intensive. You spend most of your day at the center for about 2 to 4 weeks. During this time you work with physical and occupational therapists and spend time in group sessions. You also meet daily with your case manager to discuss your progress and any areas that remain difficult for you.

With other programs, the schedule is more relaxed. You meet for just a few hours each week over several weeks.


How to locate a pain facility


To find a reputable pain program that fits your needs, talk with your doctor. Some programs require a letter of referral from your doctor and a copy of your medical records.

If you have a medical school nearby, check to see if it operates a pain center or clinic. Or if you're attending a support group, you can ask members of the group if they've been to a pain facility and listen to what they have to say about that program.

You also can obtain a list of approved pain centers from the Commission on Accreditation of Rehabilitation Facilities. This organization certifies pain rehabilitation centers. Other organizations that you can contact for references include the American Pain Society or the American Academy of Pain Medicine.

What to look for


Pain centers and pain clinics abound. But because facilities and personnel vary in their qualifications and focus, consider these factors when evaluating your options:


What are its goals? Is the program focused strictly on relieving your pain, or does it include services to help determine the cause of your pain or the personal problems that may be associated with your pain?


What methods does it advocate? Be particularly careful in evaluating programs that advocate long-term use of potentially addictive drugs, such as opioids, or that routinely include surgery or rely on unproven therapies, such as homeopathy or herbal supplements.


Are staff members friendly and willing to listen? It's important that you feel comfortable with those around you. Members of the staff should be interested in you and your condition and take time to listen to your concerns.


Is the program accredited or certified? It's not required that pain centers or clinics be accredited or certified to operate. However, some states require accreditation to receive insurance reimbursement. Certification also helps ensure that the program meets the basic requirements for appropriate medical care.


Does it have a good success rate? Ask what the long-term success rate of the program is. No program can offer a 100 percent success rate. However, generally about half of people who visit comprehensive pain centers are able to return to work.


Does it include follow-up services? If you need additional care once you've completed your treatment, there should be a number you can call or person you can contact. Avoid programs that offer no follow-up care.


How much does it cost? Cost is always a concern. Make sure that you know approximately how much the treatment will cost beforehand. And check with your insurance company to see what expenses will be covered. Some insurance companies cover treatment provided by comprehensive pain programs, others don't. And depending on the type of treatment offered, services associated with specialized pain facilities may or may not be covered.


Your role


Pain centers and clinics are similar to many things in life - you only can get from the program what you're willing to put into it. If you're unwilling to learn new skills and you continue to have a negative attitude, the program may help you very little. But if you enter the program with a positive attitude and realistic expectations, you can come away with a better understanding of what you need to do to manage your pain, and confidence in your ability to do it.