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Originally printed in the SpaceMed Newsletter Fall 2013 www.spacemed.com

Demand for Pain Management Centers is Increasing By Cynthia Hayward

BACKGROUND Whether episodic or chronic, pain is the most common reason patients visit doctors and hospitals. Because of this, pain represents a growing market for healthcare or-ganizations. According to a 2011 Institute of Medicine report, pain costs the U.S. up to $635 billion each year in medical treatment and lost productivity. As a result, hospitals are creating pain management centers that use a variety of procedures and therapies and are staffed by multidisciplinary teams including anesthesiolo-gists, interventional radiologists, and acupuncture practitioners.

KEY CHALLENGES Key challenges for hospitals and physicians include:

Dealing with prescription drugs. Many general practitioners are reluctant to become involved in pain management because of their concerns about in-creased law enforcement scrutiny with widespread misuse of prescription drugs. Much law enforcement and media attention has been placed recently on so-called drug or pill mills where physicians overprescribe powerful drugs that are linked to the abuse of painkillers. According to the Center for Disease Con-trol, nearly three in four prescription drug overdoses are caused by opioid pain relievers — such as morphine, oxycodone, and methadone.

Co-managing pain. Patients typically undergo an evaluation that may include x-rays, magnetic imaging scans, or nerve studies to find the specific cause of the pain. Image-guided techniques may then be used to deliver steroids, burn nerve endings, or perform other targeted therapies at the precise area causing pain. Too often, primary care physicians lack knowledge about pain manage-ment so a major role of the pain management specialists is to educate primary care physicians as to the alternatives available.

Patient satisfaction. Sometimes, patients just want more drugs to relieve their pain which presents a major challenge for pain management. As a result, hos-pitals are implementing a multidisciplinary approach with an emphasis on communication and proper protocols for medication administration.

SOME EXAMPLES Barnes-Jewish Hospital in St. Louis expanded the size of its Washington University Pain Management Center from 5,000 to 10,000 square feet to accommodate grow-ing patient demand. It also restructured its pain program into two areas — concen-trating chronic and cancer pain in one area and acute perioperative pain in another area of the center. At Massachusetts General Hospital in Boston, the number of pain patients has also increased steadily. At least 70% of its patients seek treat-ment for spine-related pain with the balance of patients treated for pain conditions such as musculoskeletal pain, arthritis, shingles, and cancer-relate conditions. To increase efficiency, back pain patients are admitted to the observation unit in the hospital’s emergency department rather than to an inpatient nursing unit so that consults, imaging, and injections can occur quickly thus reducing length of stay.

Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.