Specialized Pain Clinics in Primary Care: Common Diagnoses, Referral Patterns and Clinical Outcomes – Novel Pain Management Model

  • Yacov Fogelman
  • Eli Carmeli
  • Amir Minerbi
  • Baruch Harash
  • Simon Vulfsons
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1047)


An estimated 19% of the adult population in western countries lives with chronic pain. Pain management lies mainly within the primary care and community setting. We evaluated the outcome of a new model of secondary care clinics, conducted by primary care physicians with specialized training in pain medicine. Data on referral patterns, prevalence of pain diagnosis, and medication consumption were recorded at five secondary pain management clinics in the community setting. In total, 997 patients with pain attended 2,652 visits (average 2.7 visits per patient) during 12 mo. Patients’ age ranged from 18 to 92 yr (mean 59 ± 19). Mean pain intensity on the first visit, evaluated by the visual analogue scale was 7.7/10. Myofascial pain syndrome was the most common diagnosis (82%). Treatment included dry needling or trigger point injection (82%), manual myofascial release (23%), and pharmacotherapy (38%). Significant short-term improvement after treatment was reported by 75% of patients, and 72% reported long-term improvement. Four percent were referred to tertiary care pain clinics, 5% were referred to other specialists, and 5% to imaging. Secondary, community-based pain clinics, run by specially-trained primary physicians, demonstrated feasibility. The vast majority of patients referred to the clinics were treated using simple, inexpensive modalities, while sparing referrals to unnecessary consultation visits, imaging tests, and medications.


Myofascial pain syndrome Pain Primary care physician Secondary pain management 



We thank Dr. Alon Margalit and Dr. Aviva Elad for participation and data collection for this study.

Conflicts of Interests

The authors declare no conflicts of interest in relation to this article.


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Copyright information

© Springer International Publishing AG  2017

Authors and Affiliations

  • Yacov Fogelman
    • 1
    • 2
  • Eli Carmeli
    • 3
  • Amir Minerbi
    • 1
    • 2
  • Baruch Harash
    • 1
    • 2
  • Simon Vulfsons
    • 1
    • 2
  1. 1.Institute of Pain MedicineRambam Health Care CampusHaifaIsrael
  2. 2.The Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of Physical TherapyUniversity of HaifaHaifaIsrael

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