pp 1-10 | Cite as

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
Chapter
Part of the Advances in Experimental Medicine and Biology book series

Abstract

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.

Keywords

Myofascial pain syndrome Pain Primary care physician Secondary pain management 

Notes

Acknowledgments

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.

References

  1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10:287–333CrossRefPubMedGoogle Scholar
  2. Carmeli E (2014) The invisibles: unpaid caregivers of the elderly. Front Public Health 2:91PubMedPubMedCentralGoogle Scholar
  3. Declaration of Montréal (2017) http://www.iasp-Pain.org/DeclarationofMontreal?navItemNumber=582. Accessed 25 Jan 2017
  4. Dubois MY, Gallagher RM, Lippe PM (2009) Pain medicine position paper. Pain Med 10:972–1000CrossRefPubMedGoogle Scholar
  5. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I (2016) A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 9:457–467CrossRefPubMedPubMedCentralGoogle Scholar
  6. Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H (1986) Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 26:181–197CrossRefPubMedGoogle Scholar
  7. Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D (2010) Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 11:32CrossRefPubMedPubMedCentralGoogle Scholar
  8. Fogelman Y, Kent J (2015) Efficacy of dry needling for treatment of myofascial pain syndrome. J Back Musculoskelet Rehabil 28:173–179CrossRefPubMedGoogle Scholar
  9. Freedman KB, Bernstein J (2002) Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am 84:604–608CrossRefPubMedGoogle Scholar
  10. Gerwin RD (1995) A study of 96 subjects examined both for fibromyalgia and myofascial pain. J Musculoskelet Pain 3:121Google Scholar
  11. Gureje O, Gregory ES, Von Korff M (2001) Cross-national study of the course of persistent pain in primary care. Pain 92:195–200CrossRefPubMedGoogle Scholar
  12. Halle JS, Halle RJ (2016) Pertinent dry needling considerations for minimizing adverse effects- part two. Int J Sports Phys Ther 11:810–819PubMedPubMedCentralGoogle Scholar
  13. Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ (2010) Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 7:CD002014Google Scholar
  14. Kalichman L, Vulfsons S (2010) Dry needling in the management of musculoskeletal pain. Am Board Fam Med 23:640–646CrossRefGoogle Scholar
  15. Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM, Tucker M (2013) Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 43:620–634CrossRefPubMedGoogle Scholar
  16. Kroenke K (2014) A practical and evidence-based approach to common symptoms: a narrative review. Ann Intern Med 161:579–586ADSCrossRefPubMedGoogle Scholar
  17. Leverence RR, Williams RL, Potter M, Fernald D, Unverzagt M, Pace W, Parnes B, Daniels E, Skipper B, Volk RJ, Brown AE, Rhyne RL, Net Clinicians PRIME (2011) Chronic non-cancer pain: a siren for primary care -a report from the PRImary care MultiEthnic network (PRIME net). J Am Board Fam Med 24:551–561CrossRefPubMedGoogle Scholar
  18. Lincoln LE, Pellico L, Kerns R, Anderson D (2013) Barriers and facilitators to chronic non-cancer pain management in primary care: a qualitative analysis of primary care providers’ experiences and attitudes. J Palliative Care Med S3:001Google Scholar
  19. Mäntyselkä P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamäki H, Halonen P, Takala J (2001) Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain 89:175–180CrossRefPubMedGoogle Scholar
  20. Matzkin E, Smith EL, Freccero D, Richardson AB (2005) Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 87:310–314CrossRefPubMedGoogle Scholar
  21. Mehta N, Inturrisi CE, Horn SD, Witkin LR (2016) Using chronic pain outcomes data to improve outcomes. Anesthesiol Clin 34:395–408CrossRefPubMedGoogle Scholar
  22. Minerbi A, Vulfsons S (2013) Pain medicine in crisis – a possible model toward a solution: empowering community medicine to treat chronic pain. Rambam Maimonides Med J4:e0027Google Scholar
  23. Peppin JF, Cheatle MD, Kirsh KL, McCarberg BH (2015) The complexity model: a novel approach to improve chronic pain care. Pain Med 16:653–666CrossRefPubMedGoogle Scholar
  24. Skootsky SA, Jaeger B, Oye RK (1989) Prevalence of myofascial pain in general internal medicine practice. West J Med 151:157–160PubMedPubMedCentralGoogle Scholar
  25. Speerin R, Slater H, Li L, Moore K, Chan M, Dreinhöfer K, Ebeling PR, Willcock S, Briggs AM (2014) Moving from evidence to practice: models of care for the prevention and management of musculoskeletal conditions. Best Pract Res Clin Rheumatol 28:479–515CrossRefPubMedGoogle Scholar
  26. Steglitz J, Buscemi J, Ferguson MJ (2012) The future of pain research, education, and treatment: a summary of the IOM report “relieving pain in America: a blueprint for transforming prevention, care, education, and research”. Transl Behav Med 2:6–8CrossRefPubMedPubMedCentralGoogle Scholar
  27. Thomsen AB, Sørensen J, Sjøgren P, Eriksen J (2002) Chronic non-malignant pain patients and health economic consequences. Eur J Pain 6:341–352CrossRefPubMedGoogle Scholar
  28. Turk DC, Fillingim RB, Ohrbach R, Patel KV (2016) Assessment of psychosocial and functional impact of chronic pain. J Pain 17(Suppl):T21–T49CrossRefPubMedGoogle Scholar
  29. VHA Directive 2009-053 (2009) Pain Management. Department of Veterans Affairs, Washington, DCGoogle Scholar
  30. WHO (2003) The burden of musculoskeletal conditions at the start of the new millennium: report of a WHO scientific group. WHO, Geneva, SwitzerlandGoogle Scholar

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

Personalised recommendations