Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison.

BACKGROUND: In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. METHODS: We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. RESULTS: In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. CONCLUSIONS: This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

[Quality assurance of pain care in Austria : Classification of management facilities]. / Qualitätssicherung der schmerzmedizinischen Versorgung in Österreich : Klassifikation schmerztherapeutischer Einrichtungen.

In Austria there is no nationwide coverage of pain management, which meets even approximately international criteria. At present there are about 30 interdisciplinary pain management offices and clinics providing care according to a concept of the Austrian Pain Society (ÖSG), about 10 other outpatient pain clinics are located in district and country hospitals. A few years ago, there still were about 50 pain clinics. Yet closure of outpatient clinics and cost-cutting measures in the health sector jeopardize adequate pain relief for patients with chronic pain conditions.Hence, the supply of care for approx. 1.8 mio. Austrians with chronic pain is not guaranteed due to lack of a comprehensive demand planning of pain care facilities. Furthermore, existing structures such as specialized clinics or emergency services in hospitals are primarily based on the personal commitment of individuals. At present, the various centres for pain management in Austria are run with very different operating times, so that for 74% of the chronic pain patients the desired requirements for outpatient pain management are not met and about 50 full-time pain clinics are missing.Under the patronage of the Austrian Pain Society, various national specialist societies have defined the structure and quality criteria for pain management centres in Austria, include, among others, proof of training, cooperation in interdisciplinary teams or minimum number of new patients per year, depending on the classification of the institution.This stepwise concept of care provision for pain patients is intended as first step to help improve the care of pain patients in Austria!

[Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine]. / Struktur der schmerzmedizinischen Versorgung in Deutschland : Klassifikation schmerzmedizinischer Einrichtungen - Konsens der Gemeinsamen Kommission der Fachgesellschaften und Verbände für Qualität in der Schmerzmedizin.

On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

[Consensus paper of the German Migraine and Headache Society on the structure of headache care facilities in Germany]. / Konsensuspapier der Deutschen Migräne- und Kopfschmerzgesellschaft zur Struktur von Kopfschmerzzentren und Kopfschmerzschwerpunktpraxen in Deutschland.

This consensus paper introduces a classification of headache care facilities on behalf of the German Migraine and Headache Society. This classification is based on the recommendations of the International Association for the Study of Pain (IASP) and the European Headache Federation (EHF) and was adapted to reflect the specific situation of headache care in Germany. It defines three levels of headache care: headache practitioner (level 1), headache outpatient clinic (level 2) and headache centers (level 3). The objective of the publication is to define and establish reliable criteria in the field of headache care in Germany.

[Recommendations on classification of German pain treatment services]. / Empfehlung zur Klassifikation Schmerztherapeutischer Einrichtungen in Deutschland.

On behalf of the German chapter of the International Association for the Study of Pain (IASP) recommendations for German pain treatment services have been developed for the first time. The criteria were based on the IASP recommendations but adapted to the specific German situation. According to the structure and process criteria four different levels of pain treatment services can be distinguished. The aim of the recommendations is to serve as a guide for future development and implementation of pain therapy and quality assurance.

Cáncer de vesícula: manejo del dolor y otros síntomas / Gallbladder cancer: pain and other symptoms management

El cáncer de vesícula es generalmente diagnosticado tardíamente, por lo cual manejar adecuadamente los síntomas y optimizar la calidad de vida es fundamental. El dolor es generalmente de origen visceral y en su manejo se privilegia la vía oral y subcutánea, según el concepto de escalera analgésica de la OMS; esto facilita el acceso de los pacientes a la analgesia opioide y a los fármacos coadyuvantes. Los métodos invasivos son: analgesia espinal y bloqueo neurolítico de plexo celíaco.Otros síntomas como náuseas y vómitos, anorexia, astenia, constipación, ictericia y prurito, edema de extremidades, ascitis, singulto y cuadros ansioso-depresivos, se tratan con diversas estrategias farmacológicas y no farmacológicas. La atención de los problemas psicosociales del paciente y su familia es también muy importante. En la experiencia del Instituto Nacional del Cáncer entre 1994 y 2001, se observa un incremento progresivo de los pacientes con cáncer de vesícula avanzado, describiéndose la incidencia, evolución y tratamiento de 120 pacientes con distintos síntomas de una patología cuya sobrevida fue entre 1 y 224 días (promedio 49.8 días) y en los cuales se aplicó un modelo de manejo integral del paciente, bajo el concepto de medicina paliativa.

Gallbladder cancer is diagnosed too late most of the time. For this reason symptomatic management and improve quality of life is essential. Pain has visceral origin and must be alleviated using the WHO analgesic ladder strategy by oral or subcutaneous route. Access of patient to different opioids and coadyuvants is mandatory. Invasive methods for analgesia includes spinal analgesia and neurolityc celiac plexus block. Other symptoms like nausea and vomits, anorexia, asthenia, constipation, jaundice and pruritus, lower limbs oedema, ascites, hiccup, and depressive states, need pharmacological and non pharmacological approach. Psychosocial intervention is advisable. Analysing "Instituto Nacional del Cáncer" experience since 1994 to 2001, a progressive increment in patients with gallbladder cancer is observed, describing the incidence, evolution and management of pain and others symptoms in 120 patients with this pathology. Mean survival of patients was between 1 and 224 days, (mean 49,8 days). An integral management of palliative medicine was applied.

Medidas no farmacológicas para el alivio del dolor

El objetivo de esta revisión es discutir algunos aspectos de las terapias no farmacológicas para aliviar el dolor y sufrimiento las cuales no han recibido la atención que merecen por parte del personal de la salud. Se incluyen elementos de la terapia física como el calor, el frio, el ejercicio, la neuroestimulación y la acupuntura; la terapia cognoscitiva y conductual con métodos como la educación, la retroalimentación, la relajación, la musicoterapia, la hipnosis, la distracción, la sustitución de pensamientos e imágines y la terapia grupal y familiar. Se discuten aspectos de la asistencia espiritual y el tacto humanizado. Todo esto con el fin de lograr un acercamiento humanizado al hombre que sufre

Clínica de dolor en niños: una experiencia

Se describen las actividades de la consulta de dolor del Hospital de La Misericordia entre agosto de 1988 y junio de 1990. Se discuten los hallazgos clínicos y se hace énfasis en la necesidad de implementar este tipo de atención para los pacientes con dolor en la edad pediátrica.