Pain Medicine in Crisis—A Possible Model toward a Solution: Empowering Community Medicine to Treat Chronic Pain

Amir Minerbi,Simon Vulfsons

doi:10.5041/rmmj.10134

Abstract

Pain medicine in Israel and in the world has reached a crisis. The lack of available pain medicine services is resulting in the unsatisfactory treatment for chronic pain sufferers. The main causes of this crisis are: 1) the high prevalence of chronic pain, reaching levels of 17% in the adult population;2) the lack of appropriate training of primary care physicians in the field of chronic pain management; and 3) the paucity of consultation services in the field of chronic pain. In this journal article, we propose a possible model for the solution of the problem, based upon levels of treatment according to the severity of the disease and upon training of primary and secondary care physicians in the treatment of pain. According to the model, the vast majority of treatment and management will take place in the community after appropriate training of primary care physicians. More complex cases will be referred to secondary care community-based pain clinics manned by physicians with further in-depth training. Only the most complex of patients, or those needing specialized treatment such as invasive analgesic therapy, will be referred to tertiary pain centers manned by specialists in pain medicine. Implementation of this model will necessitate training of primary care physicians and the establishment of secondary care facilities and can, in our opinion, pose a pragmatic solution for the hundreds of thousands of patients suffering from chronic pain.

Highlights

Pain is often defined as “an unpleasant sensory and emotional experience.”[1]
One obvious parameter could be the change in waiting list time for pain clinics, this might not necessarily reflect on the quality of care given in the community
The secondary care physicians are suitably trained and positioned to facilitate the proposed multidimensional service and will need additional administrative staff to maintain it. This has already taken place in six centers in Israel with physicians that have graduated from our courses running a multidisciplinary, communitybased service. Pain relief medicine both in Israel and worldwide is experiencing a deep crisis that results in inadequate availability of pain relief services to the enormous number of patients suffering from chronic pain

Summary

Introduction

Pain is often defined as “an unpleasant sensory and emotional experience.”[1]. This experience is common to everyone as almost all of us experience pain throughout our lives. The pain medicine crisis stems from the very high prevalence of chronic pain coupled with poor training in the primary care setting and no secondary center consultant services.

Results

Conclusion