Spine and Pain Clinics Serving North Carolina Patients With Back and Neck Pain: What Do They Do, and Are They Multidisciplinary?

Chronic spinal pain is a common and costly problem in the United States.1,2 In a 2002 prevalence study, low back pain lasting at least a whole day in the past 3 months was reported by over 26% of US respondents, and neck pain was reported by over 13%.2 Perhaps, because the condition affects the physical, mental, emotional, social, and financial well-being of those afflicted,3,4 individuals often seek care from numerous physicians as well as other traditional and alternative health care providers. It is also common for individuals to undergo numerous treatments over months or years.5 In the past few decades, pain clinics became common—in the mid-80s, it was estimated that there were more than 1200 pain clinics in existence in the United States.5 People with chronic spinal pain have increasingly been seeking services at these clinics. Pain clinics have been described in various ways. According to Bonica,6 who has been credited with the development of modern multidisciplinary pain clinics,7 one key feature of a pain clinic is its ability to provide comprehensive assessment of an individual with a persisting and oftentimes intractable pain problem. Multidisciplinary function arose from Bonica's method of referring patients to other types of specialists, then reconvening to discuss the patient and reach consensus on the best course of action. Carron8 and Johnson9 have classified pain clinics as single modality clinics—such as those that offer nerve blocks—that are typically run by one provider type (i.e., anesthesiologist); syndrome-oriented clinics, such as back pain or headache clinics; and comprehensive clinics that are multidisciplinary and treat a variety of chronic pain problems. This classification is neither necessarily exhaustive nor mutually exclusive and as Johnson et al note,9 many clinics do not fall into these categories. The definition of multidisciplinary pain clinics also varies. According to the International Association for the Study of Pain (IASP), a multidisciplinary pain clinic should be staffed with a variety of physician and nonphysician providers who specialize in the diagnosis and treatment of chronic pain.10 At a minimum, 3 physician specialties should be represented including a psychiatrist, or 2 physician specialties and a clinical psychologist.10 Shealy and Cady's minimum criteria for multidisciplinary pain management are a physician (Medical Physician or Physician of Osteopathy), registered nurse, psychologist/psychotherapist or someone with a Master's degree in social work, and a physical therapist.11 Although many pain clinics specialize in the treatment of chronic back and neck pain, to date there has been little study in the United States of what constitutes a spine/pain clinic, who provides care at these clinics, and what types of care are provided. There is evidence that multidisciplinary biopsychosocial rehabilitation improves outcomes in chronic back pain, when compared with inpatient or outpatient nondisciplinary and/or “unimodal” treatments.12-14 Whether and to what extent current spine and pain clinics are “multidisciplinary” has not been evaluated to date. The primary objective of our study was to describe spine and pain clinics serving North Carolina (NC) residents with chronic back and/or neck pain. Specifically, we were interested in types of providers and services offered, and organizational characteristics of the clinics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. The substantial costs of back pain15 mandate examination of current treatment patterns16; gaining a better understanding of the nature of spine and pain clinics will help to inform future clinical and health services research on the treatment of chronic spinal pain.