Recommendations for Pain Treatment Services

The principles set forth in this document can serve as a guide for clinicians, educators, administrators, and governmental or professional organizations involved in the establishment and maintenance of standards for pain treatment services.  There is substantial evidence for the effectiveness of multidisciplinary treatment for chronic pain problems. This document distinguishes between multidisciplinary pain centers and multidisciplinary pain clinics.  The document also makes recommendations for providers with a non-multidisciplinary practice.

Multidisciplinary Pain Centers

A multidisciplinary pain center is distinguished by the broad range of its clinical staff, patient care services, pain conditions treated, and educational and research activities.  It should be part of or affiliated with a higher education and/or research institution.

The staff should include clinicians from a variety of medical and other health care disciplines; all clinicians should have expertise in pain management.  The clinicians who assess and treat patients in the pain center should include physicians, nurses, mental health professionals (e.g., clinical psychologist, psychiatrist), and physical therapists.  The center should be able to treat any type of pain problem; thus, there must be a system for obtaining consultation as needed from physicians from disciplines not included on the staff. 

A distinguishing feature of a multidisciplinary pain center is that the clinicians from different specialties work together in the same space and communicate with each other on a frequent and scheduled basis about patients, pain center policies and procedures, and therapies offered in the pain center.  Care is delivered in a programmed and coordinated manner, and is patient-centered, up-to-date, evidence-based, and safe.  Clinical activity must be supervised by an appropriately trained and licensed clinical director with expertise in pain management.  All the providers in the center should be appropriately qualified and licensed in their specialty and should be knowledgeable about the contributions of biological, psychological, and social/environmental factors to pain problems.

The center should serve as a model of excellence for the structure, processes, and outcomes that are essential for high quality pain management.  Patient assessment and treatment should be multidisciplinary, involving appropriate specialists as needed, to ensure optimal management of all biomedical and psychological aspects of pain problems.  Treatment should aim to improve pain and/or pain management, and also to improve patient physical, psychological, and work and social role functioning.  The clinicians should be familiar with all relevant treatment guidelines, and these should be considered in planning clinical activities.  The center staff should routinely collect and summarize data on the characteristics and outcomes (including pain intensity, psychological distress, function, and quality of life) of the patients evaluated and treated, and should engage in continuous quality improvement efforts.

The center should be committed to advancing and applying current scientific knowledge related to pain, and to disseminating relevant information to patients, other health care providers and organizations, and the public at large, in order to improve the quality of pain management across the continuum of care.  As the experts in pain management, the center’s staff are expected to act to improve pain management in local, regional, and national health care services.  It is also expected that the center provide educational activities and training in multidisciplinary pain management for clinicians from multiple disciplines (e.g., physicians of different specialties, clinical psychologists, nurses, physical therapists).  Ideally, training should be provided at undergraduate, graduate, and postdoctoral levels.

The center should be actively engaged in research, ideally playing a leadership role.  The center should contribute to the evidence base for the treatment and management of pain, and train future pain researchers.

Multidisciplinary Pain Clinics

A multidisciplinary pain clinic differs from a multidisciplinary pain center only in that research and academic teaching activities are not necessarily included in its regular programs.  As with a multidisciplinary pain center, the multidisciplinary pain clinic staff should include clinicians from a variety of medical and other health care disciplines; all clinicians should have expertise in pain management.  The clinicians who assess and treat patients in the pain clinic should include physicians, nurses, mental health professionals (e.g., clinical psychologist, psychiatrist), and physical therapists.  The clinic should be able to treat any type of pain problem; thus, there must be a system for obtaining consultation as needed from physicians from disciplines not included on the staff. 

The clinicians should communicate with each other on a frequent and scheduled basis about patients and pain center policies, procedures, and therapies.  Care is delivered in a programmed and coordinated manner, and is patient-centered, up-to-date, evidence-based, and safe.  Clinical activity must be supervised by an appropriately trained and licensed clinical director with expertise in pain management.  All the providers in the clinic should be appropriately qualified and licensed in their specialty and should be knowledgeable about the contributions of biological, psychological, and social/environmental factors to pain problems.

Patient assessment and treatment should be multidisciplinary, involving appropriate specialists as needed, to ensure optimal management of all biomedical and psychological aspects of pain problems.  Treatment should aim to improve pain and/or pain management, and also to improve patient physical, psychological, and work and social role functioning.  The clinicians should be familiar with all relevant treatment guidelines, and these should be considered in planning clinical activities.  The clinic staff should routinely collect and summarize data on the characteristics and outcomes (including pain intensity, psychological distress, function, and quality of life) of the patients evaluated and treated, and should engage in continuous quality improvement efforts.

Pain Practice

A single provider may have a pain practice if he or she is licensed in his or her specialty, has completed specialty pain medicine training or equivalent, and is certified in pain management by the appropriate local or national credentialing organization.  This provider must be knowledgeable about the contributions of biological, psychological, and social/environmental factors to pain problems.  There must be a system for obtaining consultation as needed from health care providers from other specialties.  In addition, the provider should refer patients to a multidisciplinary pain clinic or center whenever there are diagnostic or therapeutic issues that exceed the provider’s capabilities.

Additional Considerations

Adherence to the highest standards of ethics and professionalism is expected of all pain practitioners, regardless of facility or practice. 

Health care professionals in pain treatment facilities should be encouraged to be members of IASP and their national IASP chapter in order to maintain high standards and to facilitate exchange of information and research activities.

Single modality therapy programs should be identified by the modality they utilize (e.g., "Biofeedback Clinic") rather than the term, "Pain Clinic."  Multidisciplinary programs that specialize in one region of the body or a specific type of pain should be identified accordingly in their title (e.g., "Multidisciplinary Headache Clinic" or “Multidisciplinary Spine Clinic”).  Single modality and pain syndrome programs should follow any appropriate national or international guidelines.  The clinic staff should routinely collect and summarize data on the characteristics and outcomes (including pain intensity, psychological distress, function, and quality of life) of the patients evaluated and treated in the clinic, and should engage in continuous quality improvement efforts.

Centers or clinics designed to meet the needs of a specific age group, such as pediatric, adolescent, or older patients, must be able to demonstrate leadership by qualified specialists in the age-related field (e.g., pediatrics, gerontology), and involve clinicians with specific experience and training with the targeted population.  Clinicians in these establishments are expected to have a thorough understanding of age-related influences on pain problems.

Throughout the world, there is wide variation in the availability of financial resources, facilities, and appropriately trained health care professionals.  In developing nations, pain treatment services appropriately may be delivered by a small number of health care professionals working within the restraints of the available resources.  Even with limited resources, care should be guided by an understanding that pain is influenced by biomedical, psychological, and social/environmental factors, and treatment should be evidence-based and safe.  To whatever extent possible, treatment should be multidisciplinary and aimed at alleviating pain, as well as improving patient physical function and psychological distress.  Clinicians in other disciplines should be consulted as needed, when available.  Such services should strive to have research and patient outcome assessment components, and very importantly, to educate clinicians in the community.

Adopted by IASP on May 2, 2009