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

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.

Keywords: Chronic pain; crisis in pain medicine; postgraduate medical training; primary care; secondary care.

Figure 1

The Pyramid Model for the Stratification of Chronic Pain Treatment in the Community. Most pain patients will be treated by primary care physicians trained as pain trustees. More challenging patients will be treated by physicians certified in pain and musculoskeletal medicine in secondary community clinics, while the most severe patients and the ones requiring invasive procedures will be seen in tertiary pain clinics. The two bottom levels of the pyramid—training medical students and addressing the public—are not discussed in this paper and have been omitted from the figure.