pain clinics


Summary: Facilities providing diagnostic, therapeutic, and palliative services for patients with severe chronic pain. These may be free-standing clinics or hospital-based and serve ambulatory or inpatient populations. The approach is usually multidisciplinary. These clinics are often referred to as "acute pain services". (From Br Med Bull 1991 Jul;47(3):762-85)

Top Publications

  1. Kitahara M, Kojima K, Ohmura A. Efficacy of interdisciplinary treatment for chronic nonmalignant pain patients in Japan. Clin J Pain. 2006;22:647-55 pubmed
    ..Our results suggest that an interdisciplinary treatment based upon the biopsychosocial model of pain was associated with significant improvement in multiple outcomes in this sample of Japanese patients with chronic pain. ..
  2. Jamison R, Fanciullo G, McHugo G, Baird J. Validation of the short-form interactive computerized quality of life scale (ICQOL-SF). Pain Med. 2007;8:243-50 pubmed
    ..Additional studies are needed to determine the reliability and sensitivity to change of the ICQOL-SF. ..
  3. Boyle R. Value of rapid-access chest pain clinics. Heart. 2007;93:415-6 pubmed
    Rapid-access chest pain clinics have contributed enormously to improvements under the NSF coronary heart disease banner.
  4. Sekhri N, Feder G, Junghans C, Hemingway H, Timmis A. How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients. Heart. 2007;93:458-63 pubmed
    To determine whether rapid access chest pain clinics are clinically effective by comparison of coronary event rates in patients diagnosed with angina with rates in patients diagnosed with non-cardiac chest pain and the general population...
  5. Linde M, Jonsson P, Hedenrud T. Influence of disease features on adherence to prophylactic migraine medication. Acta Neurol Scand. 2008;118:367-72 pubmed publisher
    ..Characteristics of the disease per se did not predict non-adherence which was also observed among patients with severe migraine. The full benefit of drugs cannot be realized at currently achieved levels of adherence. ..
  6. Rodriguez M, García A. A registry of the aetiology and costs of neuropathic pain in pain clinics : results of the registry of aetiologies and costs (REC) in neuropathic pain disorders study. Clin Drug Investig. 2007;27:771-82 pubmed
    ..this study was to determine health resource consumption and costs in patients with neuropathic pain managed in pain clinics in Spain. This was a retrospective, cross-sectional study performed in 2004 in 18 pain clinics across Spain...
  7. Gunreben Stempfle B, Griessinger N, Lang E, Muehlhans B, Sittl R, Ulrich K. Effectiveness of an intensive multidisciplinary headache treatment program. Headache. 2009;49:990-1000 pubmed publisher
    ..Randomized controlled trials and subgroup analysis are needed to find out if these results can be replicated and which patient characteristics allow for sufficient improvements for headache sufferers even with less complex treatment. ..
  8. Powell A, Davies H, Bannister J, Macrae W. Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service. Br J Anaesth. 2009;102:824-31 pubmed publisher
    ..Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management. ..
  9. Goodacre S, Nicholl J, Dixon S, Cross E, Angelini K, Arnold J, et al. Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ. 2004;328:254 pubmed
    ..252). Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care. ..

More Information


  1. Lamé I, Peters M, Vlaeyen J, Kleef M, Patijn J. Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. Eur J Pain. 2005;9:15-24 pubmed
    ..Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity. ..
  2. Roberts R, Zalenski R, Mensah E, Rydman R, Ciavarella G, Gussow L, et al. Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA. 1997;278:1670-6 pubmed
    ..01). In this trial, ADP saved $567 in total hospital costs per patient treated. Use of ED-based ADPs can reduce hospitalization rates, LOS, and total cost for low-risk patients with chest pain needing evaluation for possible AMI or ACI. ..
  3. Walker J, Sofaer B, Holloway I. The experience of chronic back pain: accounts of loss in those seeking help from pain clinics. Eur J Pain. 2006;10:199-207 pubmed
    ..of the experiences that help to shape the worldviews of chronic back patients as they seek help from pain clinics. To elaborate on the lived experience of chronic back pain in those actively seeking help from pain clinics...
  4. Zeeberg P, Olesen J, Jensen R. Efficacy of multidisciplinary treatment in a tertiary referral headache centre. Cephalalgia. 2005;25:1159-67 pubmed
    ..05). For patients with MOH a reduction in headache frequency was seen for TTH and migraine (P<0.001). A specialized headache centre is valuable in treatment of patients with complex headache disorders. ..
  5. Harding G, Parsons S, Rahman A, Underwood M. "It struck me that they didn't understand pain": the specialist pain clinic experience of patients with chronic musculoskeletal pain. Arthritis Rheum. 2005;53:691-6 pubmed
    ..Developing, implementing, and evaluating approaches to address patients' spoiled identities might allow us to improve patient-centered outcomes in chronic musculoskeletal pain. ..
  6. McCracken L, Eccleston C. Coping or acceptance: what to do about chronic pain?. Pain. 2003;105:197-204 pubmed
    ..Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables. ..
  7. Bardiau F, Taviaux N, Albert A, Boogaerts J, Stadler M. An intervention study to enhance postoperative pain management. Anesth Analg. 2003;96:179-85, table of contents pubmed
    ..Establishing teams of surgeons, anesthesiologists, and nurses is the prerequisite for this improvement. ..
  8. Dolin S, Cashman J, Bland J. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89:409-23 pubmed
    ..1-2.7)% per year. These results suggest that the UK Audit Commission (1997) proposed standards of care might be unachievable using current analgesic techniques. The data may be useful in setting standards of care for Acute Pain Services. ..
  9. Magnusson J, Riess C, Becker W. Effectiveness of a multidisciplinary treatment program for chronic daily headache. Can J Neurol Sci. 2004;31:72-9 pubmed
  10. Sekhri N, Feder G, Junghans C, Hemingway H, Timmis A. Rapid-access chest pain clinics and the traditional cardiology out-patient clinic. QJM. 2006;99:135-41 pubmed
    The National Service Framework for coronary heart disease recommends rapid-access chest pain clinics (RACPCs) for cardiological assessment of new-onset chest pain within 2 weeks of referral...
  11. Rydman R, Zalenski R, Roberts R, Albrecht G, Misiewicz V, Kampe L, et al. Patient satisfaction with an emergency department chest pain observation unit. Ann Emerg Med. 1997;29:109-15 pubmed
    ..Our findings add important information to the standard practice of weighing clinical and cost outcomes between two medical care alternatives. ..
  12. Clancy M. Chest pain units. BMJ. 2002;325:116-7 pubmed
  13. McManus R, Mant J, Davies M, Davis R, Deeks J, Oakes R, et al. A systematic review of the evidence for rapid access chest pain clinics. Int J Clin Pract. 2002;56:29-33 pubmed
    To determine the impact of rapid access chest pain clinics (RACPC) on patient management, a systematic search (1966-2000) was performed of electronic databases, recent conference abstracts, citations of all identified studies, and by ..
  14. Goodacre S. Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature. J Accid Emerg Med. 2000;17:1-6 pubmed
    ..There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK. ..
  15. Harpole L, Samsa G, Jurgelski A, Shipley J, Bernstein A, Matchar D. Headache management program improves outcome for chronic headache. Headache. 2003;43:715-24 pubmed
    ..We currently are conducting a randomized controlled trial to better evaluate the clinical and financial impact of a headache management program for patients with chronic headache. ..
  16. Harden R, Weinland S, Remble T, Houle T, Colio S, Steedman S, et al. Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians. J Pain. 2005;6:364-71 pubmed
    ..It computes a single numeric value for a patient's pain medication profile. This number can be used by both clinicians and researchers to track pain levels through a treatment course or research study. ..
  17. Walker J, Holloway I, Sofaer B. In the system: the lived experience of chronic back pain from the perspectives of those seeking help from pain clinics. Pain. 1999;80:621-8 pubmed
    ..of their lived experiences were collected from twenty back pain patients who were seeking help from two pain clinics in the UK...
  18. Jensen C, Jensen O, Christiansen D, Nielsen C. One-year follow-up in employees sick-listed because of low back pain: randomized clinical trial comparing multidisciplinary and brief intervention. Spine (Phila Pa 1976). 2011;36:1180-9 pubmed publisher
    ..Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain. ..
  19. Claar R, Simons L. Adolescents' pain coping profiles: expectations for treatment, functional outcomes and adherence to psychological treatment recommendations. Pain Res Manag. 2011;16:192-6 pubmed
    ..The results of the present study identify preliminary clinical implications for the way in which practitioners in multidisciplinary pain clinics present recommendations for psychological treatment to patients and their families.
  20. Ruppen W, Bandschapp O, Urwyler A. Language difficulties in outpatients and their impact on a chronic pain unit in Northwest Switzerland. Swiss Med Wkly. 2010;140:260-4 pubmed publisher
    ..Language barriers can be problematic in all cultures and consultation situations. The average consultation length may be associated with better outcomes in chronic pain patients. ..
  21. Rubio Pascual P, de La Cruz Bertolo J. [Pediatric acute postoperative pain management service: 6 years' experience]. Rev Esp Anestesiol Reanim. 2006;53:346-53 pubmed
    ..16%. Satisfaction was good or very good for 98% of the parents and 94% of the children interviewed. The pain management service in our hospital was able to control postoperative pain safely and effectively. ..
  22. Dando W, Branch M, Maye J. Headache disability in orofacial pain patients. Headache. 2006;46:322-6 pubmed
    ..These findings clearly demonstrate the necessity for evaluation of headache and related disability in orofacial pain patients. ..
  23. Gruner A, Ljutow A, Schleinzer W, Bosancic D. [Implementation of an electronic patient record. Experience in an interdisciplinary pain clinic]. Schmerz. 2008;22:24-33 pubmed
    ..In conclusion, implementation of a complex electronic patient record provides a valuable instrument for quality control, interdisciplinary collaboration and improved efficiency in a large, multimodal pain clinic. ..
  24. Fishbain D, Lewis J, Cutler R, Cole B, Steele Rosomoff R, Rosomoff H. Does smoking status affect multidisciplinary pain facility treatment outcome?. Pain Med. 2008;9:1081-90 pubmed publisher
    ..Return to work within smokers is predicted by pain and worker compensation status. Pain facilities should target current smokers with significant perceived pain for close treatment monitoring in an attempt to improve treatment outcome. ..
  25. Kronborg C, Handberg G, Axelsen F. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients. Eur J Health Econ. 2009;10:5-13 pubmed publisher
    ..The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities. ..
  26. Tzavellas P, Papilas K, Grigoropoulou I, Zolindaki C, Kouki P, Chrona H, et al. A survey of postoperative epidural and intravenous analgesia in Greece. Eur J Anaesthesiol. 2007;24:942-50 pubmed
    ..Implementation of acute pain services that are satisfying the quality criteria may help to improve patient care. ..
  27. Olesen A, Jarvig L, Hansen O, Højsted J, Jensen N, Jonsson T, et al. [Differences in the prescription of analgesics in the treatment of cancer pain in six Danish pain treatment units]. Ugeskr Laeger. 2007;169:2024-9 pubmed
    ..The strong opioids were prescribed for the treatment of breakthrough pain. Differences in the prescription of analgesics between the six hospital units were observed in this study. ..
  28. Chambers J, Marks E, Knisley L, Hunter M. Non-cardiac chest pain: time to extend the rapid access chest pain clinic?. Int J Clin Pract. 2013;67:303-6 pubmed publisher
    ..We suggest that this approach should be tried for chest pain using a multidisciplinary clinic model including cardiologists, psychologists and nurses linked with a Rapid Access Chest Pain Clinic. ..
  29. Leykin Y, Pellis T, Ambrosio C, Zanette G, Malisano A, Rapotec A, et al. A recovery room-based acute pain service. Minerva Anestesiol. 2007;73:201-6 pubmed
    ..A RR-based APS can effectively act as coordinating centre for acute pain treatment without adjunctive personnel. ..
  30. Giordano J. Moral agency in pain medicine: philosophy, practice and virtue. Pain Physician. 2006;9:41-6 pubmed
    ..It is argued that an agent-based, virtue ethics best enable the clinician to both apprehend the complexity of this relationship and appreciate other ethical approaches in the discourse arising from issues of care. ..
  31. Buckenmaier C, Mahoney P, Anton T, Kwon N, Polomano R. Impact of an acute pain service on pain outcomes with combat-injured soldiers at Camp Bastion, Afghanistan. Pain Med. 2012;13:919-26 pubmed publisher
    ..Findings from this quality of pain care study show that aggressive multimodal analgesia interventions by an APS in a CSH is associated with decreased pain intensity and increased pain relief. ..
  32. Mlekusch S, Schliessbach J, Cámara R, Arendt Nielsen L, Juni P, Curatolo M. Do central hypersensitivity and altered pain modulation predict the course of chronic low back and neck pain?. Clin J Pain. 2013;29:673-80 pubmed publisher
    ..Future studies adopting other assessment modalities and possibly standardized treatments are needed to further elucidate the prognostic value of WCH and altered CPM in chronic pain. ..
  33. Verkerk K, Luijsterburg P, Heymans M, Ronchetti I, Pool Goudzwaard A, Miedema H, et al. Prognosis and course of disability in patients with chronic nonspecific low back pain: a 5- and 12-month follow-up cohort study. Phys Ther. 2013;93:1603-14 pubmed publisher
    ..At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS. ..
  34. Paul J, Buckley N, McLean R, Antoni K, Musson D, Kampf M, et al. Hamilton acute pain service safety study: using root cause analysis to reduce the incidence of adverse events. Anesthesiology. 2014;120:97-109 pubmed publisher
    ..The process was effective in giving credibility to recommendations, but addressing all the action plans proved difficult with available resources. ..
  35. Byers H, Lichstein K, Thorn B. Cognitive processes in comorbid poor sleep and chronic pain. J Behav Med. 2016;39:233-40 pubmed publisher
    ..We identify research and clinical implications of this study. ..
  36. López Martínez A, Esteve Zarazaga R, Ramírez Maestre C. Perceived social support and coping responses are independent variables explaining pain adjustment among chronic pain patients. J Pain. 2008;9:373-9 pubmed publisher
    ..The results indicate that perceived social support and pain coping are independent predictors of chronic pain adjustment, providing support for a biopsychosocial model of pain. ..
  37. Green C, Todd K, Lebovits A, Francis M. Disparities in pain: ethical issues. Pain Med. 2006;7:530-3 pubmed
  38. Lopez Soriano F, Lajarín B, Rivas F. [Quality assurance in pain clinics]. Rev Esp Anestesiol Reanim. 2007;54:639 pubmed
  39. Meltzer Brody S, Leserman J, Zolnoun D, Steege J, Green E, Teich A. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol. 2007;109:902-8 pubmed
    ..The association of trauma with poor health may be due in part to the development of PTSD resulting from trauma. These findings demonstrate the importance of screening for trauma and PTSD in women with chronic pelvic pain. II. ..
  40. Uthaman U, LeRoy P. Pain treatment in ambulatory medical practice. Del Med J. 2006;78:61-9 pubmed
  41. Grazzi L. Multidisciplinary approach to patients with chronic migraine and medication overuse: experience at the Besta Headache Center. Neurol Sci. 2013;34 Suppl 1:S19-21 pubmed publisher
    ..For this reason a multidisciplinary strategy of treatment which considers every aspect of individual life, social and emotional, is needed. ..
  42. Landrø N, Fors E, Våpenstad L, Holthe Ø, Stiles T, Borchgrevink P. The extent of neurocognitive dysfunction in a multidisciplinary pain centre population. Is there a relation between reported and tested neuropsychological functioning?. Pain. 2013;154:972-7 pubmed publisher
    ..Chronic pain patients receiving opioids did not perform worse than patients off opioid treatment. Systematic assessment of basic neurocognitive functions in centres treating chronic pain patients is warranted. ..
  43. Hainsworth K, Davies W, Khan K, Weisman S. Development and preliminary validation of the child activity limitations questionnaire: flexible and efficient assessment of pain-related functional disability. J Pain. 2007;8:746-52 pubmed
    ..The data suggest that the benefits of the CALI may be realized with this new paper-and-pencil version. ..
  44. Moe R, Uhlig T, Kjeken I, Hagen K, Kvien T, Grotle M. Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial. BMC Musculoskelet Disord. 2010;11:253 pubmed publisher
    ..This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs. Current Controlled Trials ISRCTN25778426. ..
  45. Broekmans S, Dobbels F, Milisen K, Morlion B, Vanderschueren S. Pharmacologic pain treatment in a multidisciplinary pain center: do patients adhere to the prescription of the physician?. Clin J Pain. 2010;26:81-6 pubmed publisher
    ..Future research should examine underuse and overuse as different types of nonadherence as different factors might predict this behavior. ..
  46. Tietjen G, Brandes J, Peterlin B, Eloff A, Dafer R, Stein M, et al. Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache. 2010;50:20-31 pubmed publisher
    ..All types of childhood abuse and neglect are strongly associated with remote and current depression and anxiety, and the relationship strengthens with an increasing number of maltreatment types. ..
  47. Lotsch J, von Hentig N, Freynhagen R, Griessinger N, Zimmermann M, Doehring A, et al. Cross-sectional analysis of the influence of currently known pharmacogenetic modulators on opioid therapy in outpatient pain centers. Pharmacogenet Genomics. 2009;19:429-36 pubmed
    ..Using the ABCB1 3435 genotype to predefine lower individual opioid doses barely merits the laboratory effort. If any, the results suggest that a genetics guided outpatient pain therapy may be based on ABCB1 and OPRM1 variants. ..
  48. Buchner M, Neubauer E, Zahlten Hinguranage A, Schiltenwolf M. The influence of the grade of chronicity on the outcome of multidisciplinary therapy for chronic low back pain. Spine (Phila Pa 1976). 2007;32:3060-6 pubmed
    ..Therefore, therapy should not be limited to the patients in lower stages of chronicity. ..
  49. Nicholas M, Asghari A, Blyth F. What do the numbers mean? Normative data in chronic pain measures. Pain. 2008;134:158-73 pubmed
    ..Despite that, relatively few of the measures used in pain clinics or research studies have normative data for reference...
  50. Berger A, Kramarz P, Kopperud G, Edelsberg J, Oster G. Economic impact of shifting the locus of care for neuropathic pain from specialists to general practitioners. Eur J Health Econ. 2007;8:245-51 pubmed
    ..pain were assumed to initiate care with their GPs and then be referred to specialists and, ultimately, pain clinics as required for adequate pain control...
  51. Marmura M, Abbas M, Ashkenazi A. Dynamic mechanical (brush) allodynia in cluster headache: a prevalence study in a tertiary headache clinic. J Headache Pain. 2009;10:255-8 pubmed publisher
    ..chronic CH), disease duration or disease severity. In conclusion, BA was common in this CH patient sample. The therapeutic implications of the presence of BA in CH need to be further studied. ..
  52. Fechtel S. Patient evaluation and general treatment planning. Phys Med Rehabil Clin N Am. 2006;17:303-14 pubmed
  53. Peng P, Stinson J, Choiniere M, Dion D, Intrater H, Lefort S, et al. Role of health care professionals in multidisciplinary pain treatment facilities in Canada. Pain Res Manag. 2008;13:484-8 pubmed
    ..However, few of them are involved on a full-time basis and the extent to which pain is assessed and treated in a truly multidisciplinary manner is questionable. ..