Ends of the line: diversity among chronic pain centers

Chronic pain may cause an endless search for care for its sufferers, while presenting a persistently intractable problem for physicians and disability administrators faced with an illness that defies both conventional medical thinking and established disability compensation mechanisms. In the past 15 years pain centers have mushroomed. Some pain specialists, who are typically based on these centers, have claimed to provide comprehensive treatment for chronic pain and definitive solutions to problems of disability policy. However, pain control is not yet a unified field. Approaches to treatment vary and the definitions of the objects of treatment, i.e. chronic pain syndromes, differ. This paper describes the lines of diversity which characterize this emerging field of health care through an explanatory, cross-sectional survey of 25 pain treatment facilities operating in a single urban community. Pain centers were found to vary with respect to the following dimensions: institutional affiliation, professional background of the staff, treatment modalities offered, populations served, patient selection criteria, types of pain condition treated, and diagnostic and etiologic frames of reference. Pain centers may present a diverse array of options in a pain sufferer's search for care. In addition, the reliance on pain specialists for a resolution of complex problems of disability policy may be premature.