Chris Hayes and Brenda Lau

Hunter Integrated Pain Service, NSW,Australia

The foundations of multidisciplinary pain management have been laid by pioneering workers over the past 50 years.The first Multidisciplinary Pain Centre (MPC) was established by Dr John Bonica and associates in Seattle in 1961.The International Association for the Study of Pain (IASP) was formed in 1973 to bring together clinicians, researchers and educators. Since that time MPC’s have sprung up across Australia in capital cities and regional areas.The formation of the Faculty of Pain Medicine in 1999 and subsequent specialty recognition in 2005 were landmark events testifying to the efforts of our own pain medicine pioneers in Australia.

MPC’s now have a well recognised target population as the previously “silent epidemic” of persistent pain begins to speak more loudly. Recent Australian figures demonstrated the high prevalence of persistent pain and estimated its total cost at 34.3 billion dollars for 20071. In the face of an established evidence base for treatment effectiveness2,3, the future of MPC’s should be assured.Yet, many of us working in pain medicine lack that sense of assurance and recognise that there is another parallel story to be told.

The burden imposed by increasing demand for limited resources has placed many services under scrutiny. Long waiting times, inconsistent treatment approaches, expensive technology and the lack of consistent outcome measurement have raised questions about the viability of MPC’s in the minds of at least some health service managers. In the last decade two of the world’s leading MPC’s (St Thomas’s Hospital in London and Bonica’s original unit in Seattle) have been closed down and are now struggling through a process of re-establishment. Many other units around the world are under increasing pressure to justify their existence.

This pressured healthcare environment is beginning to drive a process of clinical reform.The traditional siloed approach of an MPC that assumes responsibility for assessment and management of all patients referred is giving way to more flexible models of healthcare delivery. A number of MPC’s around the world are exploring new models and several common strategic themes are emerging.These include:Multidisciplinary pain management has arrived at a critical crossroad.This session offers an opportunity to review both an Australian and an international perspective as you consider the future of MPC’s.

1. The development of collaborative networks between MPC’s.
2. The use of chronic disease management approaches.
3. Health service integration.
4. Stratification of care based on patient complexity.
5. Improved education for community and healthcare professionals vi.More consistent measurement of outcome data.

References

1. Access Economics Pty Ltd AEPL (2007).The high price of pain: the economic impact of persistent pain in Australia.
2. Flor H, Fydrich T et al. (1992). Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain 49:221-230
3. Patrick L,Altmaeier E et al. (2004). Long-term outcomes in multidisciplinary treatment of chronic low back pain. Spine 29(8):850- 855