Organization of pain management services

Historically, pain services have been poorly integrated into hospital management systems and allocated relatively poor resources. Institutions differ in their needs and complexity, ranging from single modality clinics to large interdisciplinary facilities offering complex treatment including psychological rehabilitation and implantation technologies. The organizational needs of these services differ substantially. Organization has to be considered at three levels: within the department, within the organization, and within the health system. Departmental organization should consider a common management structure for all the interdisciplinary team, including the administrative and clerical staff. The clinical leader of the service need not be a doctor, but must have a job plan that includes sufficient time for necessary managerial tasks. Within a Trust or hospital, the pain service should have the same weighting as other clinical departments and the same resources available. The need for close links with other departments (e.g. orthopaedics, oncology) requires active cooperation between different directorates. Joint clinics can tax organizational systems but can be an effective way of managing patients with complex problems. Chronic pain poses a significant burden on the health care system. Increasing focus on chronic disease management by the production of guidelines and service frameworks for conditions such as diabetes and asthma have done little for the substantial number of people disabled by chronic pain. If pain services are to have a significant impact on chronic painful conditions they have to develop closer ties with primary care and health planning authorities. Such a move would see pain services being as much about education, training and development of policy as simply providing clinical care.