Survey Addresses Location, Practice Patterns of Pain Specialists

SAN ANTONIO – Lack of nearby pain practices helps explain why only about 5% of U.S. adults with chronic pain ever see a pain specialist, Brenda Breuer, Ph.D., said at the annual meeting of the American Pain Society.

The finding comes from a survey of 748 pain specialists who responded to a survey that was sent to about 2,500 pain specialists certified by the American Board of Medical Specialties or the American Board of Pain Medicine.

“We felt that if we identified any deficiencies, that would be a first step towards improvement,” explained Dr. Breuer of the department of pain medicine and palliative care at Beth Israel Medical Center, New York.

The specialties, age, and geographic location of the physicians who responded to the survey were similar to those of the nonresponders. Most (74%) had primary training in anesthesiology, whereas others were trained in physiatry (15%), neurology (5%), psychiatry (3%), and other areas (11%).

Analysis of census data showed that individuals residing near pain practices were similar to the general U.S. population. Pain practices were underrepresented in rural areas, and people living near pain specialists tended to have higher incomes and higher education levels that the general population.

Academic physicians, who accounted for about one-third of the respondents, were more likely than others to have had their primary training in neurology, and were more likely to have completed a pain fellowship. They were also more likely to be associated with a facility involved in research, to hospitalize patients for aggressive treatment of severe pain, and to have interdisciplinary practices.

Respondents in practices that focus on a specific modality (29%) were more likely than others to have had their primary training in anesthesiology, and were significantly less likely to have interdisciplinary practices, to prescribe and maintain patients on controlled substances, to follow patients longitudinally, and to hospitalize for aggressive treatment of severe pain. They were also more likely than others to treat pain in only one part of the body, such as headaches.

Conversely, physicians in multimodality, comprehensive practices were more likely to use opioids and to collaborate with specialists. They were also likely to have an integrated practice, which included not only physicians of different specialties but also a psychologist, a physician assistant, and a social worker.

Board certification does not imply a uniform approach to chronic pain treatment. Nationally, there are only six board-certified pain physicians per 100,000 adult chronic pain patients, but it is as yet unclear whether there is a shortage, she said.

“Future surveys of pain patients are needed to complement physicians' surveys to assess the actual efficacy of pain management,” Dr. Breuer said.

SAN ANTONIO – Lack of nearby pain practices helps explain why only about 5% of U.S. adults with chronic pain ever see a pain specialist, Brenda Breuer, Ph.D., said at the annual meeting of the American Pain Society.

The finding comes from a survey of 748 pain specialists who responded to a survey that was sent to about 2,500 pain specialists certified by the American Board of Medical Specialties or the American Board of Pain Medicine.

“We felt that if we identified any deficiencies, that would be a first step towards improvement,” explained Dr. Breuer of the department of pain medicine and palliative care at Beth Israel Medical Center, New York.

The specialties, age, and geographic location of the physicians who responded to the survey were similar to those of the nonresponders. Most (74%) had primary training in anesthesiology, whereas others were trained in physiatry (15%), neurology (5%), psychiatry (3%), and other areas (11%).

Analysis of census data showed that individuals residing near pain practices were similar to the general U.S. population. Pain practices were underrepresented in rural areas, and people living near pain specialists tended to have higher incomes and higher education levels that the general population.

Academic physicians, who accounted for about one-third of the respondents, were more likely than others to have had their primary training in neurology, and were more likely to have completed a pain fellowship. They were also more likely to be associated with a facility involved in research, to hospitalize patients for aggressive treatment of severe pain, and to have interdisciplinary practices.

Respondents in practices that focus on a specific modality (29%) were more likely than others to have had their primary training in anesthesiology, and were significantly less likely to have interdisciplinary practices, to prescribe and maintain patients on controlled substances, to follow patients longitudinally, and to hospitalize for aggressive treatment of severe pain. They were also more likely than others to treat pain in only one part of the body, such as headaches.

Conversely, physicians in multimodality, comprehensive practices were more likely to use opioids and to collaborate with specialists. They were also likely to have an integrated practice, which included not only physicians of different specialties but also a psychologist, a physician assistant, and a social worker.

Board certification does not imply a uniform approach to chronic pain treatment. Nationally, there are only six board-certified pain physicians per 100,000 adult chronic pain patients, but it is as yet unclear whether there is a shortage, she said.

“Future surveys of pain patients are needed to complement physicians' surveys to assess the actual efficacy of pain management,” Dr. Breuer said.

SAN ANTONIO – Lack of nearby pain practices helps explain why only about 5% of U.S. adults with chronic pain ever see a pain specialist, Brenda Breuer, Ph.D., said at the annual meeting of the American Pain Society.

The finding comes from a survey of 748 pain specialists who responded to a survey that was sent to about 2,500 pain specialists certified by the American Board of Medical Specialties or the American Board of Pain Medicine.

“We felt that if we identified any deficiencies, that would be a first step towards improvement,” explained Dr. Breuer of the department of pain medicine and palliative care at Beth Israel Medical Center, New York.

The specialties, age, and geographic location of the physicians who responded to the survey were similar to those of the nonresponders. Most (74%) had primary training in anesthesiology, whereas others were trained in physiatry (15%), neurology (5%), psychiatry (3%), and other areas (11%).

Analysis of census data showed that individuals residing near pain practices were similar to the general U.S. population. Pain practices were underrepresented in rural areas, and people living near pain specialists tended to have higher incomes and higher education levels that the general population.

Academic physicians, who accounted for about one-third of the respondents, were more likely than others to have had their primary training in neurology, and were more likely to have completed a pain fellowship. They were also more likely to be associated with a facility involved in research, to hospitalize patients for aggressive treatment of severe pain, and to have interdisciplinary practices.

Respondents in practices that focus on a specific modality (29%) were more likely than others to have had their primary training in anesthesiology, and were significantly less likely to have interdisciplinary practices, to prescribe and maintain patients on controlled substances, to follow patients longitudinally, and to hospitalize for aggressive treatment of severe pain. They were also more likely than others to treat pain in only one part of the body, such as headaches.

Conversely, physicians in multimodality, comprehensive practices were more likely to use opioids and to collaborate with specialists. They were also likely to have an integrated practice, which included not only physicians of different specialties but also a psychologist, a physician assistant, and a social worker.

Board certification does not imply a uniform approach to chronic pain treatment. Nationally, there are only six board-certified pain physicians per 100,000 adult chronic pain patients, but it is as yet unclear whether there is a shortage, she said.

“Future surveys of pain patients are needed to complement physicians' surveys to assess the actual efficacy of pain management,” Dr. Breuer said.