The most prevalent trend among ASCs is to create a spine and pain service line. The trap door to failure — as with brain and spine — is muddling the two separate specialities together.

True, a spine center does indeed use spinal injections as an integral therapy. And many spine patients can benefit from specific interventional procedures that are provided either by a PMR trained in interventional work or a pain specialized anesthesiologist.

The issue is when back and neck pain patients exhaust non-surgical treatment options and when spine surgeons decide a spine surgery would be counter-productive. In that sense, the PAIN PROGRAM resides below the funnel created by a SPINE PROGRAM. Done correctly, the two programs collaborate rather than compete.

Secondly, if you integrate chronic pain into the spine program, you sabotage the success of the spine program because clinical outcomes will be poisoned by chronic pain patients who typically have LESS functional improvement pre and post treatment, and MORE dependence on pills. These poor outcomes scores, along with higher billings associated with pain patients, can poison the spine center’s image with referral sources and those who are paying the high costs (health insurance companies and employers).

The reality is that pain management — when set up correctly — is a specialty unto itself.

Chronic pain is a complex problem that needs to be addressed by a specialty center with a separate team of:

• Anesthesiologist who is proficient in C-arm guided injections (blind injections without C-arm guidance are not the community standard for injection therapy)
• Non-injectionist PMR
• Psychologist for pain management & MMPI assessment
• Biofeedback technician for non-pharmacological pain management techniques
• Occupational therapy for return to function, activities of daily living
• Vocational Counselor for designing a path back to work
• Social Worker for impact of pain on patients family and work life
• Case Manager (external) for disability case closure

Consequently, Prizm sets up these programs synergistically so they exist, but with separate brand names and separate growth tracks so each matures correctly.