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Anesth Analg 2003;97:156-162
© 2003 International Anesthesia Research Society

PAIN MEDICINE

A Prospective One-Year Outcome Study of Interdisciplinary Chronic Pain Management: Compromising Its Efficacy by Managed Care Policies

Heather Robbins, PhD, Robert J. Gatchel, PhD, Carl Noe, MD, Noor Gajraj, MD, Peter Polatin, MD, Martin Deschner, PhD, Akshay Vakharia, MD, and Laura Adams, PhD

The Eugene McDermott Center for Pain Management, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Address correspondence and reprint requests to Dr. Robert J. Gatchel, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9044. Address e-mail to robert.gatchel{at}utsouthwestern.edu

Although interdisciplinary pain management programs are both therapeutically effective as well as cost-effective, they are currently being underutilized because of managed care policies. We used this prospective comparison trial, with 1-yr follow-up of chronic pain patients, to demonstrate the short- and long-term efficacy of an interdisciplinary pain management program, and evaluate the impact of managed care’s physical therapy "carve out" practices on these treatment outcomes. Consecutive chronic pain patients (n = 201) were evaluated, some of whom had their physical therapy "carved out" from this integrated program. Results revealed that successful completion of interdisciplinary pain management was therapeutically effective. Most importantly, physical therapy "carved out" practices had a negative impact on both the short-term and 1-yr follow-up outcome measures. Thus, interdisciplinary pain management is effective in treating the major health problem of chronic pain. However, insurance carrier policies of contracting treatment "carve outs" significantly compromise the efficacy of this evidence-based, best standard of medical care treatment. This raises important medico-legal and ethical issues.

IMPLICATIONS: Interdisciplinary pain management is effective and cost-effective in treating the major health problem of chronic pain. The present study demonstrated its efficacy using a prospective, 1-yr posttreatment evaluation methodology. Moreover, physical therapy "carve out" practices by insurance carriers had a negative impact on the outcomes, raising important medico-legal and ethical issues.




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M. K. Nicholas
Managed Care Policies and Pain Management Programs
Anesth. Analg., July 1, 2003; 97(1): 1 - 1.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.