Patient Safety and Quality

Spine and pain clinics in North Carolina vary by types of practitioners and services offered

Back pain affects 8 out of 10 people at some point during their lives, making it one of the most common medical problems. Patients often seek care at clinics that specialize in managing chronic back pain. However, when researchers surveyed 46 spine and pain clinics in North Carolina, they found wide variation in the types of providers staffing clinics and the services offered.

Most sites had between one and five physicians, and practices were staffed on average by seven physician and nonphysician providers. Common provider types were anesthesiologists (56 percent); physiatrists, who are experts in treating muscular, musculoskeletal, or neurological problems (33 percent), and surgeons (orthopedic surgeons: 18 percent, neurosurgeons: 16 percent). Further, 65 percent of sites employed physicians who were certified in pain management. Physical therapists, mental health providers, and alternative medicine practitioners were on staff at less than a third of the clinics.

This finding shows that many clinics have room to improve their staffing, because evidence supports a multi-disciplinary active approach in treating chronic back and neck pain, the authors suggest. The most common services offered were medications, trigger point injections in which an anesthetic is injected in a knotted muscle, and epidural injections. Most of the clinics (30 of 33) that offered narcotics for pain relief monitored patients through urine testing. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00032).

See "Spine and pain clinics serving North Carolina patients with back and neck pain: What do they do, and are they multi-disciplinary?" by Liana D. Castel, Ph.D., M.S.P.H., Janet K. Freburger, P.T., Ph.D., George M. Holmes, Ph.D., and others in the March 15, 2009, Spine 34(6), pp. 615-622.

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