No license is needed to call oneself a pain specialist. Therefore, a wide variety of peoplemay tout themselves as pain experts. There are 12 states where no state prescription monitoring databases or tracking systems for powerful drugs such as Oxycontin and Oxycodone. It is these states, especially, Florida, that such pill mills flourish and operate with impunity.

According to Edward Covington, a pain specialist at the Cleveland Clinic, multidisciplinary pain clinics are on the wane. There are no statistics, but Covington says he suspects their numbers have dwindled about 90% in the past 30 years. The problem is that a lot of patients just don’t like them.

Insurance companies also sometimes balk at multidisciplinary clinics, which are costly. They’ll cover them, Covington says, but usually “only enough so they lose just a little bit of money on them every year.” Insurers say they sometimes have trouble determining how legitimate the clinics are or how much of a service they’ll provide, since there are no national guidelines for what the clinics should encompass.

Apparently, the treatment of chronic pain is a relatively new field, since fully 43% of all pain clinics responding to Marketdata's first  mail survey were founded during the 1984-86 period, with another 21% started during the 1970s. The oldest clinic was founded in 1960.

Like any new specialty, pain programs are experiencing "growing pains" regarding acceptance, effectiveness, and a lack of hard scientific data and research. At the same time, as a growing field, it frequently attracts many less-than-ethical or qualified practitioners.

Many physicians simply don't have adequate training in effective pain management therapies.  Acute pain, the kind caused by injuries, which is short-lived and doesn't recur for years, is easier to treat via drugs and known therapies. Chronic pain, however, is a far more complicated area which has not been part of the typical medical school education.

The Image Problem:

While pain centers have emerged at hospitals to deal with acute pain patients, and some have sprung up to treat cancer pain, chronic pain is usually handled by freestanding clinics where the methods and effectiveness varies greatly.  Patients may be shuffled from one specialist to another with no improvement. As a result, many insurance firms are reluctant to pay and frequently handle coverage on a case-by-case basis.  Insurers are also wary of claims for chronic pain treatment because of the potential for addiction to pain medications by patients and abuse or incompetence by practitioners.

Even a university affiliation does not guarantee that a pain clinic can provide good care. Pain programs in 2003 still have a lack of hard data to support their claims of efficacy. Many practitioners, especially at the larger multidisciplinary pain clinics, claim that smaller, non-accredited clinics may lie about their outcome studies, and they very often cannot document the efficacy of their programs. However, it should be noted that some large, well-respected clinics are not accredited, and some small ones are. Lack of accreditation does not necessarily mean that the clinic is not good.

No license is needed to call oneself a pain specialist. Therefore, a wide variety of people may tout themselves as pain experts.

Some in the field charge that disreputable pain clinics make no effort to accurately diagnose their patients, putting all of them through a "cookie cutter" program, where all patients receive physical therapy, for example.