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Pain clinics, a new role for psychiatrists

Results of a questionnaire survey of liaison psychiatrist involvement in pain clinics in the Greater London area

Social, Genetic and Developmental Psychiatry Research Centre, The Institute of Psychiatry, Maudsley Hospital, 111 Denmark Hill, London SE5 8AF

Gnanie Panch, Consultant Anaesthetist

Department of Anaesthetics, Whittington Hospital, Highgate Hill, London N19 5NF

AIMS AND METHOD

The aim of this study was to find out the extent of psychiatric involvement in pain clinics and also clarify the treatment approaches taken for the significant psychiatric comorbidity reported in these clinics. A questionnaire survey was conducted, by a psychiatrist and an anaesthetist, of the 31 pain clinics in the Greater London area.

RESULTS

Psychiatric involvement in the management of patients with chronic pain is extremely limited, despite the extensive psychiatric morbidity associated with these patients (response rate, 74%). The majority of surveyed pain clinics wish to provide a multi-disciplinary approach to these patients, utilising the skills of a psychiatrist for both assessment and management. Only a small minority of pain clinics, however, have sufficient access to a liaison psychiatry service that could provide the broad multi-disciplinary approach and the psychiatric treatment options that they believe chronic pain patients require.

IMPLICATIONS

The involvement of psychiatrists in pain clinics is very limited. Increased involvement is desired and would likely lead to an improved profile of pain clinics, a more realistic and comprehensive treatment approach and, in turn, enhanced patient care.