Basic principles in managing chronic pain.

Experience over the past 30 years suggests that treatment of patients with chronic pain is best achieved through a multidisciplinary team approach. The pain clinic at the University of Washington, started in 1961, has developed into a group of 20 health professionals representing 13 disciplines. Successful operation of such a heterogenous group depends on careful organization and a clear definition of responsibility. A patient is referred to a specific member, who becomes his manager, or to the clinic without specifying the physician, in which case a manager is assigned. The manager examines the patient, coordinates the evaluation by consultants, interprets the evaluation, and, if the diagnosis and therapy are clear-cut, refers the patient either back to his physician or to be cared for by the pain clinic group. Where the diagnosis or therapy or both are still doubtful, the patient's case is reviewed at the pain clinic weekly conference.