The Role of the Anesthesiologist in a Pain Center (With Emphasis on the Regional Anesthesia Techniques for Pain Relief)

Anesthesiologists have assumed leadership roles in developing multidisciplinary pain centers across the country over the last two decades mainly through their skills in nerve block techniques combined with their experience in managing pain problems and medication management. Experiences of many of the anesthesiologists from major pain centers indicate that although nerve block techniques can be used safely and effectively for management of acute pain, extention of this approach to the management of chronic pain is of limited usefulness and is potentially dangerous. Chronic pain differs from acute pain in fundamental and important aspects that necessitate a very thorough evaluation of all possible contributing factors before nerve block techniques can be considered. The informed, rational, and safe use of nerve block techniques requires a collaborative approach that involves the anesthesiologist beyond his/her role as a block technician. Such involvement with pain management is demanding of time and effort, more than some anesthesiologists may be willing to spend. These realizations may have adverse effects on practicing anesthesiologists who frequently use these techniques as a major form of pain control in the nerve block clinic setting, on anesthesiology residents who express an interest in pain predicated on the misconception that sophisticated nerve blocks are the mainstay of the pain treatment, and finally on further developments of regional anesthesia techniques that are poorly taught and seldom encountered in the operating room of many teaching hospitals. The possible solutions are discussed.