• Peter S Staats, Ricardo Vallejo, Nicolas C Gasquet, and Christine N Ricker.
• National Spine and Pain Centers, Rockville, MD; World Institute of Pain, Winston-Salem, NC.
• Pain Physician. 2023 Mar 1; 26 (2): 207217207-217.

BackgroundPoorly managed chronic spinal pain encumbers medical resources and drives healthcare costs, suggesting a target for improvement.ObjectivesTo determine how specialist-care pathways influence healthcare costs in the first year after a referral for chronic spine pain.Study DesignThis was a retrospective cohort analysis of administrative claims from a large commercial health insurance provider, analyzing a 6-month baseline, a variable "pre-referral period," and a one-year period of specialist care.SettingUS patients covered by private commercial insurers.MethodsAdult patients diagnosed with chronic, spine-related pain between July 2016 and February 2018 and under the active care of a specialist were eligible. Patients with neurological deficits or cancer-related pain were excluded. Patients were categorized based on sequence-dependent exposure to a pain specialist, a surgeon, or both specialties. Key measures were pain-related and all-cause medical resource use and costs and opioid prescription fills.ResultsOf 306,080 eligible patients (mean age 61.6; 61.5% women), 13% saw a pain specialist, 71% a surgeon, 7% a pain specialist then a surgeon, and 9% a surgeon then a pain specialist. Referral to a pain specialist alone was associated with lower resource use and per-patient adjusted cost savings of $3,311 (pain-related) and $6,447 (all-cause) compared to patients referred to a surgeon alone. The pain specialist pathway was associated with increased indicators of prescription opioid use.LimitationsCohort design constraints temper the results' generalizability, given the need to simultaneously examine specialty pathway and medical resource incurred over the same time period.ConclusionsWe observed meaningful savings in cost and resource use when chronic spine-pain patients were managed by pain specialists. Pain-management referrals should be an element of a thoughtfully designed care pathway.

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