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Published by: Marketdata Enterprises Inc.
Published: Nov. 12, 2003 - 190 Pages
Table of Contents
Introduction: Study Scope, Objectives, Sources Used
* How information was obtained, list of sources used, sample cover letter and
questionnaire used for mail survey, forecasting methodology
Executive Overview of Major Findings
* Summary/discussion: definition of chronic pain, prevalence among Americans,
characteristics of the field, patient demographics (who suffers, estd. no.), market
structure & types of providers (clinics, programs, anesthesiologists, others), status
of pain management in 2003 vs. 2001-key trends of past 2 yrs., most important issues
faced by pain programs, outlook for the field by major trade groups, insurance
reimbursement, emergence of new pain drugs, operating measures/results of 2003
Marketdata mail survey (caseloads, cost of treatment, mix of clients by pain condition,
concern over opioids regulation, treatment methods, data for: 1992, ‘94, ‘97, ‘99,
2001, 2003 outcome data tracking, caseloads by type program, $ market size &
growth estimates (1985-2007F), 2003 outlook, 2007 4-year projections.
Nature & Structure of The Field
* National cost of lost workdays, drugs, due to pain
* Definition of chronic pain vs. acute pain, types of pain conditions, cost of pain
in the workplace, number of: accredited vs. non-accredited pain clinics, solo
practitioners, years when pain clinics first appeared
* Accreditation & Industry Standards
* CARF (Commission on Accreditation of Rehab. Facilities)—its mission, criteria
for accreditation, what accreditation means, categories of pain programs
* IASP (Intl. Assn. for the Study of Pain) trade group, definitions for: pain facilities,
multidisciplinary centers, modality-oriented clinics, etc., desirable characteristics
of pain clinics/operating guidelines
* American Academy of Pain Management: types of members, accreditation &
certification requirements, types of programs
List: 2003 directory of CARF-accredited multidisciplinary pain clinics/programs
in the U.S. (hospital, university, freestanding), by state (name/address/phone), by
inpatient/outpatient category.
Patient Demographics - What Conditions Do Chronic Pain Patients
Suffer From?
* Findings of 2002 American Pain Foundation study “Pain in Maryland 2002” (attitudes
toward pain, frequency of pain, etc.)
* Findings of 2000 Merck study “Pain in America” study of pain sufferers: use of
drugs/other therapies, referrals by MDs, effectiveness of medical profession, actions
taken, time to get pain under control, etc.
* Findings of Prevention Magazine/CBS News poll, Jan. 2003 study (type/severity of
pain, relief, use of drugs, alternative therapies used, etc.)
* Analysis of number of Americans with pain-related conditions—scope of the
affected population (why some estimates are inaccurate): back pain, arthritis, RSIs,
migraines, TMJ, etc., opinions of accuracy of figures from pain associations/societies
* Discussion of repetitive stress injuries/carpal tunnel syndrome, BLS data
* Discussion of back pain patients, no. of Americans with back pain (ACA), back
surgeries, no. of patient-visits for chiropractors, percentage who are realistic
candidates for pain clinics
* Headaches - discussion of types (vascular, migraine, cluster) number of sufferers,
new & traditional treatment methods, new drug developments
* Arthritis - number of sufferers, (by sex, race, age), by types of arthritis
* TMJ/TMD (temporomandibular joint disorders) - discussion of condition, causes,
misdiagnoses, treatment options, patient demographics, trigeminal neuralgia
* Cancer patients - no. of new cases in 2002, for 16 types of cancer (by male/female)
Pain Management Treatment Methods & Status Report of
The Pain Drugs Market
* List of most common methods used to treat chronic pain, discussion/analysis of each:
multidisciplinary programs, drugs/opioids, TENS, trigger point injections, nerve
blocks, psychotherapy, brain stimulation, acupuncture, work hardening, physical
therapy, biofeedback, stimulators, pumps, radiofrequency, etc.
* Typical staff of a multidisciplinary pain clinic team, goals of a treatment program,
number of anesthesiologists certified in pain therapy, their treatment methods
* Inpatient vs. outpatient programs--typical costs, length, mix--percent of a pain clinic's
total patient population
* How pain programs work - typical phases/patient activities, example: Mensana Clinic
Status report of the U.S./World pain management pharmaceuticals market, 1996-2002
* Discussion of new drugs in development, COX-2 inhibitors, sodium channel blockers
* Summary of the pain drugs market: prescription/non-pres. drugs used for pain relief:
* Anti-seizure drugs, Cox-2 inhibitors, joint injections, soft tissue injections, NSAIDS,
opioids, etc.
* Discussion of controversy about the regulation of opioids, discuss. Of analgesics, tri-
Cyclic antidepressants, other antidepressants
* World and US $ value of prescription/nonpres. drugs market (2000-2008 forecast), by
type drug class (NSAIDS, analgesics, etc.).
Major Findings of 2003 Proprietary Marketdata Mail Survey
Chronic Pain Programs
Summary of Results by Major Group: Combined Total, Multidisciplinary Programs, Anesthesiologists
Table: total group vs. multidisciplinary and anesthesiologists separately: 2002 & 2001:
no. of patient visits, 2002 % chg., 2003 expected growth rate, new patient visits, 2002
% chg., no. of procedures performed, 2002 % chg.
- Patient caseloads: 2001, 2002 avg., 2002 increase, 1990-96 growth, explanation of
actual patients vs. patient-visits data, adjustments made
- Major findings and comparisons among groups.
- Accreditation rate for all programs, multidisciplinary programs.
- Most critical problems facing pain programs in 2003, 2001, 1999, 1997, 1994, 1992
Table: Pain conditions patients are treated for: 2003, 2001, 1999, ranked
- Average program treatment costs: 2003, 2001, 1998, 1997, 1994, 1991, accredited vs.
non-accredited programs costs - possible reasons for declining costs.
- Average program length-time patient spends in treatment: 2003, 2001, 1998,1996
Table: Treatment methods used (% of programs using: 1992 - 2003): multidisciplinary,
psychotherapy, physical therapy, TENS, nerve blocks, saline injections, medications,
acupuncture, implantable pumps, at-home pca, others)
Table: Percent of payments by: Medicare, Medicaid, cash, managed care entities,
Private insurance, workmen’s compensation: 2003, 2001, 1999, 1997.
- Documentation & tracking of outcome data - 2003, 2001, 1999, 1997, 1994: % of pain
programs that can document it, % with a tracking system, what measures are tracked,
how programs use data (with payors, etc.), patient follow-up methods, by type.
- Who pain programs compete with most often, ranked order: 1994 - 2003
(MDs, other clinics, chiropractors, hospitals, biofeedback centers, etc.).
- The most commonly denied modalities by insurers: 2003, 2001, 1999.
- Opioids regulation: % of program directors concerned about regulation.
- Attitude of anesthesiologists about giving up pain practice if their O.R. hrs. were to rise
- Opinions re new JCAHO standards, whether they have improved quality of pain
programs
- Patient access: do program directors feel that patients know how to find/access pain
programs? If not, how can access be improved?
Historical Data: One-Time Questions
- Most important needs of pain programs, tools desired: 1999, 1997
- Typical number of operating staff: 1999, 1997, 1994, 1992
- Professional specialty of physicians on staff
v- Intentions to join future pain clinic national network: 1997
- Most popular advertising /marketing methods used by clinics: 1999
- Age mix of patients - 1999, 1996, 1994
- Type of pain facility chosen most often: 1992 (hospital-based, university,
free standing)
- Alliances with other healthcare professionals - who?: 1997
- Year pain clinic was established
- Capability/expertise of pain program staff- % using: Md., psychiatrists, physical
therapists, social workers, etc.: 1994.
The Role of Anesthesiologists in Pain Management
* Why anesthesiologists’ income has been squeezed, why they are seeking other
subspecialties such as pain therapy, number practicing, avg. income
* Share of total anesthesiologists active in pain therapy: 1989, 1999, 2001, 2003, typical
caseloads of pain patients, high/low volume practices
* Number of anesthesiologists certified in pain management to date.
* Training and A.B.A. certification requirements
Results of Marketdata’s 2003 Mail Survey: Anesthesiologist Group Tabulations
(comparisons to multidisciplinary programs when relevant)
- List: the organization where they received certification in pain mgmt., schools attended.
- Physical location of their program (hospital, freestanding clinic, MD office, university,
other - %).
- Percent of the anesthesiologist’s time spent in: hospital/ER vs. their pain program.
- No. of total patient visits annual avg. in 2001, 2002, 1990-96 historical growth.
- 2002 percent increase in patient visits
- 2001, 2002 percent of visits related to NEW patients.
- 2001, 2002 no. of procedures performed annually
- 2003 expected increase in caseloads/no. of patient visits
- Most critical problems faced, most frequently denied modalities - 2003
- Percent concerned about increased regulation of opioids.
Table: Percentage of pain patients treated, by condition - 1997, 1999, 2001, 2003
- Avg. total and per-visit cost of treatment - 1997, 1999, 2001, 2003 - discussion.
- Avg. length of time patients in treatment: 1997, 1999, 2001, 2003
Table: Methods of payment by patients (Medicare, Medicaid, HMO, private insurance,
workman’s comp.) - 1999, 2001, 2003
- Single most denied modality - list of.
- How their practice has changed: list of changes, discussion
Table: Treatment methods used by anesthesiologists, ranked by % using: 2003, 2001,
1999, 1997.
- Documentation of outcome data - 2003, 2001, 1999
- Methods of patient follow-up, how information is used - 1999
Table: Who do anesthesiologists compete with most often? - 2003, 2001, 1999, 1997
-Attitude of anesthesiologists about giving up pain practice if their O.R. hrs. were to rise
Historical Data/Questions (1997 & 1999 surveys
-Percent of their programs accredited
- Patients by age group
- Number of physicians in their program
- Top marketing methods used - 1999
- Expected future effects of managed care.
Market Size, Growth Rates, Forecasts & Outlook
* Discussion/analysis of total no. of pain programs, clinics, solo practitioners in
2003 vs. 2001, annual patient caseload: 2002 estimates for CARF accredited,
JCAHO accredited, American Academy of Pain Mgmt. accredited, non-accredited
programs, anesthesiologists, chiropractors, discussion of inpatients/outpatients
mix, overlap between types of programs
* Dollar Market potential, by type treatment facility or solo provider (see above)
* Historical estimated $ market value 1985-2007 forecast
* 2003-2004 outlook & 2007 forecasts, rationale for estimates, caseload volume vs.
declining cost of treatment, relative weightings, factors affecting demand
Profiles of Some Leading Pain Programs
(In-depth descriptions of how programs work, outpatient vs. inpatient programs,
costs, estimated caseloads, services offered, type specialists on staff)
* The Cleveland Clinic Foundation
* The Mayo Clinic
* Mensana Clinic
* Norman Marcus Pain Institute
* Scripps Memorial Hospital
* University of Washington Medical Center
* Pain Control & Rehabilitation Inst. of Georgia
* The Rosomoff Comprehensive Pain & Rehabilitation Center
* Johns Hopkins - Blaustein Pain Treatment Center
* Wake Forest Baptist Medical Center (former Bowman-Gray School of Medicine.
Status Report of the Chiropractic Services Industry
* Discussion of the profession, competition with pain programs for same clients, federal low
back pain guidelines, industry receipts (1985-2001)
* Patient demographics--survey results, patients by: sex, age, race, occupation
* Controversial new research/study by the Annals of Internal Medicine, other recent studies
* ACA Statistical Study results: avg. number patient-visits per doctor per week,
no. of new patients, referrals, gross & net income, historical new patients & patient-
visits (1984-1996), type conditions patients treated for (1995, ‘97, ‘89), age of patients,
sources of chiropractor revenue by type insurance
* Future trends - the major issues likely to affect the profession, current state legislative
actions, diagnostic testing, outcome assessment, etc.
Reference Directory of Chronic Pain and Related Associations, Societies,
Groups, Institutes
* Name/address/phone, director, description, no. of members, mission, activities,
journals/newsletters/directories
AbstractThis has grown into a $7+billion market. Nearly 3,800 programs and sole practitioners (clinics and centers, anesthesiologists, chiropractors) treat an estimated 8 million Americans suffering from: chronic back pain, migraines, cancer, arthritis, migraines, carpal tunnel syndrome, etc.. This newly updated Marketdata study (the only business/demographic analysis available) is based on proprietary mail surveys and phone interviews and covers: 1985-2007F $ market size, mkt. structure, treatment methods, no. of patients/annual caseloads, avg. program costs/length, marketing methods, insurer reimbursement, and more. Contains proprietary findings of Aug.-October 2003 mail survey of 1,400 pain programs & anesthesiologists (separate operating data for multidisciplinary programs vs. anesthesiologists). Also covers patient demographics, status of the pain drugs market, status of the chiropractic profession, and a directory of CARF-accredited clinics. Profiles of John Hopkins, Mensana, Mayo Clinic, Univ. of Miami, other top programs. This report also available by chapters. Call for prices.
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