Since the establishment of the San Diego program in 1985, four other programs have gained medical director support in Southern California Kaiser Permanente. All of these started with interest from practicing clinicians, later approved by upper-level management. To add another service is to add a level of care without a perceived need. Standard multidisciplinary pain facilities are expensive. Treatments, especially anesthetic procedures, lack efficacy data.
Resources are limited.
A dollar spent on pain management is a dollar taken away from another more deserving program. Since expenditures are comparable to other chronic medical conditions, there is less pressure to control these costs. Even if pain patients' costs are better controlled, the savings do not generate true revenue. Fewer visits to primary and specialty care providers may reduce appointment backlogs but do not allow for reduction in the work force. Without this reduction, administrators will not realize true savings.