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Dynamic Chiropractic Canada – April 1, 2014, Vol. 07, Issue 04
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Is a Chronic Pain Specialty Practice Right for You?

By John Hayes Jr., DC, MS, DACBO

Developing a chronic pain patient specialty practice is a hard thing to do even if you are very skilled as a clinician. It is one thing to work with your patients to heal a simple pain that occurred suddenly and unexpectedly, but it is a whole new field of expertise to help heal a chronic, reoccurring pain from an ill patient that may be induced by a lot of different factors.

Even if you are very well trained clinician and the routine cases are not any problem for you, there are always those special cases that can stump you. For example, in my own practice, I have treated active cancer patients, many post chemotherapy patients, trigeminal neuralgia and many forms of chronic intractable pain. Perhaps most gratifying, is many of these are referrals from medical physicians, who have already done all they can to help these patients.

Unless you fully realize this going into it, and are willing to work within the medical system, you're likely to find out this style practice can be extraordinarily frustrating. The question to ask yourself first is whether you are going to give up and redirect these very difficult to treat patients or are you going to take up the challenge and be fully equipped to handle their problems? And all the related problems that this style of practice demands. What you should know is that working with seriously ill patients with miserable and intractable pain that accompanies RSD, CRPS and chemotherapy induced neuropathy is a whole skill on its own to develop.

chronic spinal pain - Copyright – Stock Photo / Register Mark Special Skill Set

Taking care of patients that have serious problems and helping them with their chronic pain is a specialized skill that you may choose to further develop. Know this. It will make you a more skilled professional as a whole. But if you think chronic pain care is just about weight loss or a single device or machine, you may be in for a very rude (and dangerous) awakening. And unfortunately, there are many out there who would have you believe that developing a chronic pain specialty practice is this simple. Nothing could be further from the truth.

There are all kinds of different patients that may suffer not only from chronic pain, but also from other diseases. Very often, these are undiagnosed. So the clinical scenario here is that in this style of practice, you must make an accurate diagnosis, work with all the other healthcare professionals necessary and come up with a working treatment plan that becomes your responsibility to implement, follow-through and verify results.

You must be exceptionally clinically astute to take into account any other diseases or conditions which may also be affecting the patients' chronic pain or neuropathy. It makes no difference whether the patient has excellent third-party coverage for their expenses are not. The ultimate responsibility rests with you.

As a DC, developing a chronic pain specialty practice is a big step to fulfil in order to both expand your horizons and a way to develop a larger practice filled with more patients that require different treatment than you may currently be equipped to provide.

A Variety of Patients

In this style practice you will see all kinds of different patients. From patients with diabetes and neuropathy, to patients with gangrenous feet who need emergency help for their specific conditions. There are failed back surgeries, cancer patients and the list goes on and on. Developing a chronic pain specialty practice adds additional challenges to this mix. Even if you have some of the right clinical skills, you may very easily get into trouble if you lack in the needed skills to manage this style private practice, especially when it comes to the current economic environment.

Nevertheless, you can make a conscious choice to study and learn all the steps and measures that you need to take in order to optimize the star practice for the balance of your career. You must learn how to run your practice extremely well. Throughout the past year, you have probably realized that public healthcare and private healthcare have grown apart from one another and nowhere is this more obvious than in primary care medical practices. The decisions that now need to be made by PCPs are the same for all private clinicians.

Unfortunately, as smaller and more fragmented profession, the DC's in private practice still do not have the same advantages as the hospital in town and bigger health institutions. And this leads to difficulties all their own. Our private practices do not receive taxpayer dollars and we cannot expect economic or academic support.

A New Reality

Another thing that may be elusive for a lot of clinicians that own private health facilities is that the whole way of communication between their patients has changed. Specifically, social media has changed everything. How patients communicate amongst themselves is hugely different than it used to be. Make a mistake, irritate a patient and your entire community knows about it within minutes. This reality is for too many seasoned in private practice may be the most difficult thing of all.

Unless you have the infrastructure in place to fully communicate in all these social media platforms, you may find this style practice extraordinarily difficult, if not impossible. This, accompanied by current economic conditions and the uncertainty about healthcare plans, is somewhat troublesome for a lot of private practice owners attempting to effectively make the shift to a chronic pain practice.

Should you choose to develop a chronic pain specialty practice, one key point to realize is you'll need to constantly keep track of marketing and positioning changes to make sure you are doing enough to reach the patient population you desire after having invested so much time and money in this career path.

The best way to keep track of what your patients want and need from this style of practice is to take the time to ask them yourself so you can easily map the trends and where you think the patients demands for care in you community are going. Only by practicing in this way you can keep track of what you are doing right, what you are doing wrong and how your patients see your practice.

Chronic pain patients also regularly need extra support when it comes to their personal care and you should be able to provide it! There are all types of facets here - everything from their nutrition to their sexuality. You can easily assume that people with chronic pain may also know others with the same problem, as this is a topic that easily comes up and it is not too hard to avoid.

If patients have received relief for their ailments they will undeniably mention this to their friends and this will of course bring in more business for you. This is why you should must pay extra attention both on and off line and have all the systems in place necessary to capture these referrals.

Finally, always remember that dealing with uncomplicated patients is one type of practice, but developing a private practice suitable for patients with chronic pain that are desperately looking for relief is a very different career path all on its own. Just be sure you are up for the challenge and know exactly what this style practice will demand from you.

Dr. John Hayes Jr., a graduate of National College of Chiropractic, practices in Massachusetts. He also has a Master of Science in Biology and Nutrition from the University of Bridgeport and is a diplomate of the American Board of Chiropractic Orthopedists. Dr. Hayes is the founder and president of Health Solutions Group and the author of Beating Neuropathy - Taking Misery to Miracles in Just 5 Weeks! For more information, visit

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