[The multidisciplinary outpatient pain clinic in relation to anesthesia. An important task for the anesthesiologist].

Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. Bonica who fought for an increased interest in chronic pain. The establishment of the first Multidisciplinary Pain Center at the University of Washington in Seattle, the foundation of the International Association for the Study of Pain (IASP) and Melzack and Wall's now 25 year old gate control theory were the driving forces behind rapid developments in research and treatment in the area of chronic pain. The realization that chronic pain was the most frequent cause of disability in the United States also gave an impetus for new efforts in treatment. The classic anesthesiological topics, such as operative anesthesia emergency medicine and intensive care, have been extended to include acute pain services and chronic pain treatment facilities. This reflects the understanding that anesthesiological knowledge and techniques can be valuable to patients in severe acute pain and those in lingering long-term chronic pain phases. Anesthesiologists are skilled in the use of opioid narcotics and in the administration of strong analgesics. Many severe pain problems can be solved by correct use of the analgesic regimen. Special ways of administering narcotic analgesics, such as epidural infusion or patient-controlled analgesia, have already alleviated the pain problems of many patients. Anesthesiological techniques are also crucial in diagnosis. Sequential differential blockade and simple nerve blocks can be helpful in the diagnosis and classification of the pain problems. Anesthesiological contributions to a chronic pain service are not restricted to medical interventions. Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.