Comparative aspects of chronic pain in the head and neck versus trunk and appendages: experiences of the Multidisciplinary University of North Carolina Pain Clinic.

The interdisciplinary University of North Carolina Pain Clinic, in existence since 1973, is a coordination center for research, pre and postdoctoral and resident training, and clinical services. It functions primarily as a tertiary care center for outpatients as a component of the North Carolina Memorial Hospital. Inpatient consultations and therapy direction are carried out on request. Approximately 400 new patient visits and 1,200 consults and return visits are made yearly. The clinic is administered by codirectors from the Departments of Oral and Maxillofacial Surgery and Anesthesiology. Consultants to the clinic include the disciplines of psychiatry, neurosurgery, family medicine, pathology-oral pathology, dentistry, physical therapy, social work and nursing. Support staff includes a head nurse, half-time transcription and half-time general secretary and a financial technician. Facilities consist of an 8-room clinic dual equipped for patient care and clinical research. An adjacent conference room is used for research and patient presentation conferences. In addition to routine examining and interview rooms, a minor procedure operating room is equipped with resuscitation equipment, suction, oxygen, anesthesia machine, a physiologic monitoring system with polygraph, a cryosurgical unit and a radiofrequency lesion generator. A second room is equipped for neurosensory studies of peripheral nerve functions including a battery of tactile-mechanical and thermal threshold stimuli tests, as well as nerve conduction and EMG. A system for psychophysical testing is available through tie-in with a computer, which is located in an adjacent laboratory used for data analysis and also subhuman primate experiments. Another room is equipped with psychophysiologic training equipment, particularly EMG biofeedback. A computer terminal on line to the University IBM 360 is located in the Pain Clinic for use in entering patient-research data. A library with dictating space is available for use by consultants, postdoctoral trainees, and residents.