TABLE 6.

Proposed Algorithm for Determining the Appropriate Setting for Pain Management

CLINICAL PARAMETER	GENERALIST CARE ↔ SPECIALIST CARE
Pain Etiology	Clear, straightforward etiology of pain	Uncertain etiology, but some physiological clues or a suggestive pattern of pain	Etiology unknown, no physiological clues, no familiar pattern, or complex treatment needs
Psychiatric Disorder	No history of psychiatric disorder	Stable, well-compensated psychiatric disorder	Psychiatric instability
Addiction	No history of substance abuse or addiction	In recovery or history of major substance abuse	Active addiction, current illicit use
Social Support	Good social support	Some social discord or challenging social net	Isolated, major social distress, destructive associates
Activity Engagement	Rich work or avocational life	Some engagement with meaningful activities	No satisfying work, recreation, or other activities