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Daring discourse: should acute pain medicine be a stand-alone service?
  1. Andres Missair1,
  2. Alexandru Visan2,
  3. Ryan Ivie3,
  4. Ralf E Gebhard4,
  5. Stephen Rivoli5 and
  6. Glenn Woodworth3
  1. 1 Anesthesiology, Division of Acute Pain Medicine, Bruce W Carter VA Medical Center, Miami, Florida, USA
  2. 2 Executive Cortex Consulting, Birmingham, Alabama, USA
  3. 3 Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portalnd, Oregon, USA
  4. 4 Anesthesiology, Univ Miami, Miami, Florida, USA
  5. 5 Anesthesiology, New York University, new york, New York, USA
  1. Correspondence to Dr Andres Missair, Univ Miami, Miami, FL 33136, USA; andresmissair{at}


Acute pain medicine (APM) has been incorporated into healthcare systems in varied manners with some practices implementing a stand-alone acute pain service (APS) staffed by consultants who are not simultaneously providing care in the operating room (OR). In contrast, other practices have developed a concurrent OR-APS model where there is no independent team beyond the intraoperative care providers. There are theoretical advantages of each approach primarily with respect to patient outcomes and financial cost, and there is little evidence to instruct best practice. In this daring discourse, we present two opposing perspectives on whether or not APM should be a stand-alone service. While evidence to guide best practice is limited, our goal is to encourage discussion of the varied APS practice models and research into their impact on outcomes and costs.

  • acute pain
  • pain management
  • economics
  • regional anesthesia

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Data availability statement

There are no data in this work.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.