Specialist pain clinics and addiction management services are vital in addressing some of the most complex and costly health care conditions. However, their success depends on stable and robust primary care systems. Without strong primary care as a foundation, these health care initiatives risk fragmentation, poor continuity, and low patient accountability. Stable primary care ensures timely access, coordinated care, longitudinal monitoring, and patient engagement, all essential elements for the value-based care of chronic pain and addiction.
Primary care is the health system’s first point of contact and long-term anchor. For chronic pain or substance misuse patients, symptoms evolve and require ongoing assessment, management, and referral. Stable primary care provision can recognize early warning signs, prevent escalation, and provide continuity between specialist interventions. Pain and addiction clinics may be siloed, working within tertiary or outpatient specialty settings with limited follow-up opportunities. Primary care can fill this gap by reinforcing care plans, monitoring medications, and integrating psychosocial supports. Through shared care models and interconnected electronic medical records, primary care can track referrals, communicate with specialists, and align treatment goals, thereby mitigating duplication, conflicting advice, and treatment gaps. This interconnectedness is vital for patients with co-occurring disorders like anxiety, depression, insomnia, or diabetes, which impact pain or substance use outcomes.
Chronic pain and addiction care require behavioral changes and sustained engagement, yet many patients struggle with motivation, insight, or social support. Recent research reveals a troubling trend: Chronic pain patients without consistent primary care significantly engage in verbal aggression, emotional manipulation, and harassment toward pain clinic staff. A clinical study was published in the Anesthesiology and Pain Medicine journal in May 2024. The study showed that these patients, often dislocated from any consistent medical home, brought unmet needs, mistrust, and desperation into specialist clinics, escalating conflict and harming therapeutic relationships. The finding highlights an overlooked consequence of fragmented care: It burdens patients and endangers health care professionals.
The study indicated that when the safety net of primary care is missing, patients escalate complaints, push for inappropriate interventions, or use manipulative behaviors to obtain medication. The study’s findings are a call to action. The harassment of pain clinic staff is not just a behavioral issue; it is a systems failure. It reflects the pressure placed on specialists to fill the gaps left by inadequate primary care. It’s a sign that patients, too, are hurting, not just physically, but emotionally and socially, because they lack the stable, longitudinal relationships that primary care provides. Furthermore, such an inadequate environment causes higher rates of clinician burnout, staff absenteeism, and compromised clinic safety, an unacceptable reality that undermines the sustainability of pain management systems.
In underserved communities facing health care workforce shortages or fragmented systems, inadequate primary care exacerbates health inequities. Indeed, marginalized populations with limited access to family physicians are likely to fall through the cracks of specialist-based care. Without stable primary care provision, the care continuum for addiction programs may be delayed, undermining patients’ recovery.
To enable value-based pain management and addiction therapy, we must stop viewing them as isolated solutions. We must reframe them as dependent on stable primary care to promote care continuity, ensure patient accountability, and mitigate harassment of physicians caused by patients. Investing in robust primary care isn’t just good for health outcomes; it’s essential for clinic safety, staff well-being, and sustainable care. The future of pain and addiction care lies not in more specialization alone, but in stronger integration, relationship-based care, and systemic accountability across the health system.
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
