Abstract
**Background:** According to statistics from the Hanoi Pain Society (2015), it is estimated that if Vietnam's population is 100 million, more than 63 million people suffer from chronic pain conditions, of whom over 37 million have severe to very severe disease. Pain treatment outcomes remain limited; only 61.98% of patients treated for pain were satisfied with treatment outcomes, while 19.5% were dissatisfied, despite substantial financial investment (46.55% of patients with pain had spent USD 150 or more over the past 6 months on examination and treatment). One of the causes of this situation is the lack of a specialized pain subspecialty in our country; patients do not have access to professional pain management services, and pain treatment remains fragmented across multiple specialties. The objectives of this lecture are: 1) To highlight the urgent need for a multidisciplinary clinical pain management model; 2) To identify the barriers hindering the establishment of Pain Management Units (PMUs) and propose solutions; and 3) To report the results achieved by the Hanoi Pain Society. **Barriers to Establishing Pain Management Units and Solutions:** The difficulties encountered in establishing PMUs fall into 4 categories: 1) patient-related barriers; 2) healthcare personnel-related barriers; 3) system-related barriers; and 4) investor-related barriers. This lecture also addresses approaches to resolving each category of barrier. It is through the application of these solutions that a network of PMUs has been successfully established and is now operating effectively. **Practical Outcomes:** The Hanoi Pain Society has approached community pain management by developing a clinical pain treatment model and establishing PMUs. The PMU model is divided into 4 levels as follows: - **Level I PMU:** With an area of 30 m², divided into 1 examination room and 1 procedure room, staffed by 1 pain physician skilled in neuropathic pain and musculoskeletal pain management, and 1 nurse. - **Level II PMU:** With an area of ≥50 m², divided into 1 examination room, 1 procedure room, and 1 room for pain-management equipment (electrical stimulation, paraffin wax therapy, therapeutic ultrasound, spinal traction, shortwave diathermy, infrared therapy, etc.). Staffed by 1–2 physicians skilled in neuropathic pain and musculoskeletal pain management, and 2–3 nurses. - **Level II-Plus PMU:** Equivalent to a Level II PMU, with the addition of ultrasound equipment for ultrasound-guided injections and nerve blocks; the pain physician here requires additional ultrasound skills. - **Level III PMU:** At this level, the PMU functions as a full clinical Pain Department with a functional floor area of ≥100 m², with the area increasing according to the number of inpatients in accordance with applicable regulations. Staffing consists of 15–20 personnel. Equipment must ensure connectivity with diagnostic imaging, operating rooms for interventional treatment, and intensive care/emergency resuscitation units, among others. Since 2016, the Hanoi Pain Society has provided consultation on this pain management program and model to 14 provincial and sectoral hospitals, and has established and put into effective operation 11 PMUs. To facilitate the exchange of experience among PMUs, the Society established the PMU Club in 2016, which holds an annual scientific conference for experience sharing. **Recommendations:** Pain Management Units should be established to serve pain prevention and treatment. Training programs should be organized to provide basic pain management knowledge and skills to physicians working in PMUs.
