Unregulated pain management clinics are coming under fire by critics calling them "pill mills" and "medical crack houses." Some have called for moratoriums on the clinics until greater national oversight can be established.

But the doctors who run pain management clinics say they resent being called pushers and drug dealers. They say they provide a much-needed service and relief to millions of pain-racked Americans.

The problem is nationwide.

Pain management clinics provide specialized medical treatment to more than 48 million Americans, including 1.5 million Louisianians who suffer from chronic pain, according to the American Medical Association. Treatment ranges from physical therapy to surgery and the prescription of narcotics, including Oxycontin and Xanax.

Dr. Patrick Waring, owner of the Pain Intervention Center in Metairie, said closing pain management clinics won't hurt the illegal clinics that should be shut down.

"We need to apply existing laws and let the DEA go after them," he said. "Unfortunately, the politicians have confused illegal drug dealing with the legitimate treatment of chronic pain. They've made 'pain clinic' a dirty word."

Lorraine Reeves, executive director of the Chronic Pain League in Harvey, was diagnosed with chronic pain more than 20 years ago. Her condition, which she treats with Oxycontin, is so severe she can't hold a steady job.

After hearing of a proposed moratorium on pain clinics, Reeves flashed back to the hysteria that enveloped Oxycontin when it first hit the market.

"The press painted Oxycontin as a horrible drug and created a fictional epidemic when it gave people with chronic pain their lives back," said Reeves. "Now the legislators who wanted to ban Oxycontin are trying to do the same with pain clinics. They don't stop to think what it will do to people with chronic pain who desperately need help and how it will stop good clinics from opening."

Pain management is big business. In 2004, the pharmaceutical industry generated more than $250 billion in painkiller sales, according to industry reports.

Twenty-five states have prescription-monitoring programs. The states without such programs gave rise to "pill mills" that profit by dispensing narcotics freely.

In April, the DEA raided three such clinics in Gretna, Slidell and Metairie.

"The number of states with prescription monitoring is growing and if all the states around you have monitoring programs, people are going to flood the market where there is no monitoring," Waring said. "That's the point of a national monitoring system."

Pain clinics in Louisiana are unregulated and often owned and operated by individuals who lack medical training, making oversight difficult. About a dozen pain clinics operate in eastern New Orleans.

Unlike neighboring states such as Arkansas, Mississippi and Texas, Louisiana also has no database to track prescriptions.

A recent rash of drug-related arrests at pain clinics in southeast Louisiana set politicians across the state scrambling to enact temporary moratoriums on the clinics.

State Sen. Tom Schedler, R-Mandeville, introduced a bill April 20 calling for a statewide ban on new pain clinics to go with similar prohibitions already approved in Orleans, St. Tammany, St. Bernard and Jefferson parishes.

Public officials say the moves are necessary to prevent the rise of one-stop prescription pill shops.

But pain management physicians say the moratoriums are "knee-jerk" reactions that hurt those most in need and drive honest doctors out of the state.

In March, the American Society of Interventional Pain Physicians reintroduced a bill in Congress to establish a national database to monitor all prescriptions. The National All Schedules Prescription Electronic Reporting Act is expected to come up for a vote as early as June.

Many pain management doctors and patients believe the combination of DEA raids, moratorium