Optimal Pain Management Requires Interdisciplinary Approach
LAS VEGAS—Chronic pain is a highly prevalent condition in the United States. One hundred million adults are affected by chronic pain, which is more than diabetes, heart disease, and cancer combined.
Costing more than $600 billion per year in lost productivity and medical expenses, chronic pain has been designated a major public health concern by the Institute of Medicine.1 However, many clinicians undertreat chronic pain, largely due to insufficient training in effective management of chronic pain. While the etiology of chronic pain involves biomedical mechanisms, such as activation of nociceptive pathways, psychosocial factors also play a central role and must be considered when formulating a treatment plan.
An interdisciplinary approach offers the optimal strategy for managing the complex and multifaceted components of chronic pain.2
Ravi Prasad, PhD, Clinical Associate Professor of Anesthesiology, Perioperative, and Pain Medicine at Stanford Medicine, reviewed the multidisciplinary treatment of chronic pain in his presentation, “It Takes a Village: Caring for the Whole Patient With an Interdisciplinary Team,” at PAINWeek 2016.3
Dr Prasad also holds appointments at Stanford Medicine as an Associate Chief of the Division of Pain Medicine, Training Director of the Postdoctoral Pain Fellowship for psychologists, and Director of the Stanford Comprehensive Interdisciplinary Pain Program, an academic inpatient pain program.
During his presentation, Dr Prasad covered the role of interdisciplinary care in pain management and the different components of the biopsychosocial model.
“The biggest take-home message is that optimum management of chronic pain conditions requires a biopsychosocial formulation of pain etiology and an interdisciplinary approach to treatment,” Dr Prasad told Clinical Pain Advisor.
“Interdisciplinary approaches should not be viewed as a treatment pathway on which to embark after other interventions have failed; rather, it should be the framework employed from the start of care. It is critically important that clinicians help patients understand that, although there may not be a cure for their pain condition, use of nonpharmacologic strategies and techniques can help improve functioning and overall quality of life.”
Dr Prasad discussed that multiple psychosocial factors such as fear-avoidance, history of adverse childhood events, catastrophization, psychological distress, and cultural and family influences may all play a role in the transition from acute to chronic pain. Regularly assessing these factors can help identify patients who are at increased risk for chronification of pain and who might benefit from prevention strategies.
According to Dr Prasad, for patients in whom chronic pain has already been established, the goal of treatment is to focus on quality of life and functioning and to help patients learn to live with pain. Dr Prasad compared chronic pain to diabetes, another chronic condition without a cure, in which managing the disease requires an approach that spans nutrition, medications, and patient self-monitoring.
For chronic pain management, Dr Prasad identified 3 primary facets of interdisciplinary care: medical optimization by physicians and physician extenders, physical reconditioning by rehabilitation specialists, and behavioral and lifestyle modification by mental health professionals.
Several multidisciplinary strategies have been empirically validated as effective regimens for treating chronic pain. Self-management education has been shown to improve symptoms and functional status and decrease work disability.4,5
Cognitive behavioral therapy, when used alongside conventional pain treatment, decreased rates of long-term sick absence, pain, and productivity loss, while promoting better quality of life and general health.6,7 An early intervention program designed to prevent high-risk pain patients from progressing to chronic pain was shown to reduce medication use, healthcare utilization, and self-reporting of pain variables.8
- Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine of the National Academies. Available at: http://nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief.aspx. Published June 29, 2011. Accessed September 1, 2016.
- Pergolizzi J, Ahlbeck K, Aldington D, et al. The development of chronic pain: physiological change necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013;29(9):1127-1135.
- Prasad R. It takes a village (part 2): caring for the whole patient with an interdisciplinary team. Presented at: Pain Week 2016. Las Vegas, NV; September 6-10, 2016.
- Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-367.
- Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035.
- Linton SJ, Andersson T. Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain. Spine (Phila Pa 1976). 2000;25(21):2825-2831.
- Linton SJ, Nordin E. A 5-year follow-up evaluation of the health and economic consequences of an early cognitive behavioral intervention for back pain: a randomized, controlled trial. Spine (Phila Pa 1976). 2006;31(8):853-838.
- Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003;13(1):1-9.