Interdisciplinary pain management programs are evidence-based rehabilitation environments to assist patients disabled by pain to recover important functional capacity. They employ education and rehabilitation using the biopsychosocial model. This chapter describes the elements of these programs and the rationale for their use. Interdisciplinary treatment is effective for chronic musculoskeletal pain and may have greater utility for subacute pain. Interdisciplinary treatment is safer than many other treatments for chronic pain and is often more effective. Interdisciplinary pain medicine has origins in allopathic medical care, where various specialists are brought together due to the complexity of presentation. The complex chronic pain patient, where no single specialist or clinical perspective offers the explanation for the cause of the patient’s condition, often benefits from this type of treatment. The involvement of various medical specialists such as anesthesiologists, physiatrists, neurologists, orthopedists, and neurosurgeons to combine with psychologists, nurses, and physical therapists as well as occupational therapists sometimes including social workers, vocational therapists in recognition of the pain having physical, environmental and emotional aspects which need to be better understood to best treat the patient. Often, this type of approach is considered multidisciplinary, but in the most comprehensive form is actually interdisciplinary. The primary differentiator between interdisciplinary care and multidisciplinary care is the communication and coordination that occur with the concurrent care delivery planned and orchestrated by the collocated group of providers and the patient. These four Cs of communication, coordination, concurrence, and colocation have evolved most recently with the promotion of telemedicine to now include virtual colocation expanding the access and availability to this gold standard of pain care. The process of pursuing medical care in the United States has much to do with how the expertise of interdisciplinary clinics developed. Because most patients who present to western trained medical providers are educated to look for the cause of their pain in order that a cure for that pain might be provided the search for the pain cause is often attended by a primary care provider, an orthopedist, a neurologist, an anesthesiologist each of whom tries their best to order appropriate diagnostic tests, prognostic or therapeutic injections and surgery with complimentary prescribed medications to those patients as they search for the cause and the treatment of that pain. The reinforcement of a simple biomedical model where the search for a cause of pain results in a cure for that pain is the primary motivator for this course of treatment. Unfortunately, these multidisciplinary treatment plans do not find a singular cause and when they do, they cannot offer a cure as the condition is recognized as incurable. This conundrum creates the abandonment of the patient by the individual providers, each of whom feels inadequate to address the problem. The patient invariably feels victimized by this experience as they learn of the absence of a cure and they hear their providers each describing that they do not have anything else to offer. It is the patient with such intractable pain, victimized by their medical condition, abandoned by their providers, and feeling increasingly hopeless who presents for Interdisciplinary Pain Treatment. Consequently, interdisciplinary programs need to have expertise in surgical and interventional care, psychoeducational content, medication management, and rehabilitative resources to assist the patient in learning additional ways to cope with pain and enjoy life despite the persistence of their pain. Education about tissue damage and how even optimal healing can still result in a painful condition that is not harmful is essential in reaching these increasingly hopeless patients. Interdisciplinary treatment optimizes what the mind and body can do even in the presence of persisting pain to allow the most normal function and highest productivity to reduce the impact that intractable pain has on a patient’s life. This learning leads to a mastery of the pain experience. This mastery is a lifelong pursuit that includes a change in common thinking patterns that adversely affect the response to pain. Developing a level of pain acceptance while employing behavioral skills, such as relaxation or biofeedback, to self-regulate psychophysiological arousal as well as pain is the course work of interdisciplinary care. In addition to these more medically and psychologically focused goals of an interdisciplinary pain rehabilitation program, a specific component of training is combined to teach techniques for adaptive living, ergonomics and energy conservation, pacing, and vocational counseling to allow one to resume their most important life roles. Patients following interdisciplinary care benefit by having continued access to pain specialty providers longitudinally to allow integration of novel and innovative treatments as well as pain research to keep the hope of pain improvement a vital part of their overall care.

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Interdisciplinary Pain Treatment

  • William G. Brose,
  • Dokyoung S. You,
  • Corrine Cooley,
  • Allie Schmeissing,
  • Fei Cao

摘要

Interdisciplinary pain management programs are evidence-based rehabilitation environments to assist patients disabled by pain to recover important functional capacity. They employ education and rehabilitation using the biopsychosocial model. This chapter describes the elements of these programs and the rationale for their use. Interdisciplinary treatment is effective for chronic musculoskeletal pain and may have greater utility for subacute pain. Interdisciplinary treatment is safer than many other treatments for chronic pain and is often more effective. Interdisciplinary pain medicine has origins in allopathic medical care, where various specialists are brought together due to the complexity of presentation. The complex chronic pain patient, where no single specialist or clinical perspective offers the explanation for the cause of the patient’s condition, often benefits from this type of treatment. The involvement of various medical specialists such as anesthesiologists, physiatrists, neurologists, orthopedists, and neurosurgeons to combine with psychologists, nurses, and physical therapists as well as occupational therapists sometimes including social workers, vocational therapists in recognition of the pain having physical, environmental and emotional aspects which need to be better understood to best treat the patient. Often, this type of approach is considered multidisciplinary, but in the most comprehensive form is actually interdisciplinary. The primary differentiator between interdisciplinary care and multidisciplinary care is the communication and coordination that occur with the concurrent care delivery planned and orchestrated by the collocated group of providers and the patient. These four Cs of communication, coordination, concurrence, and colocation have evolved most recently with the promotion of telemedicine to now include virtual colocation expanding the access and availability to this gold standard of pain care. The process of pursuing medical care in the United States has much to do with how the expertise of interdisciplinary clinics developed. Because most patients who present to western trained medical providers are educated to look for the cause of their pain in order that a cure for that pain might be provided the search for the pain cause is often attended by a primary care provider, an orthopedist, a neurologist, an anesthesiologist each of whom tries their best to order appropriate diagnostic tests, prognostic or therapeutic injections and surgery with complimentary prescribed medications to those patients as they search for the cause and the treatment of that pain. The reinforcement of a simple biomedical model where the search for a cause of pain results in a cure for that pain is the primary motivator for this course of treatment. Unfortunately, these multidisciplinary treatment plans do not find a singular cause and when they do, they cannot offer a cure as the condition is recognized as incurable. This conundrum creates the abandonment of the patient by the individual providers, each of whom feels inadequate to address the problem. The patient invariably feels victimized by this experience as they learn of the absence of a cure and they hear their providers each describing that they do not have anything else to offer. It is the patient with such intractable pain, victimized by their medical condition, abandoned by their providers, and feeling increasingly hopeless who presents for Interdisciplinary Pain Treatment. Consequently, interdisciplinary programs need to have expertise in surgical and interventional care, psychoeducational content, medication management, and rehabilitative resources to assist the patient in learning additional ways to cope with pain and enjoy life despite the persistence of their pain. Education about tissue damage and how even optimal healing can still result in a painful condition that is not harmful is essential in reaching these increasingly hopeless patients. Interdisciplinary treatment optimizes what the mind and body can do even in the presence of persisting pain to allow the most normal function and highest productivity to reduce the impact that intractable pain has on a patient’s life. This learning leads to a mastery of the pain experience. This mastery is a lifelong pursuit that includes a change in common thinking patterns that adversely affect the response to pain. Developing a level of pain acceptance while employing behavioral skills, such as relaxation or biofeedback, to self-regulate psychophysiological arousal as well as pain is the course work of interdisciplinary care. In addition to these more medically and psychologically focused goals of an interdisciplinary pain rehabilitation program, a specific component of training is combined to teach techniques for adaptive living, ergonomics and energy conservation, pacing, and vocational counseling to allow one to resume their most important life roles. Patients following interdisciplinary care benefit by having continued access to pain specialty providers longitudinally to allow integration of novel and innovative treatments as well as pain research to keep the hope of pain improvement a vital part of their overall care.