Multidisciplinary Care in Pain Management

Welcome to PPA Pain Project. This page is being developed by participants of a project to populate the Pain section of Physiopedia.  The project is supervised and co-ordinated by the The Physiotherapy Pain Association.

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•  Multidisciplinary care: Describe and explain the role and responsibilities of the physical therapist in pain management and the integration of physical therapy into the interdisciplinary team.
• Roles and responsibilities of other health care professionals in the area of pain management and the merits of interdisciplinary collaboration.
  

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Top Contributors - Elvira Muhic, Lauren Lopez, Jo Etherton, Kim Jackson, Naomi O'Reilly, WikiSysop and Claire Knott  

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Severe chronic noncancer pain is a considerable health issue, profoundly affecting not only the quality of patients' social and working lives but also impacting on healthcare providers and society as a whole. Marked changes in sleep patterns, coping mechanisms and ability to exercise, undertake normal daily tasks, and attend work and social activities are associated with chronic pain, leading to a reduction in the physical, psychological and social wellbeing of the patient. The impact of chronic pain on the individual patient is also exacerbated further by an increase in prevalence of comorbidities such as anxiety, depression and decreased physical and mental functioning.

Patients with chronic noncancer pain often require long-term care with frequent reassessment and adjustment of therapy. Usually, the situation is further complicated by the coexistence of several types of chronic pain in an individual patient, the multidimensionality of chronic pain and the fact that the pain is often therapy resistant. The biopsychosocial model of chronic pain recognises these conditions as a combination of physical disfunction, beliefs and coping strategies, distress, illness behaviour and social interactions. Since the introduction of the biopsychosocial model, treatment for chronic pain has become multimodal and multidisciplinary, with emphasis on a range of strategies aimed at maximising pain reduction, improving health-related quality of life, independence and mobility, enhancing psychological wellbeing and preventing secondary disfunction.

In order to achieve these goals, successful long-term management requires the use a range of specialist treatment that is tailored to the individual patient needs. 

Pharmacotherapy	Psychological approaches	Physical approaches	Practical approaches	Interventional procedures
paracetamol NSAIDs opioids antidepressants anticonvulsants topical treatements and others	psychological counselling    CBT self-help strategies behavioral medicine	exercise physiotherapy / physical therapy spa therapy electrotherapy using TENS and rehabilitation	patient education vocational counselling patient support groups	nerve blocks advanced technologies (e.g.,implantable intrathecal pumps, drug administration systems and spinal cord stimulation systems / neurostimulation) surgical procedures

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It is not possible for every chronic pain patient to be managed in a multidisciplinary way as the numbers are too high and healthcare resources may not always be available; therefore, it is imperative to identify which patients will benefit from this multidisciplinary approach to care. Patients who have not responded to initial therapy, and with an uncertain diagnosis despite detailed medical evaluation, should be referred to and managed by a multidisciplinary team.

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