Multidisciplinary Care in Pain Management
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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 |
|---|---|---|---|---|
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Table 1. Multimodal treatment approaches for chronic noncancer pain
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Patients who are in chronic pain may take an active part in their own referral and treatment.
True multidisciplinary management of chronic noncancer pain requires a core team of healthcare professionals. Together, the core members should be capable of assessing and managing the medical, physical, psychological, vocational and social aspects of chronic pain. The primary care physician usually plays a central key role in this team as a gatekeeper and coordinator of the treatment strategy. He or she is responsible for the long-term management and care of the patient with chronic according to the treatment plan, and refers the patient for further treatments and assessment as necessary.
The core members of the team also vary according but typically include members from three or more medical specialities (e.g.,anaesthesiology, neurology, rheumatology, orthopaedics, neurosurgery, clinical psychology/psychiatry, nursing, rehabilitation and physiotherapy/physical therapy). In many countries, in practice, the core team consists of three physicians (primary care physicians, anaesthesiologists and psychiatrists) and nonphysicians (psychologists, physiotherapists and nurses).
According to the International Association for the Study of Pain (IASP) guidlines, if one of the physicians is not psychiatrist, physicians from two medical specialities and a clinical psychologist are the minimum required.
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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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