An effective but overlooked treatment for chronic pain

More than 20% of American adults, or 50 million people, live with chronic pain conditions such as spinal disorders and disc disease, pinched nerves, low back pain, neck pain, complex regional pain syndromes, fibromyalgia, shingles, neuropathies caused by diabetes and arthritis. and musculoskeletal disorders, according to the Centers for Disease Control and Prevention.

Chronic pain sufferers were frequent targets of opioid overprescription, and many of them fell victim to the opioid epidemic that swept the world. People with chronic pain have faced added stress and forced isolation during the COVID-19 pandemic, which has often also led to depression and weight gain.

At first glance, it may seem that modern medicine is well placed to manage pain patients, with its arsenal of high-tech treatments such as spinal fusion and disc surgeries, spinal cord stimulators, injections of steroids and painkillers, nerve ablations (“burn”) and blocks, and, of course, opioid drugs. Yet, all is not well in the world of pain medicine, and concepts such that “wallet biopsy” (in which a patient’s ability to pay determines their treatment) and “x-ray diagnosis” (in which abnormalities revealed may not even be the cause of pain) suggest some of the problems.

Costly overtreatment is just one feature of pain medicine today. Another is the search for “quick fixes”.

In sports, universities, and the world of work, the need for patience and hard work is accepted, but when it comes to pain, people want instant results. Unfortunately, the quick fixes to pain that Americans and their doctors seem to prefer often don’t get the job done and produce a new sector of lifelong pain patients who bounce from one ineffective treatment to another, often discouraged and discouraged. An example of the pain treatment merry-go-round is seen in the frequently reported phenomenon of failed back surgery syndrome.

Rehabilitation specialists and physiatrists (doctors trained in physical medicine and rehabilitation) note that quick pain treatments like surgery or injections, sometimes called single-modal treatments, do not take a long-term perspective on the patient’s recovery. . Many help the medical profession and insurers more than patients.

Why is chronic pain so difficult to treat?

Chronic pain can mystify doctors because it doesn’t always have a clear anatomical cause. For example, people report pain in amputated or paralyzed limbs and should report no pain, and soldiers and first responders feel nothing when injured in a crisis situation.

Chronic pain has a strong mental component and is affected by emotional states. Many, perhaps most, chronic pain patients experience emotions such as depression, sadness, hopelessness, helplessness, and anger toward the people or situations that caused the pain, or toward a profession medicine that does not seem to be able to help them escape it. Many chronic pain patients are afraid of activities that could make the pain worse and therefore become reluctant to resume a normal life. As a result, they may become sedentary.

While negative emotions result from pain, they also make pain worse and fuel a vicious cycle, experts say. Some pains seem more closely tied to emotions than others. Certain types of back pain, for example, are consistently linked to anger. “Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior, and treatment outcomes,” notes a research review published in the Journal of Psychosomatic Research in 2019. When patients with chronic pain have been forced to take time off work, they also often feel isolated, as if they no longer participate in life, or even worthless. Their relentless pain and gloomy mental state can also cast a cloud over those around them.

A better model for treating chronic pain

What if every aspect of a chronic pain patient’s situation could be addressed by the medical system, from their physical pain, emotional anguish, and psychological stress to the day-to-day activities of their work and personal life? This is the tenet of “multidisciplinary” treatment of chronic pain, a model that prevailed until recent decades, when it fell out of favor as medicine became increasingly reimbursement-oriented.

Yet many experts recommend multidisciplinary treatment for chronic pain, which brings together the expertise of clinicians from many disciplines. A multidisciplinary team is made up of a doctor, various therapists (physiotherapists, occupational therapists, professional, recreational, exercise and ergonomic), a social worker, a psychologist and a rehabilitation nurse. The team may also include a nutritionist or dietitian, social worker, biofeedback expert, pharmacist, pain support groups, and even members of the clergy. Sometimes family members are even included in the team; they are certainly aware of the health situation and intimately affected by it.

A multidisciplinary team has many advantages. Unlike non-multidisciplinary care, in which the patient is often told what to do and passively recovers from surgery and procedures, multidisciplinary treatment includes the patient as an active, credible and listened-to member of the team. Being part of the medical team and having a say in treatment is often a new experience for pain patients, even if it’s a no-brainer because only the patient knows how they feel. In multidisciplinary care, a patient will almost never be told that they “shouldn’t have” the pain because there is no “anatomical problem” or the “surgery worked”, messages too often heard in traditional pain treatment.

Multidisciplinary care has another advantage. Patients with chronic pain often fear physical activity and exercise because they expect it to cause them more pain. Rehab experts know the opposite is true – physiotherapy, for example, may hurt at first, but addresses the pain issue. When a patient is part of the team, it often inspires them to embrace the therapies that their team members recommend with new vigor. Non-multidisciplinary care therapies, on the other hand, are often passive, requiring no effort or ambition on the part of the patient.

Finally, the team coordinates the care between the therapists. In traditional medical settings, patients may wonder if one clinician is communicating with another. Not only do clinicians not always seem to be working with each other, they can even seem to be working against each other!

Create your own multidisciplinary team

So how do you access multidisciplinary care for chronic pain? You can start by exploring pain centers at senior centers, natural health care centers, and even YMCAs, instead of starting with surgeons and conventional medical treatments. You can also build your own multidisciplinary team. Even if the team is no longer under one roof (as it was before reimbursement-focused medical care), you can identify one or more therapists who can cooperate with you – and each other – as team, if they are not locked into a network of suppliers.

Here are some questions to ask future members of your team.

The person :

• take the time to understand my whole situation, to treat myself and not just the pain?
• respect and work with other disciplines, holistically?
• working with clinicians that I personally find or that I suggest?
• be honest with me when a treatment is unlikely to help?

Even if your team isn’t under one roof, it’s easy to host Zoom conferences and virtual meetings or hold conference calls to track your progress with proper safeguards for portability and privacy laws in place. health insurance liability. Your family can be included in these conferences.

More and more insurance plans are beginning to recognize that chronic pain often requires more than quick fixes and one-way treatments and are therefore now offering coverage.

Conclusion

Treating chronic pain has become a $635 billion a year business in the United States. More money is spent annually on lower back pain, neck pain, spinal disorders, arthritis and musculoskeletal pain and other painful conditions than on heart disease ($309 billion), cancer ( $243 billion) and diabetes ($188 billion). Few would complain about the cost if patients got better, but despite highly addictive drugs and expensive new procedures and surgeries, many pain patients do not improve and some become permanent patients. Isn’t it time to give a new face to the multidisciplinary management of chronic pain?