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Multidisciplinary Pain Treatment Centers By Richard L. Stieg, MD, MHS At one time in the history of pain medicine in America, multidisciplinary centers were a common place for treatment of chronic pain. These centers offered a wide variety of medically directed treatment options including, but not limited to,
True multidisciplinary clinics are now rare, despite the fact that the medical literature shows that such treatment was and remains very useful. The following three papers once again remind us about the value of multidisciplinary pain treatment centers. In the first, Dr. Gatchel and his associates review the literature on comprehensive pain rehabilitation programs. In the second, Dr. Huge and associates show the value of a functional restoration program for patients with chronic low back pain. Lastly, Dr. Hooten and his group discuss successful multidisciplinary treatment for patients with fibromyalgia (FM) at the Mayo Clinic.
A Review of the Effectiveness of Comprehensive Pain Rehabilitation Programs This seemed particularly timely since such clinics had almost disappeared from view. After reviewing the literature and discussing how to best use the data gathered, Dr. Gatchel's task force produced a document entitled "Evidence-Based Scientific Data Documenting the Treatment and Cost Effectiveness of Comprehensive Pain Programs for Chronic, Non-malignant Pain." The task force wanted to distribute the document to insurance companies and other third-party payers to alert them to the potential benefits of multidisciplinary pain programs. The task force concludes that, "the only therapeutic approach that has shown efficacy and cost-effectiveness is a comprehensive pain program (CPP) with functional restoration as a primary goal." This includes all other treatments currently available. The task force also recognized that despite "clear evidence of the significant long-term clinical and cost benefits of CPPs," that third-party payers "continue to resist reimbursement for the expenses of these rehabilitation programs and that they furthermore have instituted many cost-cutting mechanisms, which have actually steered patients away from treatments that demonstrably reduce health care utilization and towards more expensive therapies with poorer outcomes." In other words, most insurance companies still do not recognize the benefits of multidisciplinary pain centers but will pay for more expensive treatments, like surgery, which often have worse outcomes for patients. This inadequate state of affairs has been acknowledged by many health care delivery systems, including the US Veterans Administration and the Joint Commission on Accreditation of Healthcare Organizations (an organization that accredits hospitals). Such organizations assert that patients have a right to have their pain adequately managed. At this time, there has been no report from the task force about the success of their mission. Source: Robert J. Gatchel and Akiko Okifujii, "Executive Summary of the APS Task Force on Comprehensive Pain Rehabilitation Report," APS Bulletin. Winter 2006. American Pain Society. Functional Restoration for Patients with Chronic Low Back Pain This report comes from Munich, Germany, a country similar to the United States, but with considerably more government-sponsored social benefits to its citizens. The impact of an intense multidisciplinary program for patients with long histories of chronic low back pain was compared to a similar group of patients receiving less intense services. The multidisciplinary program emphasized functional restoration and cognitive behavioral treatment. The two groups of patients were re-examined one year after treatment was concluded. The researchers found what many other studies have previously demonstrated — the patients receiving the more intense multidisciplinary treatment had significantly less pain, less depression, better ability to assume physical role functions, better social functioning and less "doctor shopping" behavior (which would have indicated treatment failure). The study has positive implications for the ability of similar American clinics to be able to offer successful treatment to culturally diverse groups of patients. Source: Volker Huge, MD, et. al. "Impact of a Functional Restoration Program on Pain and Health-Related Quality of Life in Patients with Chronic Low Back Pain," Pain Medicine 7 (6), Pages 501-508, 2006.
Multidisciplinary Treatment for Patients with Fibromyalgia
Patients stopped taking all medications during the program, based on medical studies that previously showed the lack of effectiveness of nonsteroidal anti-inflammatory drugs, benzodiazepines or opioid analgesics in fibromyalgia and the clinic's own positive experience with medication withdrawal in other types of chronic pain. Pain intensity and physical functioning significantly improved despite discontinuation of these medications. The authors point out that these successes occurred in the setting of an intense multidisciplinary pain treatment program and that the results of their work may not necessarily be applicable to all patients with fibromyalgia in other settings. Source: W. Michael Hooten, et. al. "Treatment Outcomes after Multidisciplinary Pain Rehabilitation with Analgesic Medication Withdrawal for Patients with Fibromyalgia". Pain Medicine 8 (1) Pages 8-16, 2007 Author's note: The best way to find out if clinics in your area offer multidisciplinary pain services is to call them and ask what specific treatments they offer. Further information can be obtained by consulting the Pain Care Provider Directory on this website or by visiting the American Academy of Pain Medicine site and searching their membership directory. — R. Stieg
Other articles by Richard Stieg |
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