The Many Faces of Chronic Pain Treatment

The Many Faces of Chronic Pain Treatment

By: Dr. Esther Kim, PT, DPT

The National Institute of Neurological Disorders and Stroke identify chronic pain as persistent pain signals from the nervous system lasting months or years. It may originate from an initial injury, chronic diseases, or in the absence of body damage.1 Regardless of the origin of the pain, the fact is that pain is present and if left alone, it can wreak havoc in all facets of life as it typically does in individuals with chronic pain. The difficulty with treating individuals with chronic pain is due to the fact that it is not simply physical pain, it is emotional, psychological, and socially impactful. Therefore, it is often difficult for one provider to properly manage their care. The biopsychosocial model to treatment is gaining exposure in the literature as more and more clinicians recognize the widespread nature of chronic pain. A multidisciplinary biopsychosocial rehabilitation (MBR), as complicated as it sounds, is a team of health care providers working together to integrate the physical, psychological, education, and work-related interventions of an individual with chronic pain.2

The most prevalent of chronic pain is low back pain (LBP) which is most often a point of discussion in the literature. A Cochrane systematic review* and meta-analysis was conducted to assess the long-term effects of an MBR program in individuals with LBP. 2 The review determined that MBR is more effective than “usual care”, which consisted of recommendations from a general practitioner or medical specialist, and “physical treatments” in decreasing pain and disability among individuals with chronic LBP. An even more surprising conclusion was that the effect of MBR on work equates to double the odds of returning to work after 12 months.2 Unfortunately, MBR can be resource intensive and time consuming2 which may contribute to the lack of clinical utility and prevalence of high-quality research.

So why is this important? Dr. Perry Nickelston, DC, NKT, FMS, SFMA, stated that “Pain is a request for Change”. The traditional method of only seeing a physician or a physical therapist worked for a time period, but the pain returned, so the same treatments or protocols will not effectively resolve symptoms. As a physical therapist, I am humbled by the notion that I can’t fix everything on my own, but feel privileged to be positioned as a mediator to help manage their care appropriately. In order to provide the individual with the best possible resources, there must be sufficient communication between all parties. Dr. Jessica Schwartz stated, “you have to know what you are looking AT to know what you are looking FOR.” A breakdown in communication between the patient and therapist or therapist and physician may result in missed opportunities for referrals and treatment interventions. Understanding all aspects of the patient’s life can provide the therapist with perspective to know what the patient may need outside of physical therapy. Incorporating other healthcare professionals in their plan of care would assist in addressing the multiple dimensions of chronic pain.

*The systematic review contained low to moderate quality research

1. NINDS Chronic Pain Information Page. Chronic Pain Information Page: National Institute of Neurological Disorders and Stroke (NINDS). Published August 12, 2016. Accessed August 25, 2016.
2. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Bmj. 2015;350(feb18 5). doi:10.1136/bmj.h444