Multidisciplinary pain management

Multidisciplinary pain clinics were first established in the 1960s by an anaesthetist who realised that treating chronic pain successfully could require several different kinds of medical specialists to work in cooperation. For example, a single patient might benefit from the expertise of a neurologist, an orthopaedic surgeon and an occupational therapist as well as an anaesthetist. If the patient had been in pain for a long time they might have developed additional problems, such as depression or family stresses, which could require the services of a psychologist or social worker.

Once the psychologists got involved in pain management, it seems they quickly established a leading role for themselves on the multidisciplinary team. It is their methods that dominate the treatment in most chronic pain programs today.

Following the "bio-psycho-social" (as opposed to "biomedical") model of medicine, psychologists see chronic pain as arising from a combination of psychological, social and cultural factors, rather than just injury or disease. It's often difficult for doctors to identify a physical cause for the patient's persistent pain. But psychologists can point to a long list of non-physical reasons such as:- depression; anxiety; stress; somatisation; "secondary gain" (payoffs such as not having to work), inactivity, reliance on drugs for pain relief, poor coping styles; claiming insurance or compensation; and faulty beliefs and attitudes.

Treatment involves weaning the patient off their pain medication, encouraging them to get fitter with graded exercise programs, and fixing up their thoughts through "cognitive behavioural therapy". These methods are claimed to be successful.

This public position paper from the Australian Pain Society outlines the techniques used in Multidisciplinary Pain Management Programmes for chronic, Persistent or Longlasting Pain.

The biopsychosocial explanation is now also used to explain those other hard-to-explain illnesses, CFS and fibromyalgia. A cognitive behavioural therapy (CBT) program incorporating graded exercise is a standard recommendation for CFS treatment (see for example the RACP Guidelines). Patient advocacy groups disagree with this approach, warning that it can be ineffective or possibly harmful.

Related articles:

Article about pacing v graded exercise

A CFS patient's experience in a multidisciplinary pain clinic

Know your enemy: The "rehabilitation model" of chronic pain

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