Multi-disciplinary approach to chronic pain management has been considered the most effective approach in addressing the limitations, reducing pain and improving functional outcomes. However, most of the programmes simply patch together concurrent physiotherapy and psychology sessions without true integration of underlying philosophy of multi-disciplinary approach.
This leads to disjointed care with poor outcomes and the client is left to go to and fro between the GPs, physios, psychs, pain consultants and all sorts of other interventions like acupuncture, yoga, massage, injections, surgeries etc. Whilst these may provide some short term relief (hours, weeks or days) but the pain always returns and sometimes with a vengeance.
So what should an effective programme look like?
Lentz et al (2020) highlighted 6 key factors for successful pain management programmes to ensure continued progress in combating the opioid crisis:
1. Bespoke to the patient based on their individual needs and goals. There is no one size fits all that works for chronic pain.
2. Takes a comprehensive, evidence-based, and guideline-concordant approach to pain management, avoiding low value and ineffective interventions.
3. Incorporates multiple provider disciplines and services, including but not limited to: psychological and behavioral health interventions; rehabilitative approaches (e.g., physical or occupational therapies); integrative health approaches (e.g., yoga, meditation and others) and medical management (e.g., pharmacological and surgical interventions).
4. Encourages non-pharmacological, non-surgical treatments as first line of intervention.
5. Incorporates routine, standardized quality and outcomes measurement.
6. Provides digital options and flexibility for care delivery based on patient needs.
One exemplar is the U.S. Department of Veteran’s Affairs (VA) Whole Health System. The Whole Health System is a person-centered, systematic approach to providing comprehensive health care early in the relationship between VA and the veteran. While the system is not specific to pain management, chronic pain management is a frequent focus. Unlike traditional episodic care models, this system is designed for continuous engagement with the veteran throughout life. The model emphasizes self-care within the broader context of well-being, and incorporates a full range of conventional and complementary and integrative health approaches, such as stress reduction, yoga, tai chi, mindfulness, nutrition, acupuncture, and health coaching.
Our RESTORE programme for chronic pain holistically combines technology, evidence-based behavioural science and clinical supervision to achieve successful outcomes for patients. A vital differentiating characteristic is integrating modular pain neuroscience education and behaviour modification with 1:1 specialist clinical support and 24/7 health coaching. It is underpinned by principles of Acceptance Commitment Therapy and Cognitive Functional Therapy and therefore combines tools such as pacing and mindfulness with physical activity and focus on functional abilities and work.
To read the full article by Lentz et al. 2020, please click here