Comprehensive Chronic Pain Management Program

Studies show that when pain becomes chronic, it increases in complexity and the patient becomes more resistant to treatment. It is widely accepted that continuation of the sequential outpatient-inpatient approach of the medical model is not successful for the typical chronic pain patient.

Since chronic pain syndrome is a complex problem with medical and psychosocial aspects, it requires a comprehensive and interdisciplinary approach to evaluation and treatment. Chronic pain syndrome should be considered similar in scope to such disabilities as alcoholism, stroke, and spinal cord injury, if the patient is to reach the highest functional goals possible within medical and psychological limitations.

Pain programs have attempted to accomplish this outcome by an interdisciplinary and comprehensive approach to evaluating and treating patients with chronic pain. Programs for chronic pain management, like those for physical medicine and rehabilitation, are relatively new developments and began during World War II. Originated by Alexander and popularized by Bonica, these programs have multiplied in recent years and now number in the thousands.

Ideally, a pain clinic should be comprehensive and interdisciplinary and offer a wide range of treatment techniques. In the organization of a typical pain clinic the director provides overall leadership and the coordinator is responsible for day-to-day management. The patient's case manager is the attending physician.The clinical team regularly evaluates patients, sets goals, treats patients, and evaluated treatment outcomes. The team members typically include a physician, psychologist, physical therapist, social services counselor, pharmacist, dietician, and nurse. Some programs use other professionals such as kinesiotherapists, exercise physiologists, and so forth. Other medical subspecialists are usually available on a consultative basis. They attend regular team conferences that select patients to be accepted for treatment and monitor their progress.

The physician leads the team, coordinates the program, and provides overall medical management. The psychosocial-vocational team, consisting of the psychologist, social worker, and vocational counselor, provides leadership in the evaluation and treatment of the behavioral changes that are a result of chronic pain, and appropriate vocational intervention.

The therapy team members typically consists of nursing, pharmacy, dietary, physical therapy, and occupational therapy personnel, and provide daily therapy to control medication levels, modulate the pain level, and increase patient activity.