In 1996 the International Association for the Study of Pain defined pain as "an unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage." An estimated 50 million Americans live with chronic pain caused by disease, disorder, or accident. An additional 25 million are treated for acute pain related to surgery or accidental injury (National Pain Survey 1999). Approximately two-thirds of these patients have been living with pain in excess of 5 years. The loss of productivity and the quality of life due to pain is substantial (Chronic Pain America 1999). Million and even billions of dollars are lost from habitual health care utilization and disability compensation. In a study done in 2000 (Merck 2000), it was reported that 36 million Americans missed work in the previous year due to pain and 83 million indicated that the pain affected their participation in various activities.
In 1986, Koch estimated that 70 million office visits to physicians were motivated by pain complaints (Koch 1986). A 1994 estimate indicated that approximately one-fifth of adult population experience chronic pain and in 1999, Market Data Enterprise estimated that 4.9 million individuals saw a physician for chronic pain treatment (Joranson and Lietman 1994, Market Data Enterprise 1999). These statistics indicate that pain and its under treatment represents a major problem confronting society.
Acute pain is elicited by the injury of body tissues and activation of nociceptive transducers at the site of local tissue damage. The goals of acute pain management are to eliminate pain and to restore the patient's ability to function as rapidly as possible. Chronic pain is also elicited by an injury but may be perpetuated by factors that are both pathogenically and physically remote from the originating cause. Chronic pain is characterized by low levels of underlying pathology that does not correspond to the presence or extent of the pain experienced by the patient. Chronic pain prompts patients frequently to seek health care and it is rarely effectively treated in a primary care setting. Of the patients with chronic pain one-half to two-thirds are partially or totally disabled which all too often may become permanent. After the pain has become chronic its total eradication may be unrealistic.
Traditional biomedical methods of treating chronic pain have proven unsatisfactory both from the patients' and providers' prospective and this fomented a demand for effective therapy (Loeser). John Bonica first appreciated the need for a multidisciplinary approach to chronic pain during World War II after several months of experience in treating military personnel with the variety of pain problems (Loeser). Bonica put the concept of the multidis-ciplinary approach for the diagnosis and therapy of complex chronic pain problems during
N. Vadivelu et al. (eds.), Essentials of Pain Management,
DOI 10.1007/978-0-387-87579-8_2, © Springer Science+Business Media, LLC 2011
his practice at Tacoma General Hospital. This became the world's first multidisciplinary clinic. The group consisted of specialists who had developed interest and expertise in pain management and included an anesthesiologist, a neurosurgeon, an orthopedist, a psychiatrist, an internist, and a radiation therapist.
The importance of the multidisciplinary approach to the management of chronic pain has been emphasized by two important task groups, one in the United States and one in Canada. The Quebec Task Force suggested that if management by the treating physician specialist was not successful and the patient still had pain after 3-6 months, the patient should be referred to a multidisciplinary team, which should focus primarily on psychosocial and psychological elements on the premise that these factors are primarily responsible for the persistence of the pain.
Most multidisciplinary pain programs focus on patients who manifest chronic pain behavior and disability long after healing process should have been completed and have no treatable structural pathology. These principles of multidisciplinary diagnosis and treatment should be applied to patients with obvious chronic pathology not amenable to surgical or medical therapy, such as arthritis, cancer, deafferentation pain, and other chronic pain syndromes. Chronic pain that is not adequately treated causes the patient to develop psychological, psychosocial, and behavioral problems as well as progressive physical deterioration with marked interruption of activities of daily living.
Treating physicians who have been unsuccessful with the first or at most the second attempt in using surgery or medical therapies in managing complex pain problems are encouraged to refer such patient to a multidisciplinary pain center that can carry out a coordinated effort to establish a diagnosis and develop an effective treatment strategy.
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