Treatment Principles

General Goals of the Multidisciplinary Pain Center (MPC)

• Identification and treatment of unresolved medical problems

• Elimination of inappropriate medications

• Symptomatic improvement

• Restoration of physical functioning

• Restoration of social and occupational functioning, social integration, and return to productive employment

• Reduction in use of the health care system

• Improvement in coping skills, foster independence

Principles of MPC Program

The single most important ingredient is the existence of health care providers who are willing to work as a team. The health care providers must care about chronic illness and not be totally locked into acute diseases as is fostered by the biomedical model. The commitment of the provider to the patient is essential. Patients must want to change their lives and must be willing to give the program a try. They must recognize that in this type of program the patients do the therapeutic work. The treatment is the start of a journey to reclaim one's life; long-term support is required to keep the patient on the road to recovery. The attempt to treat the untreatable leads to demoralization of the treatment team. Patients must be properly selected.

Physical Therapy

Physical therapy uses behavioral medicine principles and engages few, if any passive modalities (Turk et al. 2000). Biofeedback can be a useful adjunct because it teaches the patient that he or she can gain control over various bodily functions. The emphasis is on improving strength, endurance, and flexibility through the patient's physical activities. The therapist provides instruction, guidance, safety, and encouragement.

Medications

Medication is given on a time-contingent basis to uncouple the reinforcement of pain behavior medication. In general, patients in an MPC program do not derive adequate pain relief from analgesic medication, and thus they are usually tapered. This technique is simply a method of converting all opioids to an equivalent dose of sustained acting opioids or methadone. The dose is then tapered over the period of treatment, always with the full knowledge of the patient. Most medications may be discontinued; the common exceptions are antidepressants, which often help chronic pain patients. Pain clinics may also discourage long-term use of other medications both because of their potential side effects and because their use undermines the philosophical concept that the patient must learn to control his or her pain and not depend on health care providers or their prescriptions.

Psychological Strategies

Generally, the aim is to alter behavior rather than change the patient's personality. Patients learn coping skills because this is frequently a deficiency that has led to the patients many difficulties.

Another important aspect of multidisciplinary pain management is education. This is an activity shared by physicians, psychologists, and nurses. Topics cover a wide array of the problems facing those who suffer from chronic pain. Subject selection and content can be tailored to the needs of each group of patients, but a core set of issues to be discussed includes:

• Stress treatment

• Relaxation training

• Coping skills

• Anger treatment

• Pain behavior

• Sleep disorder

• Physiology of stress

• Assertion training

• Cognitive strategy

• Communication skills

• Dealing with depression

• Crisis management

• Cost/meaning of pain

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