Pain specialists emphasize the value of a multidisciplinary team approach to managing difficult pain cases as practiced at pain centers, often with multiple modalities that may include opioids, but also interventional procedures, such as epidurals. But patients may not always have access to such centers, their insurance may not cover the visit, and some centers may focus on interventional procedures at the expense of other modalities, Dr. Rapoport explains.
Ravi Prasad, PhD, associate chief of the Division of Pain Medicine at Stanford Medicine, Palo Alto, Calif., says the interdisciplinary approach to managing difficult pain, using the biopsychosocial framework practiced at Stanford’s pain clinic, is essential for challenging pain cases. The pain physician, physical therapist and psychologist on the interdisciplinary team bring together medical interventions, physical reconditioning and psychological and behavioral approaches to help patients get their pain under control. Pain centers may also bring in other specialties such as acupuncture.
“We need to recognize that acute and chronic pain are different, so the way we treat them should be different—and we need to make that clear to our patients. Acute pain often has an identifiable cause and a fixed end point, whereas chronic pain is influenced by multiple factors and can be ambiguous,” Dr. Prasad says.
“We do three-part evaluations, sit down and come up with comprehensive recommendations. Then we meet with the patient and walk them through the plan. There may not be a cure for their chronic pain condition, but nonpharmacologic strategies and techniques can help improve physical function and overall quality of life. The more we can step in early on and help patients learn to live with their pain, [the more they have] permission to move forward with their lives.”
Larry Beresford is a freelance medical journalist in Oakland, Calif.
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