What’s Hot in Pain? Multidisciplinary Care Gaining Wide Acceptance

Thursday, August 9, 2007

By: Chuck Weber

Reprinted from FMOnline


Treating the whole person, not just the pain, is the essence of multidisciplinary pain management for fibromyalgia patients and others with chronic pain. Of course the goal of treatment is significant pain relief—but also improved overall functionality and quality of life. For many, being able to continue working and pursuing a normal family life is a critical therapeutic outcome.

Pain is a very complex phenomenon, as many with fibromyalgia realized when they struggled to find the right diagnosis and understand the cause of their pain. Not only is pain a physical and medical condition, proper treatment often requires psychological and social support to help patients cope effectively.

At the recent American Pain Society annual meeting, there were a number of panel presentations devoted to multidisciplinary pain care. A common thread in all these presentations was that pain affects every person differently and can cause varying levels of disability. Success with pain medications and other treatment approaches therefore can fluctuate from patient to patient.

In one session, physical rehabilitation experts showed that regular exercise can bring significant pain relief. One researcher studied healthy college student volunteers who underwent four weeks of pain perception tests, before and after carefully controlled static isometric contractions of the left elbow flexor muscles. Before exercise, men exhibited a much higher pain tolerance than women. Pain stimuli occurred from a dull blade pressed against the right index finger for two minutes. After the isometric exercise, pain thresholds increased for men, but even more for women.

Also at the meeting, APS honored several pain centers nationwide with its Clinical Centers of Excellence Awards. The awards are designed to recognize forward-thinking teams of health care professionals who address critical needs in pain management in their communities. Any US-based, multidisciplinary, clinical program that provides direct patient care and focuses primarily on pain management was eligible to apply.

A recurring theme in the award-winning pain programs was their success in helping patients improve overall functionality and quality of life. While drugs play an important role in treatment, incorporating cognitive-behavioral and physical therapies and other approaches is the major therapeutic advantage for treating the whole person, not just the pain. These and other pain programs are proving that integrated, multidisciplinary pain care yields the best long-term outcomes—medically, psychologically and socially.

One center that received an APS award relies on an aggressive physical medicine/behavioral medicine approach. The multidisciplinary team addresses patients’ physical, functional, behavioral, socioeconomic, and medical issues concurrently. Regular follow-up is an important feature. Patients are encouraged to transmit pain diaries for advice and correction, or to send photos of physical issues. It is a vigorous and tough rehabilitation program in which patients are given physical and psychological tools to control and prevent their pain from returning. For more information about the APS Clinical Centers of Excellence Awards, go tohttp://www.ampainsoc.org/.

Another key development in the pain field is increasing emphasis at NIH and other granting agencies on translational research. This term refers to translating scientific discovery into practical applications. The approach encourages scientists and clinicians to study diverse aspects of pain with the ultimate goal of moving from laboratory discovery to adoption in clinical practice. Pain is a strong model for implementing translational research initiatives. Pain research is interdisciplinary and can address multiple disease processes, such as fibromyalgia, arthritis, and diabetes. It also is translational in that the goal of pain research has always been development of practical applications that can lead to pain relief for those who need it.

Pain researchers and clinicians are optimistic that the new emphasis on translational research could steer more NIH dollars to pain studies. This could be exciting news for those with chronic pain and their families. Knowing that translational research programs are an NIH priority, more top-tier clinical researchers and new PhDs will be attracted to pain as a primary field of interest.

So the message for fibromyagia patients and their families today is that multidisciplinary pain care is improving quality of life and increasing functionality through appropriate combinations of drug treatment, cognitive-behavorial therapy, exercise and physical therapy. In addition, greater emphasis on translational research soon may help increase badly needed funding for pain research and the hope it provides.