Physical Medicine and Rehabilitation Clinics of North America
Multidisciplinary and Interdisciplinary Management of Chronic Pain
Section snippets
Multidisciplinary treatment and the biopsychosocial model
Formal investigation into the variety of influences on pain probably began during World War II, when Beecher observed that injured soldiers removed from a fierce battle requested significantly less morphine as compared to those patients later seen in civilian practice with similar degrees of injuries. In 1959 Beecher published a landmark work describing how the contextual nature of pain or other influences could affect how pain is perceived [4]. This idea was greatly advanced with the 1965
Treatment models for chronic pain: multidisciplinary versus interdisciplinary
Multidisciplinary and interdisciplinary treatment models are part of a continuum of medical care ranging from unimodal patient care to completely integrative care. These models include in order of increasing comprehensiveness and philosophical complexities: parallel, collaborative, coordinated, multidisciplinary, interdisciplinary, and integrative approaches [16]. For example, in an emergency room setting, parallel practice may be used with acute cardiac chest pain management whereby several
Multidisciplinary assessment and the chronic pain patient
Chronic pain patients are typically subject to failed interventions and therapies. As a result, the patient is frequently demoralized and turns from an active participant in their care to a more passive individual, often with great affective distress. This reaction only serves to perpetuate subjective disability and learned helplessness. If we are to treat these individuals successfully, knowledge of the issues that shape their presentation is essential. Not surprisingly, multidisciplinary
Outcomes of multidisciplinary and interdisciplinary treatment
Two systematic reviews have examined the efficacy of multidisciplinary treatment programs. Flor and coworkers [13] reviewed controlled and noncontrolled studies and concluded that MPCs were effective, although the methodologic quality of many of the studies was lacking. In comparison with no treatment or unimodal care, treated patients were functioning better than 75% of controls and had significant improvements regarding function, pain intensity, pain behaviors, and medical use. Cutler and
Future directions: examining process
Recently, in an attempt to better understand the process behind the well-documented treatment gains, studies have been conducted examining the “active ingredients” of treatment. These studies have identified cognitive changes, in particular changes in pretreatment versus posttreatment levels of catastrophizing, as crucial predictors of outcome [68], [69]. Other studies have identified changes in pain-related fear as predictors of outcome [70]. Work is now beginning at the authors' center to
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