Multidisciplinary Pain Management

The realization that chronic pain and acute pain might have different mechanisms has led to important developments in both research and patients' care. Basic research paradigms that focus upon long-term changes in tissues and the nervous system have led to useful models for chronic pain. Clinical research has shown that strategies effective for acute pain often fail in patients with chronic pain and that there is utility in the cognitive-behavioral approach to the management of patients with chronic pain. We discuss the history and implementation of comprehensive multidisciplinary pain diagnosis and treatment. We conclude with a review of the data on outcomes and cost-effectiveness for multidisciplinary pain management.

Chronic pain - multidisciplinary pain management - outcomes - cost-effectiveness

REFERENCES

• 1 Loeser J D, Sears J L, Newman R I. Interdisciplinary, multimodal management of chronic pain. In: Bonica JJ The Management of Pain. Philadelphia; Lea & Febiger 1990: 2107-2120
• 2 Bonica J J. Past and current status of pain research and therapy.  Semin Anesth. 1986;  5 82-99
• 3 Fordyce W E. Behavioral Methods for Chronic Pain and Illness. St. Louis; Mosby 1976
• 4 Gatchel RJ, Turk DC Psychological Treatment of Chronic Pain: Clinical Handbook. New York; Guilford Press 1996
• 5 Gatchel RR, Turk DC Psychosocial Factors in Pain: Critical Perspectives. New York; Guilford Press 2000
• 6 Turk D C, Okifuji A. Efficacy of multidisciplinary pain centers: antidote for anecdotes.  Baillieres Clin Anesth. 1998;  12 103-119
• 7 Turk D C, Okifuji A. Treatment of chronic pain patients: clinical outcomes, cost-effectiveness and cost-benefits of multidisciplinary pain centers.  Crit Rev Phys Med Rehabil. 1998;  10 181-208
• 8 Turk D C. Biopsychosocial perspective on pain. In: Gatchel RJ, Turk DC Psychological Approaches to Pain Management: A Practitioner's Handbook. New York; Guilford Press 1996: 3-32
• 9 Turk D C, Meichenbaum D, Genest M. Pain and Behavioral Medicine: A Cognitive-Behavioral Perspective. New York; Guilford Press 1983
• 10 Taylor H, Curran N M. The Nuprin Pain Report. New York; Louis Harris & Associates 1985
• 11 Crook J, Tunks E, Rideout E, Browne G. Epidemiologic comparison of persistent pain sufferers in a specialty pain clinic and in the community.  Arch Phys Med Rehabil. 1986;  67 451-455
• 12 Crook J, Weir R, Tunks E. An epidemiological follow-up survey of persistent pain sufferers in a group family practice and specialty pain clinic.  Pain. 1989;  36 49-61
• 13 Flor H, Fydrich T, Turk D C. Efficacy of multidisciplinary pain treatment centers; a meta-analytic review.  Pain. 1992;  49 221-230
• 14 Loeser J D, Egan K J. Managing the Chronic Pain Patient. New York; Raven Press 1989
• 15 Loeser J D. Concepts of pain. In: Stanton-Hicks M, Boas R Chronic Low Back Pain. New York; Raven Press 1982: 146
• 16 Loeser J D. Multidisciplinary pain programs. In: Loeser JD, Butler SH, Chapman CR, Turk DC Bonica's Management of Pain. 3rd ed. Philadelphia; Lippincott Williams & Wilkins 2001: 255-264
• 17 Loeser J D. Multidisciplinary pain assessment. In: Loeser JD, Butler SH, Chapman CR, Turk DC Bonica's Management of Pain. 3rd ed. Philadelphia; Lippincott Williams & Wilkins 2001: 363-368
• 18 Loeser J D, Turk D C. Multidisciplinary pain management. In: Loeser JD, Butler SH, Chapman CR, Turk DC Bonica's Management of Pain. 3rd ed. Philadelphia; Lippincott Williams & Wilkins 2001: 2069-2079
• 19 Turk D C, Monarch E S. Chronic pain. In: Llewelyn SP, Kennedy P Handbook of Clinical Health Psychology. Chichester, England; John Wiley & Sons 2003: 131-154
• 20 Turk DC, Melzack R Handbook of Pain Assessment. 2nd ed. New York; Guilford Press 2001@
• 21 Turk D C, Okifuji A, Sherman J. Behavioral aspects of low back pain. In: Twomey L, Taylor JR Physical Therapy of the Low Back. 3rd ed. New York; Churchill Livingstone 2000: 351-383
• 22 Loeser J D. Desirable characteristics for pain management facilities. In: Bond MJ Pain Research and Management. Amsterdam; Elsevier 1991: 411-416
• 23 Turk D C, Stieg R L. Chronic pain: the necessity of interdisciplinary communication.  Clin J Pain. 1987;  3 163-167
• 24 Federico J. The cost of pain centers: where is the return. In: Cohen M, Campbell J Pain Treatment Centers at a Crossroads: A Practical and Conceptual Reappraisal. Progress in Pain Research. Seattle; IASP Press 1996 7: 249-256
• 25 Marketdata Enterprises .Chronic Pain Management Programs: A Market Analysis. Valley Stream, NY; 1995
• 26 American Pain Society .American Pain Society Pain Facilities Directory. Chicago; 1995
• 27 Crook J, Tunks E. Defining the ‘chronic pain syndrome': an epidemiological method. In: Fields HK, Dubner R, Cervero R Advances in Pain Research and Therapy, vol 9. New York; Raven Press 1985: 156-168
• 28 Weir R, Browne G B, Tunks E, Gafni A, Roberts J. A profile of users of specialty pain clinic services: predictors of use and cost estimates.  J Clin Epidemiol. 1992;  45 1399-1415
• 29 Frymoyer J, Durett C. The economics of spinal disorders. In: Frymoyer J The Adult Spine. Philadelphia; Lippincott-Raven 1997: 143-150
• 30 Simmons J, Avant W, Demski J, Parisher D. Determining successful pain clinic treatment through validation of cost effectiveness.  Spine. 1988;  13 342-344
• 31 Cutler R B, Fishbain D A, Rosomoff H L et al.. Does nonsurgical pain center treatment of chronic pain return patients to work? A review and meta-analysis of the literature.  Spine. 1994;  19 643-652
• 32 Fishbain D A, Rosomoff H L, Goldberg M et al.. The prediction of return to the workplace after multidisciplinary pain center treatment.  Clin J Pain. 1993;  9 3-15
• 33 Caudill M, Schnabble R, Zuttermeister P et al.. Decreased clinic use by chronic pain patients: responsive to behavioral medicine intervention.  Clin J Pain. 1991;  7 305-310
• 34 Guck T P, Skultety F M, Meilman P W, Dowd E T. Multidisciplinary pain center follow-up study: evaluation with a no-treatment control group.  Pain. 1985;  21 295-306
• 35 Roberts A H, Reinhardt L. The behavioral management of chronic pain: long term follow-up with comparison groups.  Pain. 1980;  8 151-162
• 36 Seres J L, Newman R I. Results of treatment of chronic low-back pain at the Portland Pain Center.  J Neurosurg. 1976;  45 32-36
• 37 Tollison C D, Kriegel M L, Downie G R. Chronic low back pain: results of treatment at the pain therapy center.  South Med J. 1985;  78 1291-1295
• 38 Turk D C. Efficacy of multidisciplinary pain centers in the treatment of chronic pain. In: Cohen MJM, Campbell JN Pain Treatment Centers at a Crossroads: A Practical and Conceptual Reappraisal. Progress in Pain Research and Management. Seattle; IASP Press 1996 7: 257-273
• 39 Deathe A B, Helmes E. Evaluation of a chronic pain programme by referring physicians.  Pain. 1993;  52 113-121
• 40 Turk D, Stacey B. Multidisciplinary pain centers in the treatment of chronic pain. In: Frymoyer J, Ducker T, Hadler N The Adult Spine: Principles and Practice. New York; Raven Press 1997: 253-274
• 41 Dvorak J, Gauchat M, Valach L. The outcome of surgery for lumbar disc herniation. I. A 4-17 years' follow-up with emphasis on somatic aspects.  Spine. 1988;  13 1418-1422
• 42 Lehmann T R, Spratt K F, Tozzi J E et al.. Long-term follow-up of lower lumbar fusion patients.  Spine. 1987;  12 97-104
• 43 North R B, Campbell J N, James C S et al.. Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation.  Neurosurgery. 1991;  28 685-690
• 44 North R B, Ewend M G, Lawton M T, Kidd B H, Piantadosi S. Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation.  Neurosurgery. 1991;  28 692-699
• 45 Burton C V. Percutaneous radiofrequency facet denervation.  Appl Neurophysiol. 1976;  39 80-86
• 46 Leclaire R, Fortin L, Lambert R et al.. Radiofrequency facet joint denervation in the treatment of low back pain. A placebo-controlled clinical trial to assess efficacy.  Spine. 2001;  26 1411-1416
• 47 Seres J. The neurosurgical management of pain: a critical review.  Clin J Pain. 1993;  9 284-290
• 48 Gallon R. Perception of disability in chronic back pain patients: a long-term follow-up.  Pain. 1989;  37 67-75
• 49 Turner J A, Loeser J D, Bell K G. Spinal cord stimulation for chronic low back pain: a systematic literature synthesis.  Neurosurgery. 1995;  37 1088-1096
• 50 Van Buyten J-P, Zundert J, Vueghs P, Vanduffel L. Efficacy of spinal cord stimulation: 10 years of experience in a pain center in Belgium.  Eur J Pain. 2001;  5 299-307
• 51 Turk D C, Brody M C, Okifuji A. Physicians' attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain.  Pain. 1994;  59 201-208
• 52 Langemark M, Oleson J. Drug abuse in migraine patients.  Pain. 1984;  19 81-86
• 53 Kjaersgaard-Anderson P, Nafeo A, Skov O et al.. Codeine plus paracetamol versus paracetamol in longer-term treatment of chronic pain due to osteoarthritis of the hip. A randomized, double-blind, multi-centre study.  Pain. 1990;  43 309-318
• 54 Savage S R. Opioid therapy of chronic pain: assessment of consequences.  Acta Anaesthesiol Scand. 1999;  43 909-917
• 55 Turk D C, Loeser J D, Monarch E S. Chronic pain: purposes and costs of interdisciplinary rehabilitation programs.  In: TEN: The Economics of Neuroscience. 2002;  9 64-69
• 56 Collins S L, Moore R A, McQuay H J. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review.  J Pain Symptom Manage. 2000;  20 449-458
• 57 Cassisi J, Sypert G, Salamon A, Kapel L. Independent evaluation of a multidisciplinary rehabilitation program for chronic low back pain.  Neurosurgery. 1989;  25 877-883
• 58 Mayer T G, Gatchel R J, Mayer H, Kishino N D, Keeley J, Mooney V. A prospective two-year study of functional restoration in industrial low back injury. An objective assessment procedure.  JAMA. 1987;  258 1763-1767
• 59 Tollison C, Kriegel M, Satterthwaite J, Hinnant D, Turner K. Comprehensive pain center treatment of low back workers' compensation injuries. An industrial medicine clinical outcome follow-up comparison.  Orthop Rev. 1989;  18 1115-1126
• 60 Tollison C. Comprehensive treatment approach for lower back workers' compensation injuries.  J Occup Rehabil. 1991;  1 281-287
• 61 Long D M, Filtzer D L, BenDebba M, Hendler N H. Clinical features of the failed-back syndrome.  J Neurosurg. 1988;  69 61-71
• 62 Bergquist-Ullman M, Larsson U. Acute low back pain in industry.  Acta Orthop Scand. 1977;  (suppl 170) 1-117
• 63 Biering-Sorensen F. A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology.  Scand J Rehabil Med. 1983;  15 71-79
• 64 Crook J, Moldofsky H. The probability of recovery and return to work from work disability as a function of time.  Qual Life Res. 1994;  3(suppl 1) S97-S109
• 65 Feuerstein M, Menz L, Zastowny T, Baron B. Chronic back pain and work disability: vocational outcomes following multidisciplinary rehabilitation.  J Occup Rehabil. 1994;  4 229-252
• 66 Beals P, Hickman N. Industrial injuries of the back and extremities.  J Bone Joint Surg Am. 1972;  54 1593-1611
• 67 Wiesel S, Feffer H, Rothman R. Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treatment protocol.  Spine. 1984;  9 199-206
• 68 Kupers R, Van den Oever R, Van Houdenhove B et al.. Spinal cord stimulation in Belgium: a nation-wide survey on the incidence, indications and therapeutic efficacy by the health insurer.  Pain. 1994;  56 211-216
• 69 Painter J R, Seres J L, Newman R I. Assessing benefits of the pain center: why some patients regress.  Pain. 1980;  8 101-113
• 70 Fey S G, Williamson-Kirkland T E, Fraugione R. Vocational restoration in injured workers with chronic pain.  Pain. 1987;  (suppl 4) S379
• 71 Mayer T G, Gatchel R, Kishino N et al.. Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up.  Spine. 1985;  10 482-493
• 72 Dzioba R, Doxey N. Prospective investigation into the orthopaedic and psychological predictors of outcome at first lumbar surgery following industrial injury.  Spine. 1984;  9 614-623
• 73 Friedlieb O. The impact of managed care on the diagnosis and treatment of low back pain: a preliminary report.  Am J Med Qual. 1994;  9 24-29
• 74 Bell G, Kidd D, North R. Cost-effectiveness analysis of spinal cord stimulation in treatment of failed back surgery syndrome.  J Pain Symptom Manage. 1997;  13 286-295