More than 20 percent of U.S. adults—50 million people—live with chronic pain such as spinal disorders and disc disease, pinched nerves, low back pain, neck pain, complex regional pain syndromes, fibromyalgia, shingles, diabetes-caused neuropathies, and arthritic and musculoskeletal conditions, according to the
Centers for Disease Control and Prevention.
People suffering with chronic pain were frequent targets of opioid overprescribing, and many became victims of the opioid epidemic that has swept the world. People suffering from chronic pain have experienced additional stress and forced isolation during the COVID-19 pandemic, which often also brought depression and weight gain.
On the surface, it may look like modern medicine is well-poised to handle pain patients, with its arsenal of high-tech treatments such as spinal fusion and disc surgeries, spinal cord stimulators, steroid and pain-killer injections, nerve ablations (“burning”) and blocks, and, of course, opioid drugs. Yet all is not well in the pain medicine world, and concepts like
“wallet biopsy” (in which a patient’s ability to pay shapes their treatment) and
“X-ray diagnosis” (in which abnormalities revealed may not even be the pain cause) suggest some of the problems.
Expensive over-treatment is only one feature of today’s pain medicine. Another is the pursuit of “quick fixes.”
In sports, academia, and the job world, the need for patience and hard work is accepted, but when it comes to pain, people want instant results. Sadly, the quick fixes for pain that both Americans and their doctors seem to prefer are frequently not doing the job—and are producing a new sector of permanent pain patients bouncing from one ineffective treatment to another, often discouraged and despondent. One example of the pain treatment merry-go-round is seen in the frequently reported phenomenon of
failed back surgery syndrome.Rehab specialists and
physiatrists (doctors trained in physical medicine and rehabilitation) note that quick-fix pain treatments like surgery or injections, sometimes called unimodal treatments, don’t take a
long-term perspective on the patient’s recovery. Many are helping the medical establishment and insurers more than the patients.
Why Is Chronic Pain So Hard to Treat?
Chronic pain can mystify doctors because it doesn’t always have a clear anatomical cause. For example,
people report pain in limbs that are amputated or paralyzed and should transmit no pain, and soldiers and first responders feel nothing when they’re wounded in a crisis situation.
Chronic pain has a strong mental component and is affected by emotional states. Many, perhaps most, chronic pain patients experience emotions such as depression, sadness, despair, helplessness, and anger at the people or situations that caused the pain, or at a medical profession that can’t seem to help them escape it. Many chronic pain patients experience fear of activities that might worsen the pain and thus become reluctant to resume their normal lives. As a result, they may become sedentary.
While
negative emotions result from the pain, they also worsen the pain and feed a vicious cycle, experts say. Some pain appears more closely linked to emotions than others. Certain kinds of back pain, for example,
are consistently linked with anger. “Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome,” notes a research review published in the
Journal of Psychosomatic Research in 2019. When chronic pain patients have been forced to take time off from work, they also often feel isolated, like they are no longer participating in life, and even worthless. Their unremitting pain and morose mental state can also cast a cloud over those around them.
A Better Model to Treat Chronic Pain
What if every aspect of a chronic pain patient’s circumstances could be addressed by the medical system, from his physical pain, emotional anguish, and psychological stress to the daily activities of his work and home life? That’s the precept of “multidisciplinary” chronic pain treatment, a model that prevailed until the past few decades, when it fell out of favor as medicine became increasingly reimbursement-oriented.
Still,
many experts recommend multidisciplinary treatment for chronic pain, which unites the expertise of clinicians in many disciplines. A multidisciplinary team consists of a doctor, a variety of therapists (physical, occupational, vocational, recreational, exercise, and ergonomics), a social worker, a psychologist, and a rehabilitation nurse. The team may also include a nutritionist or dietician, a case worker, a biofeedback expert, a pharmacist, pain support groups, and even members of the clergy. Sometimes family members are even included in the team; certainly they are knowledgeable about the health situation and intimately affected by it.
A multidisciplinary team has many benefits. Unlike non-multidisciplinary care, in which a patient is often told what to do and passively recovers from surgery and procedures, multidisciplinary treatment includes the patient as an active team member who has credibility and is listened to. Being part of the medical team and having a say in treatment is often a new experience for pain patients—despite that it’s a no-brainer, since only the patient knows what he’s feeling. In the context of multidisciplinary care, a patient would almost never be told he “shouldn’t have” the pain because there’s no “anatomical problem” or the ”surgery worked"—messages too often heard in traditional pain treatment.
There is another benefit to multidisciplinary care. Chronic pain patients often fear physical activity and exercise because they expect it will cause them more pain. Rehab experts know the opposite is true—physical therapy, for example, may hurt at first but addresses the pain problem. When a patient is part of the team, it often inspires him to embrace the therapies his team members recommend with
new vigor. Therapies in non-multidisciplinary care, on the other hand, are often
passive, requiring no effort or ambition on the patient’s part.
Finally, the team ensures coordinated care between the therapists. In traditional medical settings, patients can wonder if one clinician is in communication with another. Not only do clinicians not always seem to be working with each other, they can even seem to be working against each other!
Create Your Own Multidisciplinary Team
So how can you access multidisciplinary care for chronic pain? You can begin by exploring pain centers in senior centers, natural health care centers, and even the YMCAs, as opposed to beginning with surgeons and conventional medical treatment. You can also assemble your own multidisciplinary team. Even if the team is no longer under one roof (as it was before reimbursement-oriented medical care), you can identify one or more therapists who can cooperate with you—and each other—as a team, if they aren’t locked into a provider network.Here are some questions to ask your prospective team members.
Will the person:
- take time to understand my total circumstances, treating me and not just the pain?
- respect and work with other disciplines, holistically?
- work with clinicians whom I personally find or suggest?
- be honest with me when a treatment is unlikely to help?
Even if your team is not under one roof, it’s easy to conduct Zoom conferences and virtual meetings or hold conference phone calls to monitor your progress with appropriate safeguards for
Health Insurance Portability and Accountability Act laws in place. Your family can be included in these conferences.
More insurance plans are beginning to acknowledge that chronic pain often calls for more than quick fixes and unimodal treatments and thus are now providing coverage.
Conclusion
Chronic pain treatment has become a
$635 billion a year business in the United States. More money is spent per year on low back pain, neck pain, spinal disorders, arthritic and musculoskeletal pain, and other pain conditions than on heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion). Few would complain about the cost if patients were getting better, but despite highly addictive drugs and expensive new procedures and surgeries, many pain patients aren’t getting better and some are becoming permanent patients. Isn’t it time to give multidisciplinary chronic pain treatment a new look?
