Multidisciplinary Chronic Pain Treatment - Part I

Dr. Steven Grinstead
Relapse Prevention Expert, Author & Senior Consultant Trainer for Gorski-CENAPS® Corporation

Given the biopsychosocial nature of chronic pain conditions it is imperative to utilize a multidisciplinary treatment plan. Living with chronic pain is very difficult. If a person also has a coexisting addiction or other psychological disorders it becomes even harder. People with chronic pain and coexisting disorders can become severely depressed and feel hopeless. Their self-esteem is practically non-existent and many of them lose the support of their significant others.

Healthcare providers often become confused and frustrated when their treatment interventions are ineffective. Also, we must warn people living with chronic pain not to be fooled by health practitioners who claim to do pain management, yet only do one major thing for your pain, such as medication management, or chiropractic adjustments or acupuncture. True multidisciplinary pain management involves interventions such as physical therapy, massage, medication management, counseling or therapy, biofeedback, occupational therapy, exercise physiology, an anesthesiologist or pharmacologist, and a case manager all at one site, at a minimum. It may also involve some type of movement therapy such as Tai Chi, classes on spiritual wellness, yoga or meditation.

For years the numbers of people experiencing chronic pain and coexisting psychological disorders including addiction have been increasing significantly. According to the International Association for the Study of Pain in 1999 there were approximately 86 million Americans suffering from chronic pain. In 2003, according to Peter D. Hart Research Associates, the number increased to over 117 million adults—about a 35 percent increase.

According to researched published in Pain Physician Journal (2006), 90 percent of people in the US receiving treatment for pain management are prescribed opiate medication. Of that number 9 percent to 41 percent had opiate abuse/addiction problems. We also know that at least 80 billion dollars is spent for pain relief in the United States each year—a significant amount of that is for prescription medications. What is harder to quantify is the emotional cost to family systems when one or more members suffer with a chronic pain condition.

The Addiction-Free Pain Management® (APM) System was developed to address the specific biopsychosocial needs of this under-served population. Historically, addictive disorders and pain disorders have been treated as separate issues. However, to effectively implement an APM approach, the addictive disorder, other coexisting psychological disorders and the chronic pain must be concurrently addressed. In addition, the physical, psychological, and social implications of these disorders—including the impact on family systems—must also be adequately dealt with.

As mentioned earlier, for someone with chronic pain and coexisting disorders, including addiction, to achieve effective pain management requires the implementation of a multidisciplinary treatment plan. The Addiction-Free Pain Management® System uses a collaborative three part approach: (1) A medication management plan—in consultation with an addiction medicine specialist; (2) A cognitive-behavioral treatment plan—addressing pain versus suffering, treating family system issues and changing self-defeating behaviors; and (3) A nonpharmacological pain management plan—developing safer medication-free ways to manage pain. Recovery and avoiding relapse is possible if patients are willing to do the footwork and follow the APM™ System using a collaborative multidisciplinary treatment team.

Using a multidisciplinary team is crucial in treating the synergistic problems people and their families’ face that have been severely impacted by chronic pain, addiction, and other psychological disorders. When these conditions coexist it creates a major challenge that must be addressed by utilizing a collaborative treatment approach. The inclusion of Addiction, Mental Health and Medical is vital to this process. When these coexisting conditions occur, the family problems increase synergistically. Effective treatment can be challenging and confusing for counselors, therapists and other healthcare providers, but especially for patients and their families. This article explains the APM™ strategic three-part approach outlined above that can improve treatment outcomes and give families new hope.

Collaboration Not Competition

However, there is a systemic problem that sabotages effective treatment for anyone with an addiction problem, but especially people with chronic pain and coexisting disorders. It’s called Competition! In my experience of working with this population, an integrated, multidisciplinary treatment approach is essential to the success and effectiveness of pain management recovery. But everywhere throughout society competition reigns supreme: in politics, sports, and relationships. It’s fundamental to our American economy and the foundation for every reality program on TV today. Regrettably, in the treatment field, it often develops into “Turf Wars” between healthcare disciplines. Unfortunately, one by-product of this mentality is the conclusion held by pain management specialists that there is no need for Mental Health and/or Addiction professionals to be included on a multidisciplinary pain treatment team—This is not only short sighted, but can sabotage effective treatment for patients working with a therapist.

The APM™ System requires looking at the whole person, which means treatment plans for the biological, psychological, social, and spiritual domains. We need to work with patients—not on them. The whole person also includes that person’s family and significant others. This can best be accomplished by using a truly integrated multidisciplinary treatment team that teaches the patient how to be the Captain of their healthcare team. APM™ treatment starts with a multidisciplinary assessment including medical, mental health and addiction. These three disciplines are necessary to implement the three core components of the APM™ Treatment System.

For any healthcare provider to work effectively with this population, they need to understand and integrate the principals of the Addiction-Free Pain Management® (APM) system into their treatment protocols. The APM System consists of three major components: (1) A medication management plan; (2) A cognitive-behavioral treatment plan using eight Core Clinical Exercises from the Addiction-Free Pain Management® Workbook; and (3) A proactive nonpharmacological pain management plan. Most pain patients need a strategic combination of all of the above.

Medication Management

Some pain disorders require pharmacological (prescription drug) interventions. Other conditions may respond to over-the-counter medications like aspirin or ibuprofen. Still other conditions may need a combination of both. Some pain disorders can be effectively treated with medication interventions such as acetaminophen and nonsteroidals, antidepresants, muscle relaxants, etc.

It is important to remember that for people with a genetic or personal history of an addictive disorder, any psychoactive medication could be problematic. Unfortunately, there may be times when opiate (or opioid) medication management is needed, but there are risks. In Part Two of this article you will have an opportunity to explore the other two treatment components of the Addiction-Free Pain Management® System—Cognitive Behavioral Interventions; and Nonpharmacological Treatment Plans.

Chronic pain patients have a much better chance of quality recovery when their healthcare providers use a combination of Medication Management Components, the APM™ Core Clinical Exercises, and appropriate Nonpharmacological Treatment Processes. It is the healthcare providers’ responsibility to be aware of all potential resources in their communities. For more information about Addiction-Free Pain Management® please check out the remainder of our website www.addiction-free.com.or feel free to contact us at (916) 575-9961.