At the 2018 American Academy of Pain Medicine Annual Meeting a session discussed identifying the ideal candidates for interdisciplinary care.
The speakers included:
- Ravi Prasad, PhD – Stanford University School of Medicine
- Patricia Cole, PhD – Shirley Ryan AbilityLab
There is a big difference between acute pain and chronic pain. Acute pain has a clear pathway for treatment with a fixed end point and usually has a single cause. Chronic pain has many causes and there is no fixed end point for treatment. Immobilization may be essential to treat acute pain, but it can worsen chronic pain. Medications play a greater role in treating acute pain because of it’s short duration but more caution is needed with medications for chronic pain.
For chronic pain, you need to take a disease management approach, just like you do with other chronic diseases like diabetes. The focus is on quality of life and function. The interdisciplinary team focuses on medical optimization, physical reconditioning and lifestyle modifications.
Factors That May Contraindicated Candidacy for Multidisciplinary Programs
- Significant medical or psychiatric comorbidities that have not been addressed. Many patients have these issues, but they need to be addressed as best possible.
- Incomplete medical work up. You need the full picture.
- Over-medication/medication regime not optimized.
- Sinister beliefs. Belief things will get worse and worse, and there is no hope. The person is convinced before even starting that the program will not work.
- Secondary gain. There can be financial disincentives to recovery. They may feel they need to prove their disability in order to maintain financial security.
- External vs internal motivation to change. Why is the patient there? Because they want to get better, or because they feel forced to participate because of instructions from the insurance company, physician, etc? If motivation is external, the program will not be successful.
How do we address these issues?
- Motivational interviewing. You must understand the patient’s motivations.
- Discussing/planning with treatment team. Treatment needs to be coordinated so you don’t move forward with one aspect before another aspect is ready.
- Family interventions. Family can help reinforce and encourage patient participation.