Integrated, Team-Based Chronic Pain Management: Bridges from Theory and Research to High Quality Patient Care

Abstract

Chronic pain is a significant public health concern. For many, chronic pain is associated with declines in physical functioning and increases in emotional distress. Additionally, the socioeconomic burden associated with costs of care, lost wages and declines in productivity are significant. A large and growing body of research continues to support the biopsychosocial model as the predominant framework for conceptualizing the experience of chronic pain and its multiple negative impacts. The model also informs a widely accepted and empirically supported approach for the optimal management of chronic pain. This chapter briefly articulates the historical foundations of the biopsychosocial model of chronic pain followed by a relatively detailed discussion of an empirically informed, integrated, multimodal and interdisciplinary treatment approach. The role of mental health professionals, especially psychologists, in the management of chronic pain is particularly highlighted.

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

“…Even in patients with full cognitive and physical function, diagnosing chronic pain is difficult. The recommendation is to assess patients with complex chronic pain in specialized pain rehabilitation teams consisting of pain physicians, physiotherapists, psychologists, and if needed, social workers and occupational therapists [ 40 ]. However, according to the clinical experience of the authors, people with IDs seldom have access to such teams and when they do, it is unlikely that team members with specialties other than developmental disorders will have sufficient knowledge and experience to provide care adapted to their special needs.…”

Pain and chronic pain epidemiology

“…Knowing these risk factors, even if unmodifiable, is important to identify, design and target relevant person-tailored interventions in chronic pain as well as to prevent various adverse outcomes in patients with chronic pain [7]. The findings are also in accordance with the more and more acknowledged biopsychosocial model of (chronic) pain [5]. Biological factors associated with chronic pain include tissue damage and diseases, pain intensity and quality, physical functional interference and sleep disturbance.…”

“…It has been argued that a distinction should be made between persons who are affected by pain and who can easily cope on their own, and patients with "pain disease", i. e. with high pain intensity and additional impairment due to elevated degrees of anxiety or depression related to pain, for which treatment in the health care setting is necessary [4]. A prerequisite that persons suffering from chronic pain can deal with their medical condition on their own, is empowerment, giving them skills in patient self-management, and involve them in pain management decision-making together with the health care provider [5]. In fact, another Austrian study in this edition has shown that a higher degree of health literacy in patients with chronic pain is associated with lower pain intensity and lower disability due to pain [6]; therefore, more emphasis on improving health literacy and more courage towards empowering patients with chronic pain towards selfmanagement is necessary.…”

“…Psychological factors associated with chronic pain include emotional distress, attention deficit, attitudes and beliefs, coping skills, pain catastrophizing, and kinesiophobia. Social factors associated with pain include interpersonal relationships, working ability and working disability, cultural aspects and environmental factors [5]. These biological, psychological and social dimensions can greatly interfere with each other.…”

BEEP—Bodily and Emotional Perception of Pain. A Questionnaire to Measure Reaction to Pain in Chronic Pain Disorders

“…Indeed, low back pain and migraine enlist among the first five leading causes of years lived with disability (GBD Disease and Injury Incidence and Prevalence Collaborators, 2017). Chronic pain syndromes also cause high direct and indirect costs for the patient, the family and society at large (Park et al, 2015; Driscoll and Kerns, 2016). Prevalence of chronic pain syndromes is substantial, ranging from 2 to 40% of the general population depending on the condition, its epidemiological assessment, and the characteristics of the investigated population by age, gender, and co-morbidity (van Hecke et al, 2013; Henschke et al, 2015).…”