Strategies for Managing Chronic Pain: Case of a Skilled Orthopaedic Physician and Mini-Review

Abstract

Epidemiological surveys have recently revealed a high prevalence of chronic musculoskeletal pain in Japan; however, 30% of the patients in the survey were not satisfied with their pain treatment. This indicates that standard strategies in the management of chronic pain are poorly shared among physicians in Japan. Herein we report a case of a patient with intractable chronic pain who is a skilled orthopaedic physician. A 43-year-old man who was a skilled orthopaedic surgeon presented at our center complaining of severe buttock pain especially around the right hip region for more than three years. At begging of pain onset, he was diagnosed with femoacetabular impingement syndrome (FAI) with labral tear. Despite biophysical interventions including twice surgeries and alternative conservative treatment, his pain persisted, and he occasionally had to take a day off work due to the severe pain. Therefore we had to evaluate his pathological condition using a multidimensional approach based on a biopsychosocial model. We had provided him with cognitive behavioral therapy (CBT) approach, and simultaneously suggestion for short leaving from work. Three months after the start of CBT training, his disabilities had begun to improve. About six months later, he could continue to do his work. Finally, 19 months have passed since we started implementing the CBT approach; he has regained both his previous work-life balance and his health, although the pain has not completely subsided. In conclusion, we think it is important for physicians treating chronic pain to learn the management strategies for chronic pain and to reconsider their management policy when conventional biomedical interventions were not succeeded, even in cases where medication and surgical intervention are warranted.

Telephone Consultation Partially Based on a Cognitive-Behavioral Approach Decreases Pain and Improves Quality of Life in Patients With Chronic Pain

“…Pain is the most common symptom reported in the general population and the leading cause of work disability ( 1 , 2 ). Chronic pain reduces activities of daily living (ADL) and quality of life (QOL) and is a burden not only on the patient but also on family members and others involved ( 3 - 7 ). Musculoskeletal pain is also one of the major problems for Japan and its aging population since it requires assistance and leads to patients becoming bedridden.…”

“…In such cases, satisfactory treatment outcomes may be unachievable with a uniform therapeutic approach seeking only to eliminate pain. Often a multifaceted, collaborative (multidisciplinary) intervention is needed ( 6 , 7 , 10 , 11 ). In particular, therapeutic approaches based on cognitive behavioral therapy (CBT) under multidisciplinary approaches are recommended.…”