The Development of a Multidisciplinary Spine Center: A New Shared Approach for Pain Care

Abstract

We have read with interest the paper by Itz et al., 1 focusing on a major issue for pain physicians involved in daily clinical practice. In their work, different Dutch scientific societies collaborated to make a declaration of intents and aims, taking into account diagnostic workup and therapeutic approaches adopted by healthcare professionals with different skills and knowledge in the pain field, leading to the development of shared guidelines for the invasive treatment of pain syndromes of the lumbosacral spine.Although the International Association for the Study of Pain already stated the importance of a multidisciplinary approach to pain disorders, 2 the common picture often shows the presence of uncoordinated clinicians from different medical disciplines. Several previous pain treatment guidelines hampered the agreement on a collaborative and shared approach, supported by health professionals with different background and scientific terminology. Pain physicians, physical therapists, neurologists, surgeons, and psychologists are actually still working apart, speaking their own languages, making their own diagnosis and treatment choices.This independent approach shows several pitfalls, especially if applied to pain of the spine, whose pathophysiology may involve mechanical, neurological as well as psychosocial factors, therefore requiring heterogeneous expertise in the pain management.3 Moreover, most of scientific literature is simply prone to compare physical therapy and psychosocial approach vs. surgery. 4 Progress in minimally invasive interventional and surgical techniques is encouraging, leading us to reconsider the term "multidisciplinarity" in its true meaning. 5 A shared approach to pain disorders should include common strategies for diagnosis and treatment. In this regard, we consider the scientific agreement between Dutch orthopedics, neurosurgeons, and anesthesiologists a significant step forward. To improve the chance of reaching the correct diagnosis and treatment, we recently promoted the development of a "Multidisciplinary Spine Center," where physicians expert in different specialties are encouraged to provide their knowledge toward this main goal. Clinical cases may be discussed within this pain community, exploiting the ability of each specialist and leading to improved results and better patient satisfaction. We used IASP and scientific society guidelines as a starting point for a diagnostic and therapeutic flow chart, taking into account expertise from pain medicine, neurophysiology, surgery, physical therapy, and psychology (Figure 1). The categorization of each patient's syndrome as acute, subacute, or chronic is not only related to temporal factors, but also to pathophysiological criteria. Moreover, the mutual relationship between specialists plays an extremely important role during the first approach as well as during the follow-up. Clinical guidelines should help physicians in characterizing pain syndromes, leading toward the correct treatment in agreement with pathophysiology, signs...

Online access to spine care: do institutions advertise themselves as multidisciplinary?

“…Given the wide range of medical specialties involved in the management of spine conditions, a new shift towards multidisciplinary spine care has emerged ( 10 ). Spine disorders involve a complex pathophysiology consisting of psychosocial, mechanical, and neurologic factors, thereby necessitating collaboration in diagnosing and treating such conditions ( 10 , 11 ).…”

“…Given the wide range of medical specialties involved in the management of spine conditions, a new shift towards multidisciplinary spine care has emerged ( 10 ). Spine disorders involve a complex pathophysiology consisting of psychosocial, mechanical, and neurologic factors, thereby necessitating collaboration in diagnosing and treating such conditions ( 10 , 11 ). Yanamadala et al specifically discusses how the majority of patients initially advised to undergo lumbar fusion surgery were instead recommended nonoperative management after assessment by a multidisciplinary panel ( 12 ).…”

Predicting Analgesic Use after Spinal Surgery

“…1 The authors should be commended for investigating an important healthcare problem, as the need for spine surgery continues to grow, and analgesics, many of which add significant cost to health care, are commonly utilized to control the postoperative pain for these patients. [2][3][4][5] However, in order to confirm the validity of these study findings, clarification is needed. First, it is not clear why the authors did not include a validated measurement of pain as well as the types and daily doses of pain medications used in the preoperative and postoperative assessment periods; these are a major outcomes of interest.…”