Psychologists as Leaders of Multidisciplinary Chronic Pain Management Teams: A Model for Health Care Delivery.

Abstract

Psychologists have the potential to improve the quality of life of chronic pain patients by intervening not only through direct services but also by using their training for promoting proactive leadership in multidisciplinary teams and in the larger health care environment. To significantly impact pain management, psychologists must not only deliver state-of-the-art care but also take an active role in directing the design, implementation, and evaluation of these programs.

An Interdisciplinary Pain Rehabilitation Programme: Description and Evaluation of Outcomes

“…Other studies in this field, however, have shown a longlasting treatment effect of up to 7 years post discharge. 13 A high percentage of patients in our study were considered work ready, or ready for retraining or for a labour-market re-entry programme. The vast majority of these patients had been referred with a recommendation for a pain-management programme before progressing further in their work status.…”

“…Pain was usually widespread: more than half the patients had at least three areas of pain. On intake, the mean anxiety and depression scores of the 454 patients were in the ''moderately'' elevated range (HADS score [11][12][13][14]. Detailed medication information is not available in the database, although typically the majority of patients were heavily medicated with opioids for pain and with antidepressants and sedatives for anxiety and insomnia.…”

“…There are seven items each for anxiety and depression, giving a range of scores from 0 to 21. Total scores are rated as normal (0-7), mild (8-10), moderate (11)(12)(13)(14), or severe (15-21). In addition, patients' work status was determined; patients who were not working or who were unable to proceed with retraining were considered disabled.…”

“…This treatment addressed social, occupational, and emotional adjustment issues impeding the patients' optimal functioning, including the use of pain-management strategies. 13 The cognitive-behavioural therapist (CBT) undertook the primary counselling role, helping the patient to recognize how thoughts and behaviours affect mood and pain levels. Treatment objectives included but were not limited to the identification and correction of distorted cognitive patterns, such as confusion over hurt versus harm and fear-avoidance.…”

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management

“…The predominant model for pain management is the biopsychosocial model, and interdisciplinary collaboration has emerged as the standard of care for complex chronic pain conditions [3]. This approach improves functional recovery [4], is more cost-effective than a modalityoriented approach [5,6], and reduces the likelihood that treatments for pain will inadvertently exacerbate co-morbid disorders or increase medical or mental health risks such as overdose, addiction, or suicide [7]. Behavioral medicine practitioners have one of the larger roles in this approach, as patients with pain frequently have comorbid psychiatric diagnoses [8], and psychological factors are generally the best predictors of whether acute pain progresses to Implications Practice: Behavioral medicine providers indicated that a clinical decision support system could be used across disciplines to promote effective decision-making, care coordination, and adherence to clinical practice guidelines.…”