Nowadays we must aim to follow the biopsychosocial model of pain management. Therefore it is best where possible to involve a multidisciplinary team approach. Chronic pain takes over a patient’s life, they insulate themselves, to protect themselves from further pain. They are afraid to leave their cocoon and in taking this approach pain mechanisms become more and more engrained in their psyche. This mental and often physical isolation leads to a further decline in mental health.
The first step should be to educate the patient. Educating the patient on pain mechanisms, in particular the fact that pain does not necessarily mean you are injuring yourself further, empowers the patient to take control of their situation. The importance of exercise and stretching, diet, and sleep must be emphasized. There is no quick fix for pain, treatment involves lifestyle change and it is a holistic approach.
As we know, “chronic pain can change the brain”. Where a psychological component exists it is important to bring a psychologist on the treating team.
I feel the following sentence from the cited paper sums up the modern approach:
“ Biopsychosocial treatment that acknowledges and aims to address the physical, psychological and social factors underpinning pain and disability is currently accepted as the most effective approach to chronic pain (Gatchel et al., 2007; Meeus et al., 2016) and superior to stand‐alone physical therapy such as exercise or physiotherapy (Kamper et al., 2014).”
An essential lecture on this topic is that given by pain specialist Dr. Howard Schubiner. Breakthrough with Healing Chronic Pain | Howard Schubiner | Talks at Google
Dr. Schubiner’s saying “the reign of pain lies mainly in the brain” must be our mantra!