Multidisciplinary Approach and Chronic Pain

  • Ranjan Roy

In the preceding chapters we have discussed specific psychosocial interventions. This chapter is a departure in the sense that here we propose to examine the efficacy of multidisciplinary interventions in the treatment of chronic pain either in an inpatient or in an outpatient setting. Reports of program evaluation abound in the literature. It is for this reason that our presentation is somewhat selective and arbitrary. For the most part, we report more recent literature. The most comprehensive review of the literature on the outcome of pain management programs to date confirms the overall efficacy of these programs to reduce pain, improve psychosocial functioning, and increase the probability of patients returning to work, and also their cost-effectiveness (Gatchel and Okifuji, 2006).

Multidisciplinary treatment programs vary a great deal in terms of both the number of disciplines involved and the mode and length of therapy. Group intervention is common, but not exclusive....


Chronic Pain Pain Clinic Pain Interference Minnesota Multiphasic Personality Inventory Multidisciplinary Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Altmaier, M., Lehmann, T., and Russell, D. (1992) The effectiveness of psychological interventions for the rehabilitation of low back pain. Pain, 49: 377–387.CrossRefGoogle Scholar
  2. Austrian, J., Kerns, R., and Reid, M. (2005) Perceived barriers to trying self-management approaches for chronic pain in older persons. J. Am. Geriatr. Soc., 53: 856–861.PubMedCrossRefGoogle Scholar
  3. Bailey, G. (2002) The psychological treatment of back-pain: a meta-analysis. Dissertation Abstracts International. Section B. The Sciences and Engineering, 63(1-B): 515.Google Scholar
  4. Baker, P., Goodman, G., Ekelman, B., and Bonder, B. (2005) The effectiveness of a hardening program as measured by lifting capacity, pain scales, and depression scores. Work, 24: 21–31.PubMedGoogle Scholar
  5. Barry, L., Kerns, R., Guo, D., et al. (2004) Identification of strategies used to cope with chronic pain in older persons receiving primary care from a Veterans Medical Center. J. Am. Geriatr. Soc., 52: 950–956.PubMedCrossRefGoogle Scholar
  6. Becker, N., Sjojgren, P., Bech, P., et al. (2000) Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain center compared to general practice: a randomized controlled trial. Pain, 84: 203–211.PubMedCrossRefGoogle Scholar
  7. Carragee, E. (2005) Persistent low-back pain. N. Engl. J. Med., 18: 1891–1898.CrossRefGoogle Scholar
  8. Chelminski, P., Ives, T., Felix, K., et al. (2005) A primary-care, multidisciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric co-morbidity. BMC Health Serv. Res., 5: 1–13.CrossRefGoogle Scholar
  9. Chen, J. (2006) Out-patient pain rehabilitation programs. Iowa Orthop. J., 26: 102–106.PubMedGoogle Scholar
  10. Claiborne, N., Vandenburgh, H., Krause, T., and Leung, P. (2002) Measuring quality of life changes in individuals with chronic low back pain conditions: a back education program evaluation. Eval. Program Plann., 25: 61–70.CrossRefGoogle Scholar
  11. de Williams, A., Richardson, P., Nicholas, M., et al. (1996) Inpatient vs. outpatient pain management: results of a randomized controlled trial. Pain, 66: 13–22.PubMedCrossRefGoogle Scholar
  12. Dolce, J., Crocker, M., and Doleys, D. (1986) Prediction of outcome among chronic pain patients. Behav. Res. Ther., 3: 313–319.CrossRefGoogle Scholar
  13. Donovan, M., Evers, K., Jacobs, P., and Mandleblatt, S. (1999) When there is no benchmark: designing a primary care chronic pain management program from the scientific basis up. J. Pain Symptom Manage., 18: 38–48.PubMedCrossRefGoogle Scholar
  14. Dysvik, E., Vinsnes, A., and Eikeland, O. (2004) The effectiveness of a multidisciplinary pain management programme managing chronic pain. Int. J. Nurs. Pract., 10: 224–234 .PubMedCrossRefGoogle Scholar
  15. Ersek, M., Turner, J., McCurry, S., et al. (2003) Efficacy of a self-management group intervention for elderly persons with chronic pain. Clin. J. Pain, 19: 156–167.PubMedCrossRefGoogle Scholar
  16. Fairbank, J., Frost, H., Wilson-MacDonald, J., et al. (2005) Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation program for patients with chronic low-back pain. Br. Med. J., 330: 1233.CrossRefGoogle Scholar
  17. Flor, H., Fydrich, T., and Turk, D. (1992) Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain, 49: 221–230.PubMedCrossRefGoogle Scholar
  18. Friedrich, M., Gittler, G., Arendasy, M., and Friedrich, K. (2005) Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low-back pain. Spine, 30: 995–1000.PubMedCrossRefGoogle Scholar
  19. Gatchel, R. and Okifuji, A. (2006) Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for nonmalignant pain. J. Pain, 7: 779–793.PubMedCrossRefGoogle Scholar
  20. Gibson, S., Farrell, M., Katz, B., and Helme, R. (1996) Multidisciplinary management of chronic nonmalignant pain in older adults. In: B. Ferrell and B Ferrell (Eds.) Pain in the Elderly (pp. 91-100). Seattle, IASP Press.Google Scholar
  21. Gupta, S., Francis, J., Porter, G., and Valentine, J. (2000) An independent assessment of a supra regional pain management program and comparison of patients’ and general practitioners’ perceptions of their effect. Anesthesia, 55: 374–384.CrossRefGoogle Scholar
  22. Helm, R., Katz, B., Bradbeer, M., et al. (1996) Multidisciplinary pain clinic for old people: do they have a role? Clin. Geriatr. Med., 12: 563–582.Google Scholar
  23. Hoffman, B., Papas, R., Chatkoff, D., and Kerns, R. (2007) Meta-analysis of psychological interventions for chronic low-back pain. Health Psychol., 26: 1–9.PubMedCrossRefGoogle Scholar
  24. Jankus, W., Park, T., VanKeulen, M., and Weisensel, M. (1995) Interdisciplinary treatment of the injured worker with chronic pain: long term efficacy. Wis. Med. J., 94: 244–249.PubMedGoogle Scholar
  25. Kaapa, E., Frantsi, K., Sarna, S., and Malmivaara, A. (2006) Multidisciplinary group rehabilitation versus individual physiotherapy for chronic non-specific low back pain. Spine, 15: 371–376.Google Scholar
  26. Kitahara, M., Kojima, K., and Ohmura, A. (2006) Efficacy of interdisciplinary treatment for chronic nonmalignant pain patients in Japan. Clin. J. Pain, 22: 647–655.PubMedCrossRefGoogle Scholar
  27. Kung, F., Gibson, S., and Helm, R. (2000) A community-based program that provides free choice of intervention for older people with chronic pain. Pain J., 1: 293–308.CrossRefGoogle Scholar
  28. Lang, E., Liebig, K., Kastner, S., et al. (2003) Multidisciplinary rehabilitation versus usual care for chronic low-back pain in the community: effects on quality of life. Spine, 3: 270–276.CrossRefGoogle Scholar
  29. Lansbury, G. (2000) Chronic pain management: a qualitative study of elderly people’s preferred coping strategies and barriers to management. Disabil. Rehabil., 22: 2–14.PubMedCrossRefGoogle Scholar
  30. Malone, M. and Strube, M. (1989) Meta-analysis of non-medical treatments for chronic pain, Pain, 34: 231–244.CrossRefGoogle Scholar
  31. Nizard, J., Lombrail, P., Potel, G., et al. (2003) Evaluation of l’efficacite of the taken charge of 46 chronic pain by a treatment center of the pain. Douleur et Analgesie, 16: 187–196.CrossRefGoogle Scholar
  32. Patrick, L., Altmaier, E., and Found, E. (2004) Long-term outcomes in multidisciplinary treatment of chronic low back pain: results of a 13 year follow-up. Spine, 15: 850–855.CrossRefGoogle Scholar
  33. Peat, G., Moores, L., Goldingay, S., and Hunter, M. (2001) Pain management program follow-ups. A national survey of current practice in the United Kingdom. J Pain Symptom Manage., 21: 218–226 .Google Scholar
  34. Rasmussen, C., Nielsen, G., Hansen, V., et al. (2005) Disc surgery before and after implementation of multidisciplinary non-surgical spine clinic. Spine, 30: 2469–2473.PubMedCrossRefGoogle Scholar
  35. Rivero-Arias, O., Campbell, H., Gray, A., et al. (2005) Surgical stabilization of the spine compared with a program of intensive rehabilitation for the management of patients with chronic low-back pain: cost utility analysis based on a randomized controlled trial. Br. J. Med., 330: 1239.CrossRefGoogle Scholar
  36. Rivero-Arias, O., Gray, A., Frost, H., et al. (2006) Cost-utility analysis of routine physiotherapy treatment compared with physiotherapy advice in low back pain. Spine, 31: 1381–1387.PubMedCrossRefGoogle Scholar
  37. Schonstein, E., Kenny, D., Keating, J., and Koes, B. (2003) Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst. Rev., 3 .Google Scholar
  38. Skouen, J., Grasdal, A., and Haldersen, M. (2006) Return to work after comparing outpatient multidisciplinary treatment programs versus treatment in general practice with chronic widespread pain. Eur. J. Pain, 10: 145–152.PubMedCrossRefGoogle Scholar
  39. Thomsen, A., Sorensen, J., Sjogrenm P., and Eriksen, J. (2002) Chronic non-malignant pain patients and economic consequences. Eur. J. Pain, 6: 342–352.CrossRefGoogle Scholar
  40. Van der Roer, N., van Tulder, M., Barendse, J., et al. (2004) Cost-effectiveness of an intensive group therapy training protocol compared to physiotherapy guideline care for sub-acute and chronic low back pain; design of a randomized controlled trial. BMC Musculoskelet. Disord., 5: 45–52.PubMedCrossRefGoogle Scholar
  41. William, R. (1988) Towards a set of reliable and valid measures for chronic pain assessment and treatment. Pain, 35: 239–251.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ranjan Roy
    • 1
  1. 1.University of ManitobaWinnipegCanada

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