Managing Chronic Pain Through Collaborative Care: Two Patients, Two Programs, Two Dramatically Different Outcomes

Over 48 million Americans suffer from chronic pain each year, resulting in estimated losses of $70 billion to $120 billion dollars annually. Even more importantly, pain kills. In a recent systematic review, Tang and Crane5 found that the risk of death by suicide among chronic pain patients is double that of control subjects. The prevalence of suicidal ideation among chronic pain patients is 20%, and the lifetime prevalence of suicide attempts is between 5 and 14%. A survey done by the American Pain Society found that only one in four people who experience chronic pain receive appropriate treatment, and that even when chronic pain is treated, treatment is often ineffective and/or underutilized. These findings emphasize the importance of developing and implementing models for treating chronic pain that are clinically effective, efficient, and financially viable.

Because chronic pain has such a profound impact on all areas of an individual’s life, those who treat patients with chronic pain must be able to integrate information across biological, psychological, and social domains. As such, it has become increasingly important to develop models of collaborative care that address the biopsychosocial needs of patients with chronic pain. In this chapter, we review empirical evidence demonstrating the clinical and cost-effectiveness of collaborative pain programs and present the case studies of two similar patients who were treated in two different chronic pain programs. We then discuss the differences in outcomes, analyze these outcomes within the broader context of Peek’s Three World model,7 and highlight some important lessons learned from working as behavioral health providers within multidisciplinary pain programs.