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A novel multidisciplinary approach to the treatment of chronic pain.


Description

A meta-analysis of outcome studies involving multidisciplinary pain treatment centers found that individuals participating in such programs showed substantial improvement in pain intensity, pain behaviors, activity level, and use of medical services when compared to untreated controls (Flor, Fydrich, & Turk, 1992). Two central components of multidisciplinary chronic pain treatment are group cognitive-behavioral psychotherapy and physical therapy/exercise. While each modality addresses and reinforces the other, current treatment models find physical therapists and psychologists working relatively independently. The novel approach to treatment of chronic pain utilized in this study sought to further integrate the roles of the physical therapist and psychologist by extending the role of the psychologist into the exercise room, and by extending the role of the physical therapist to the group psychotherapy room. 18 participants with chronic pain attended four weeks of group psychotherapy/ psychoeducation and six weeks of physical therapy/exercise group. Increased collaboration between psychologists and physical therapists was provided for individuals in the experimental condition, while those in the control condition participated in each group without this enhancement. Participants completed measures of anxiety, kinesiophobia, depression, pain intensity, and disability at four-week intervals, muscular strength at six-week intervals, and weekly measures of treatment fidelity. Results were analyzed using ANOVA procedures to investigate the following hypotheses: (1) multidisciplinary pain treatment received by all participants will result in lower levels of anxiety, kinesiophobia, depression, pain, disability, and increased strength, and (2) individuals in the experimental condition will demonstrate greater improvement in levels of anxiety, kinesiophobia, depression, pain, disability, and strength when compared to those in the control condition. Results provide some support for hypothesis one, as treatment resulted in significant improvement of participants' mean pain related disability and chest strength over time. There were trends toward decreasing levels of pain related anxiety and kinesiophobia. Although hypothesis two was not generally supported, results suggest that experimental participants may have experienced greater improvements in depressive symptoms. Study limitations as well as implications for future research and clinical application are discussed.