Multidisciplinary pain management clinics

Pain treatment centres'! I2» have been established in many countries and provide a diverse range of professional skills, treatments, and models of service delivery. In some, management is based mainly on anaesthetic techniques and medication, but psychological approaches are provided in others by clinical psychologists and nurse therapists. The management of problems due to inappropriate medication and substance abuse is an essential component of treatment. Many clinics offer structured programmes of education and rehabilitation, with increments of exercise, to overcome disability, rather than aiming primarily at pain relief, and to which physiotherapists or occupational therapists may contribute. There is often an emphasis on the patient assuming increasing responsibility, rather than maintaining dependence on medical services. Direct input from psychiatrists is variable and some centres specifically exclude the treatment of patients with serious mental disorders because their response to treatment is less certain. Although it is well recognized that social and environmental factors contribute to chronic pain problems, and can undermine progress following treatment, only a few specialized centres involve carers routinely in treatment or offer family therapy. (8»

A range of physical, psychological, and social approaches should be available, and offered to patients based on an individual structured assessment of needs. Members of the multidisciplinary team require specific training in the management of pain. The work of the team has to be carefullycoordinated, both within the team and with other health professionals, toavoid any ambiguity concerning the methods and goals of treatment.

Many pain clinics provide a treatment package in which cognitive therapy and exercise are predominant features. The value of a similar approach is becoming recognized for a number of other conditions, including somatization disorder, hypochondriacal disorder, fibromyalgia, and chronic fatigue, but the extent to which they may have similar origins and outcomes is uncertain.

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