Multimodal treatment

Multimodal treatment

As you already know by now, chronic pain is caused by an interplay of physiological, psychological and social factors. It is multidimensional and has a lot of different aspects to it - not only physical, but also psychological, cognitive, and behavioral ones. It is therefore not surprising that it requires a treatment program that takes all of these components into account. Just as the picture to the right shows, you need more than one arrow in order to target all angles.

Studies have shown that the most effective treatment for chronic pain is multimodal therapy, which combines multiple methods of treatment in order to target the different aspects of the condition. The patient meets with a pain management team that consists of different healthcare professionals - usually physicians, nurses, psychologists, physiotherapists and/or occupational therapists. By collaborating and sharing their own unique knowledge, skills and experiences, the team members are able to provide a more holistic rehabilitation program. Together, they create an individualized treatment plan for each patient that includes their goals and expectations as well as the different treatment methods that will be used, e.g. pharmacological treatment, physical therapy, lifestyle changes, psychological interventions, and non-pharmacological interventions such as acupuncture, progressive muscle relaxation or transcutaneous electrical nerve stimulation (TENS).

Patient involvement

One of the most essential parts of chronic pain management is that the patient needs to take an active role in their treatment and be involved in the creation of their treatment plan. In order to do so, the patient must be very well-informed. If you feel like you aren't getting enough information, don't be afraid to ask questions! Apart from understanding the basic mechanisms behind chronic pain, you may want to know:

• How do the treatment methods (e.g. TENS or muscle relaxation) help? If you understand the mechanisms, you will be more likely to actually use them.
• If the healthcare providers advise against certain treatment methods - why do they think they are not a good option?
• What can I expect (both short term and long term)? Unattainable goals and unrealistic expectations will only make everything seem hopeless.
• What kind of painkillers am I taking? How do they work? How should I take them (regularly or as needed)? What can I expect? Are there any side effects?
• When and how do we evaluate the treatment plan?

Another very important aspect is the patient-provider relationship. Although this is always important, it may be even more so when it comes to chronic pain because of how difficult it is to treat it. Furthermore, since pain is a subjective experience, the main source of information needed to assess the situation is the patient's self-report. In other words, the interaction between the patient and the healthcare provider plays a very big part. 

Studies show that productive patient-provider relationships are associated with better treatment outcomes, greater symptom relief and better emotional health. The patient will also be more likely to follow the treatment plan, which, in turn, also leads to better outcomes. So, what constitutes a good patient-provider relationship? First of all, patients want to feel understood, validated and listened to. They look for empathic, respectful, attentive and non-judgmental healthcare providers. Second, they want the providers to consider their preferences and involve them in the planning and the decision-making.