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May 11th, 2012
Many doctors treat pain. However, when an ongoing painful condition negatively impacts the way you function on a daily basis, there are tremendous advantages to attending a multidisciplinary chronic pain clinic.

Dr. John Bonica is considered the grandfather of the multidisciplinary pain clinic. People worked in teams before he did, but Bonica took the study of pain in general and especially the treatment of pain by a team of different specialists to a new level. In the 1960's he started what is now recognized as the first multidisciplinary pain clinic out of the University of Washington Medical School, in Seattle. He actually started working in teams as early as 1947 while at the Tacoma General Hospital. Since Bonica, the multidisciplinary pain clinic is considered the gold standard of care and it’s easy to see why.

Chronic pain is difficult to treat. It changes almost every system in the body. No one can be an expert in all the different body systems, the prescription medication and supplemental nutrients, the physical therapy techniques and the psychological coping methods required to deal with long-standing chronic pain. It helps to work in a team of such experts. McConley et al, and others have demonstrated this in scientific studies.

Not all multidisciplinary clinics are the same. Some have numerous doctors but no physical therapists or nutritionists. Some have only “alternative” treatment and no medical doctor supervision. Many clinics have team members working “in parallel”. You’ll see one person, they will write up a report, then on to the next person and so on. They may offer numerous services at one site, but there isn’t any communication among team members.

The best pain clinics have a variety of services available. The first person you see will help you figure out a specific diagnosis (or more than one) for what is causing your pain. They will help you get the diagnostic tests you need, if they haven’t already been done, and help you interpret what you have had done to date. Next, they will set up an individualized treatment plan. There should not be a “cookie cutter” approach for every patient. When it comes to chronic pain, the best approach usually involves several different treatments. Why?

The human brain is an amazingly adaptable organ. Once chronic pain changes occur, the brain gets reprogrammed to maintain the status quo, even when that means pain and disability. Trying single treatments or medications doesn’t usually work. The brain adapts rapidly to the new treatment to maintain the pain generating state. It needs to be “rewired”. This usually involves removing the pain triggers, boosting your endorphin-releasing and trigger-blocking ability of the brain, improving your nutritional intake and sleep patterns and (even just temporarily) breaking the “pain cycle”. These must all be done simultaneously for any chance of success. A carefully designed treatment plan involving various clinicians has the best chance of rewiring the brain. All team members need to be in constant communication with each other. Treatment needs to change if the expected results aren’t achieved or (on a positive note) if you feel better, faster than expected. Realistic goals must be established at the start, and all team members must be working towards the same goal. It is not reasonable to expect complete relief of pain in every case! Often goals must be reset higher or lower, depending on how you respond after a few treatments, or if unexpected complications appear. This is likely the model that John Bonica envisioned all those years ago.

An informed patient is his or her own best advocate. Ask about how your pain clinic works. If your pain condition is not responding to treatment, ask to be referred to a multidisciplinary clinic, the gold standard of pain care.