22/01/2019
Clinical Pain Medicine
JANUARY 21, 2019
Study Confirms Effectiveness of Interdisciplinary Approach in Pain Rehabilitation
Interdisciplinary pain rehabilitation programs (IPRPs) can be an effective treatment for chronic pain, according to a new study.
In 2015, self-reported performance was examined in two groups in three-week programs at Mayo Clinic’s Pain Rehabilitation Center (J Pain 2018;19 [6]:678-689). The study compared physician-supervised opioid tapering with nonopioid patients to find “significant improvements,” regardless of opioid use.
“Our intention was to examine if opioid users could benefit from a functional restoration treatment in a similar fashion as nonopioid users. This would provide some evidence that functioning can be improved even while coming off opioid medication, if done in the appropriate treatment context,” explained lead author Wesley P. Gilliam, PhD, LP, a psychologist at Mayo Clinic, in Rochester, Minn.
Indeed, the researchers observed that patients who tapered off opioids “showed gains comparable with their non–opioid-using counterparts” and experienced sustained improvements six months after treatment. Findings suggest that, regardless of opioid use, rehabilitation leads to sustained restoration for chronic pain patients.
Steven P. Stanos, DO, the medical director of Swedish Pain Services in the Swedish Health System, in Seattle, said the Mayo Clinic study mirrors results of similar studies conducted at the Cleveland Clinic. “There have been a number of U.S. and international studies that show the benefit of interdisciplinary programs,” he added.
“There’s this misconception that comprehensive programs are only for people on opioids. Many patients are not on opioids but have just as many pain problems. So, whether they’re on opioids or not, this study shows that patients benefit from nonpharmacological treatments.”
Limitations of the observational cohort study include the need for randomly assigned control groups to address selection bias and compare patient outcomes among those completing IPRPs without opioid withdrawal.
Dr. Gilliam called randomized controlled trials “the gold standard approach to establishing efficacy. It is very difficult to accomplish this in a clinical setting,” he noted.
Dr. Stanos agreed, stating, “It would be unethical to do a placebo-controlled, randomized study.
“This is different from a drug trial. With chronic pain, there are so many variables—depression, anxiety, sleep issues, medication use—it would be almost impossible to set up a controlled study where patients do or don’t get the treatment. I couldn’t see a patient and say, ‘I’m going to give you a 50-50 shot that you need a pain program.’”
According to the study, future research should explore ways to optimize treatment and access.
“Only a small percentage of patients have access to interdisciplinary care. If you don’t address the underlying reasons why patients take opioids, it’s challenging for the physician and patient to have a good outcome,” Dr. Stanos said.
“A study like this shows that mechanisms—like behavioral health, physical therapy and exercise—help patients to be active in their own care. For the pain physicians, you have to understand what’s going on with the individual patient,” he said. “By addressing these issues, you can have a better comprehensive approach to patients. Integrating nonpharmacologic treatments can benefit those with chronic pain. It doesn’t matter if their opioid dose is high or low.”
Dr. Gilliam said, “Utilization of rehabilitative, self-management approaches for pain management are more desirable than simply prescribing narcotics.”
—Sherree Geyere
