Care for Chronic Pain complicated by Addiction

Science tells us the multidisciplinary care works!

Multidisciplinary care typically includes:

Medical Care- The physician medical director is most often a specialist in physical medicine and rehabilitation, but may be an addiction specialist. The physician is responsible for patients overall physical well-being, manages medications, coordinates team care, and performs procedures (e.g. trigger point injections) to help break the pain cycle. When indicated, medical care includes drug or alcohol detoxification. Although the goal of specialized programs that treat addiction is usually abstinence for potentially addicting pharmaceuticals, in cases treatment may include medication-assisted treatment with buprenorphine assist patients in the recovery process. 

Physical and Occupational Therapy- Physical therapy recognizes that many patients are de-conditioned and have had experienced pain with routine PT. In pain programs, exercise is gradually increased to enabling patients to control exacerbations in pain by learning to regulate the activity and. to gradually increase their activity level. Graded therapeutic exercises safely increase functioning (e.g. flexibility, range of motion, posture, body mechanics, ambulation, gait training, core strength/stability, cardiovascular fitness, strength and endurance. PT may include stretching and hydrotherapy, but usually does not include passive treatments such ultrasound, electrical stimulation, and massage. OT include solving problems and providing assistance to improve function in work, leisure, and routine daily living activities of daily living.

Psychological Therapies- A clinical psychologist is responsible for psychosocial aspects of patient care, including addiction counseling when indicated. Treatment always includes cognitive behavioral therapy, but may also include biofeedback, progressive muscle relaxation, mindfulness- based (meditation) therapies, group psychotherapy, support group participation, guided meditation, or other therapies. Specialized addiction-pain treatment programs offer evidence-based addiction psychotherapies and support groups. 

Alternative/Complementary Therapies- May include acupuncture, restorative yoga, aroma therapy, massage or other modalities, or nutrition counseling, usually guided by patient preferences.