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.