Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]

Excerpt

Pain can be categorized as acute or chronic and also sometimes as acute, subacute and chronic pain. Definitions for each of these categories vary, and there is overlap in definitions for “acute” and “subacute” pain. For instance, acute pain is defined as pain that presents for less than three months, pain that lasts from one day to 12 weeks, or as pain that restricts daily activities and duration of one month or less. Subacute pain is defined as pain that presents for less than three months, or as pain duration of one to two months, or pain of duration of six to 12 weeks. Chronic pain is defined as pain that presents for more than three months,, or pain that restricts daily activities for longer than 12 weeks.

Chronic pain is a global health problem. In Canada, approximately 25% adults have a chronic pain condition. The prevalence estimates for chronic pain are likely to vary depending on the sample population surveyed, and the assessment method. Costs associated with chronic pain include both direct and indirect costs., It is estimated that in Canada the annual direct cost to the health care system is over six billion dollars and the annual indirect cost due to job loss and sick days is over 37 billion dollars. Chronic pain is a problem for the individual suffering and also a societal burden.

If not appropriately managed, acute and subacute pain may turn into chronic pain. Hence there is increasing recognition of the importance of intervening before symptoms reach the chronic stage. Interventions for alleviating pain include several options such as pharmacologic agents, and non- pharmacologic treatments related to physical, psychological, and social functioning. There is growing interest in multidisciplinary treatment programs. Multidisciplinary treatment program encompasses medical therapy, behavioral therapy, physical reconditioning and education. There appear to be some variations in the definitions of multidisciplinary treatment. Multidisciplinary treatment can be defined as including at least three of the following categories: psychotherapy, physiotherapy, relaxation techniques, medical treatment, patient education, or vocational therapy., Multidisciplinary treatment can also entail a physical component (e.g., exercise programs) and at least one other element from psychological, social and occupational dimensions. These treatments are often delivered by a team of healthcare professionals with different skills. Multidisciplinary treatment may also be referred to as interdisciplinary treatment, multimodal treatment, or inter-professional treatment.

These multidisciplinary treatment programs may be labor-intensive, time consuming, not easily available, and costly. Hence the evidence regarding multidisciplinary treatment programs would be useful for decision making purposes.

The purpose of this report is to review the clinical effectiveness and cost-effectiveness of multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings. Additionally, this report aims to review the evidence-based guidelines regarding multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings.

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