Townsend et al (2006) write that traditional roles of psychologists are being challenged by the Multi-Disciplinary Team (MDT) treatment now required in order to treat patients with chronic pain according to the biopsychosocial model.
Treatment of chronic pain was traditionally carried out according to a biomedical model- a patient after a car accident was treated for chronic pain syndrome but not assessed for PTSD, for example. Research has shown the efficacy of a biopsychosocial model in treating pain, where social and psychological factors as well as biological are taken into account. Turk (2002) reported patient benefits of the biopsychosocial approach (with regards to chronic pain) as increase in functional ability, fewer disability claims, and less illness caused as side effects of medical treatment or examination. Where treatment ie pain reduction is not possible, the MDT will aim to maximise the patient’s functioning.
Townsend et al describe a case study about a patient Ann who underwent intensive 3 week programme with a MDT to cope with her lower leg pain and end dependency on pain medication. In the case study, the OT’s role in the MDT was to incorporate the various pain control strategies into activities of daily living (ADLs), using for example pacing techniques and appropriate body mechanics. They could possibly have been involved with the functional assessment and assisted with outcome measurement.
Benefits of this approach were Ann removed long term need for pain medications. She was also educated how to cope with her pain independently going forwards, overall reducing the need for health service interventions. Professionals working together in this way is very effective use of their time- the lead practitioner can allocate the specific time needed to address a patient’s individual needs.
Challenges were health professionals guiding treatments provided by other disciplines as well as providing direct patient care themselves. Frequent face to face communication and clinical review is necessary. Reviews between disciplines ensure everyone is singing from the same hymn sheet and provides emotional support between health professionals when they are working with clinically & behaviourally challenging patients. The use of electronic records was necessary to allow MDT to communicate patients’ history and current progress.
Measuring outcomes at the start and conclusion of treatment provides motivation for patient and evidence for continued use of MDTs when facing opposition from pain medication approaches which only focus on pain relief and not functioning. Not specified but presumably this is pressure from drugs companies wishing to sell continued amounts of medication. Implementation of the biopsychosocial perspective could therefore be improved by an increased evidence base by recording treatment outcome measures.
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Sources:
Townsend C, Bruce B, Hooten W, Rome J (2006) ‘The role of mental health professionals in multidisciplinary pain rehabilitation programs’ Journal Of Clinical Psychology 62(11) pp 1433-1443
Turk DC (2002) ‘Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain’ Clinical Journal of Pain 18 pp 355–365
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