From the Guidelines
Multidisciplinary pain teams are strongly recommended for patients with chronic pain and central sensitization, as they provide comprehensive care that addresses the complex nature of chronic pain and improves patient outcomes. The most recent and highest quality study, published in 2023 in the Mayo Clinic Proceedings 1, highlights the effectiveness of a multidisciplinary pain rehabilitation program in improving the physical and emotional functioning of patients with severe, recalcitrant erythromelalgia, a condition often associated with chronic pain syndrome and central sensitization. This approach typically includes a team of physicians, psychologists, physical therapists, nurses, and other specialists who work together to provide coordinated treatments, such as medication management, cognitive behavioral therapy, physical rehabilitation, interventional procedures, and patient education about pain neuroscience.
The benefits of a multidisciplinary pain team approach are multifaceted:
- Improved function and reduced medication dependence
- Enhanced quality of life
- Better coping strategies for patients
- Addressing biological, psychological, and social factors contributing to pain
- Retraining pain processing pathways and addressing maladaptive behaviors that perpetuate pain cycles
While earlier studies, such as the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1, also support the use of interdisciplinary teams for chronic pain management, the 2023 study 1 provides the most recent and highest quality evidence for the effectiveness of this approach in patients with chronic pain and central sensitization. Therefore, a multidisciplinary pain team approach is the recommended course of treatment for these patients, as it has the potential to significantly improve their outcomes and quality of life.
From the Research
Evidence for Pain Team Outcomes
- Studies have shown that multidisciplinary pain management programs can be effective for chronic pain patients, including those with central sensitization 2, 3.
- A systematic review and meta-analysis found that inpatient multidisciplinary pain management programs can lead to improved outcomes for patients with severe or long-lasting pain, and that programs with a cognitive component and/or a passive therapy component may be more effective 2.
- Another study found that multidisciplinary treatments were more effective than non-disciplinary treatments for chronic pain, and that comprehensive inpatient programs may be more beneficial than outpatient programs 3.
- The use of centrally acting drugs, such as pregabalin, may also be effective in treating chronic pain, including nociceptive inflammatory pain that is resistant to other treatments 4.
Treatment Options for Central Sensitization
- Treatment options for central sensitization may include pharmacological and non-pharmacological approaches, such as pain neuroscience education, cognition-targeted exercise therapy, sleep management, stress management, and dietary intervention 5, 6.
- A combination of different strategies, each targeting a different 'desensitizing' mechanism, may be more effective than monotherapies 6.
- Targeting metabolic and neurotrophic factors, such as decreasing brain-derived neurotrophic factor, may also be a promising approach for diminishing hyperexcitability of the CNS in central sensitization pain patients 6.
Patient Characteristics and Outcomes
- Patient characteristics, such as pain severity and duration, may influence outcomes from multidisciplinary pain management programs 2.
- Programs that include a cognitive component and/or a passive therapy component may be more effective for patients with severe or long-lasting pain 2.
- The effectiveness of multidisciplinary treatments may also vary depending on the specific pain condition, with fibromyalgia and chronic back pain patients tend to profit more substantially than patients with diverse origins or chronic pain diagnoses 3.