As with other pain management programs, chronic pain management uses a multidisciplinary approach and emphasizes improving function, cutting back on or eliminating opioid medication, and educating the patient in cognitive behavioral techniques. These techniques are designed to cope with pain as well as reduce counterproductive thinking.
There are two major areas where effective chronic pain management for those considering spinal surgery differs from other programs.
Two aspects of care are crucial to successful outcomes for patients who are good candidates for chronic pain management: the quality and magnitude of patient education provided by the physician, and the physician’s support for the patient.
Learning About the Treatment Options
Many people with chronic back pain choose spine surgery because they feel it is the quickest and most effective solution to their pain. People generally do not have comprehensive information about the pros and cons of surgery, however. In many cases, they have not studied other options or given alternative, nonsurgical approaches a good chance to succeed.
A major focus of chronic pain management is to help the patient view treatment outside the traditional medical model—that pain can only be eliminated by a physician removing or ameliorating the underlying physical pathology.
This alternative model notes that a cure for chronic pain is often not possible, but that it is up to each patient to gradually improve functional ability and pain control to recover from the injury as much as possible. Treatment, then, becomes a matter of learning pain management techniques through guidance by the staff and even by other patients.
Research demonstrates that patients given more information about their medical condition and possible treatments are more likely to choose nonsurgical treatment.1 One analysis of multiple studies found that in addition to preferring nonsurgical treatment, people provided with more information were also less conflicted when deciding on a treatment.2
Since it has been established that certain groups of patients will fare better through interdisciplinary pain management, it is recommended that these patients be educated about their alternatives. For example, patients can be informed that they are more likely to obtain poor surgery results if they:
- Have high levels of psychosocial distress
- Are undergoing a second or third spine surgery
- Exhibit dependence on pain medication
Such knowledge can help patients make a better informed choice about back surgery as opposed to rehabilitation through a chronic pain management program.
Physician Support for Chronic Pain Management Is Vital
Because a chronic pain management program requires the patient to make behavioral changes rather than rely on the surgeon’s skill, it is important for the physician to play a supportive, active role in advocating a chronic pain management program. The doctor's advocacy helps patients see the program as truly in their best interest and as a collaborative health-enhancing endeavor. The physician/surgeon plays the critical role in establishing this patient mindset.
Research on social control—the theory that individuals will conform their conduct to those with whom they have strong social bonds—shows individuals’ health-related behavior can be strongly influenced by others.
When patients feel positive and supported by their doctor in the choice they make, they are more likely to engage in the health behaviors suggested or modeled by their physicians. Conversely, when an individual feels negatively about the other’s attempt to change health-related behaviors (feeling the other is nagging or trying to make the person feel guilty), the individual is likely to either ignore the suggestions or even hide unhealthy behaviors.
The implication is that the patient must see the physician as a supportive advocate who encourages functional improvements and reduction in medication through an active rehabilitation process, rather than advocating for a surgical procedure.
When to Consider Chronic Pain Management
There are two major reasons patients should be cautious about choosing back surgery over interdisciplinary chronic pain management.
- There is no universally accepted standard for the treatment of most back problems. The preferred treatment for a back condition may vary significantly.
- Second, back surgery, while often effective at correcting the pathology (such as the disc herniation), does not address psychosocial factors. Such factors include fear or unrealistic expectations, which can greatly influence the outcome of back surgery, no matter how perfectly the surgery is performed.
Chronic pain management is designed to avoid these potential problems, while providing patients with a viable, productive way of improving function and managing pain.