No one questions that patients with diabetes, hypertension, heart disease and other chronic conditions require lifelong care. These conditions can often be well controlled to the point that those affected can live relatively normal lives. Controlled does not mean cured and those who do well still require some form of regular or continuous medical treatment in order to keep doing well.
Because chronic pain is – well – chronic, it makes sense to treat it in the same way that other chronic conditions are treated. That is with continuing care. Although it is commendable that multidisciplinary chronic pain treatment programs have proliferated in recent years in hospitals and community based clinics, few programs exist that are able to provide continuous care for months and years. The day to day care (e.g. medication management, psychological support) of chronic pain patients often falls on the shoulders of primary care physicians who are poorly equipped to deal with the extra demands these patients place on their practice.
The treatment of chronic pain lags far behind what is available for the conditions mentioned above. Physicians in general as well as other health care practitioners are hampered by inadequate training and our incomplete understanding of chronic pain. There have been advances in recent years, but many medical treatment programs tend to focus on one or two treatment modalities such as neural blockade and other invasive techniques. Frequently, programs that involve education as well as physical and psychological therapies are relatively short, varying from 6-12 weeks on average.
Many of the patients I have assessed over the years have attended a variety of chronic pain treatment programs. Most felt they benefited but benefits generally decreased once the program ended. And that, of course is the point of this discussion.
We do not stop treatment for diabetes or hypertension when blood pressure or sugar levels are under control. Some form of maintenance care using medications, diet and exercise is often required indefinitely. It may be widely recognized that chronic pain patients may require medications indefinitely, but it is also known that they still face difficulties obtaining appropriate pharmacological care. Continuing physical and psychological care is perhaps even more challenging to obtain.
It is for this reason our program is open ended with patients free to attend as they wish or can. Several return regularly after long absences to deepen their practice. The focus is on teaching methods that can be incorporated into daily activities with emphasis placed on learning principles of posture, movement and relaxation. We always encourage participants to use these principles to structure their own home maintenance programs.
Above all, we stress that in order to maintain benefits, practice must be maintained. This may sound overwhelming to many people with chronic pain but in the next post you may find it does not have to be that difficult if you follow some simple guidelines.