Treatment Planning

Introduction

In your initial pain consultation visit, you will learn about the development of a pain treatment plan. Although the goals and expectations will depend on the type of pain, certain underlying principles of treatment are broadly applicable. The various treatment methods are reviewed in the context of the management of the various types of pain.

Goals and Expectations

Treatment planning establishes goals, expectations, methods and time course for treatment.

• Pain cannot be treated on the basis of pain intensity alone, for example with numeric based drug treatment algorithms like those commonly used for blood sugar or blood pressure. Rather, clinicians must respond to pain reports in a manner appropriate to the type of pain (e.g., acute versus chronic; neuropathic versus inflammatory) and setting (e.g., inpatient versus outpatient).
• Outline goals explicitly and discuss them carefully with the patient. Work with all providers and the patient to establish realistic goals. Goals may change depending upon the type of pain and the patient’s needs and circumstances. Patient and provider must understand and reach agreement on the goals; if the two parties want different things, success is unlikely.
• What is meaningful pain relief? Data from clinical trials suggest that a 33% to 50% decrease in pain intensity is clinically meaningful from a patient’s perspective and represents a reasonable standard of intervention efficacy. This holds true for acute pain and chronic pain. Functional improvement goals are variable but essential for all types of pain.

The goals of pain treatment differ depending upon the type of pain and the nature of the individual case. Patient and family goals must be reconciled with what is possible and reasonable given the situation.

Acute pain

The major goals are pain control and relief while efforts are made to identify and treat the underlying disease and to enhance healing and recovery. Adequate management of acute pain may also prevent the development of chronic pain. Analgesics are the mainstay of acute pain treatment, but nondrug methods (patient education, heat/cold, massage, distraction/relaxation, others) are essential too. In some situations regional analgesia and anesthesia are also indicated.

Chronic pain

In most cases of chronic pain, multiple mechanisms are at play and the cause of the pain may be difficult to identify and cannot be completely eliminated. Pain relief is still primary but the goals of improvement in function and quality of life gain even greater importance. In addition to pain reduction, prevention of secondary pain problems such as myofascial pain is essential.

In addition to rational multidrug therapy, physical medicine and rehabilitation modalities to treat deconditioning and disability, and behavioral /psychological treatment to enhance coping and improve mood are all important. Aim for maintained or improved daily activity, family life, and return to work if possible.