“Carving-Out” Services from Multidisciplinary Chronic Pain Management Programs: Negative Impact on Therapeutic Efficacy

The biopsychosocial approach views pain and disability as a complex and dynamic interaction among biological and psychosocial factors that perpetuates, and may even worsen, the clinical presentation. This interaction accounts for the frequent individual differences in how pain is expressed and its response to treatment. The calculation of quality-adjusted life years (QALYs) involves the cost of a specific intervention, relative to the desired improvement in health. Results of this analysis demonstrated that relative to the other two treatment groups, the multidisciplinary treatment group was associated with a better QALY. Haldorsen and colleagues have also reported results from an assessment system that identifies high-, moderate-, and low-risk patients with chronic pain. Low-risk patients did well with usual treatment and a low-intensity multidisciplinary pain management program. Multidisciplinary programs include different discipline components that are integrated into a comprehensive whole. Such an approach is consistent with the phenomenological notion of treating the person with chronic pain as opposed to merely treating the pain.