Chronic Pain

Initially, I worked in the field of Physical Medicine and Rehabilitation (PMR), which typically takes about four years of study. My work in general clinics, dealing with conditions like arthritis, stroke, and amputations, exposed me to numerous cases of chronic muscle pain, which piqued my interest and led me to explore Interdisciplinary Multimodal Pain Treatment (IMPT) for chronic back pain.

In the early stages of my career, there were no established protocols for treating chronic pain, so I began to develop my own approach. I noticed that addressing chronic pain required more than just physical treatment; it needed a combination of physical and psychological approaches. Over time, I collaborated with psychologists and other experts to integrate these aspects into the treatment. My focus has always been on the holistic management of chronic pain, where physical exercises are combined with CBT to help patients gradually increase their activity levels.

One of the most important factors is reducing catastrophic thinking, which is common among chronic pain patients. Research shows that individuals who have experienced emotional difficulties early in life, particularly before the age of three, are more susceptible to chronic pain. Stressful life events also contribute. However, the focus of treatment should be on modifying the factors that maintain the pain, rather than the causal factors themselves. I help patients embrace their pain rather than fighting it, which allows them to redirect their energy towards achieving their value-based personal goals.

We use more individualized modules that are tailored to each patient's specific needs. This shift towards personalized treatment is important because it allows us to address the unique challenges faced by each patient. For example, the fear-avoidance model is something we focus on, where patients might avoid certain activities due to fear of pain. Part of the treatment involves helping them overcome their irrational cognitions related to their fears by exposing them to the activities they fear, like bending or lifting.

Building a sustainable patient relationship is absolutely crucial, especially for patients who have experienced trauma, such as childhood abuse. Proper assessment and validation of the patient’s experience are key because many patients feel unheard and misunderstood. It’s important to acknowledge their pain as a real and personal experience, which helps in building trust and fostering a more effective treatment process.

One major issue is that doctors often focus solely on the biomedical aspect of pain and spend very little time with patients—typically around 10 minutes. This can lead to a misunderstanding of the patient’s condition. Pain in the head doesn’t mean a person is crazy; the pain is real and needs to be addressed holistically. Doctors sometimes prescribe treatments like pills or physical therapy without fully understanding the psychosocial factors involved because they don’t have the time or training to delve deeper.

We’ve developed training programs for doctors in pain rehabilitation, particularly for those who may find chronic pain difficult to manage. These programs provide them with the tools and knowledge they need to treat chronic pain effectively. We also emphasize the importance of collecting data on treatment outcomes to demonstrate the effectiveness of these programs. This data is crucial for convincing healthcare providers and policymakers of the value of holistic, interdisciplinary treatment approaches.

Chronic pain is not just a symptom; it’s a disease that requires ongoing management. It’s normal for patients to need continued treatment, but with the right approach, we can help them cope better, reduce medical and societal costs, and even enable some patients to return to work. Chronic pain ranks high among the top diseases, alongside conditions like diabetes and cardiovascular disease. Yet there is still a lack of interest and investment in addressing chronic pain, which is why I believe prevention and early intervention are key.

We need to continue raising awareness about the importance of addressing chronic pain from both physical and psychological perspectives. There is a need for more personalized treatment approaches and better communication between doctors and patients. By focusing on early intervention, we can improve outcomes for patients and reduce the overall burden of chronic pain on society.

The most rewarding part is seeing the positive impact on patients' quality of life. When a patient says, "I’ve got my life back," it’s incredibly fulfilling. It’s a reminder that our research and clinical work are making a real difference.