Multidisciplinary pain programs for chronic pain: evidence from systematic reviews

• The approach taken to evaluate the current published scientific evidence on the efficacy, effectiveness and economic consequences of multidisciplinary pain programs (MPPs) for patients with chronic pain (CP) not related to cancer, was to analyze and synthesize the findings from systematic reviews (SRs) including meta-analyses. Given the cost and consequences of CP, whether MPPs are therapeutically and financially effective are important issues of consideration.
• MPPs in this report are defined as being a comprehensive approach that involves coordinated interventions among a variety of disciplines working together in the same facility in an integrated way with joint goals and with ongoing communication. The patient is considered to be an active participant who assumes significant responsibility within the rehabilitation process with the staff playing a teaching and consulting role.
• The rationale for MPPs as a therapeutic approach is to provide simultaneous assessment and management of somatic, behavioural and psychosocial components of CP. MPPs aim to improve quality of life outcomes, to increase patient independence and to restore physical, psychological, social, and occupational functioning.
• Treatment strategies available at MPPs usually vary from centre to centre in terms of the setting (inpatient versus outpatient), number of hours and days involved, and type, intensity, and nature of treatment modalities offered. Patients seen at MPPs
are often not representative of all those with CP and alternatively, not all CP patients should attend MPPs. As tertiary centres, MPPs are generally selected for patients with complex and long-standing pain problems.
• From the twelve SRs on the effectiveness of MPPs, five met the inclusion criteria. Four of these SRs focused on MPPs as the primary intervention of interest, whereas one SR considered MPPs among several other interventions.
• The results from a recent good quality SR tend to support the effectiveness of intensive MPPs for chronic low back pain patients in terms of their effects on functional improvement and pain reduction. The results from one clinical trial included in one of the SRs support the use of MPPs in patients with chronic pelvic pain in terms of daily activity level and self-rating scales.
• The other SRs found limited evidence and therefore the findings were considered to be inconclusive regarding the effectiveness of MPPs in managing CP in other conditions such as fibromyalgia and widespread musculoskeletal pain, and shoulder
and neck pain.