Multimodal pain management is used in cases where tried-and-tested methods have failed. When do doctors prescribe multimodal pain management, and in what sort of situations can it be useful? Here’s an overview.
When pain is no longer bearable, an entirely new approach is required: this is the basis of what is known as multimodal pain management. It uses a sophisticated combination of different treatment methods with only one goal in mind: to relieve the pain and improve the patient’s quality of life.
So what does multimodal pain management involve? And how can chronic pain be relieved using different methods and approaches?
When everyday life is about nothing other than where it hurts: pain is very stressful for the individuals affected and those around them. With multimodal pain management, an entire team of experts works to relieve pain where previous treatment methods have not achieved the desired outcome. Multimodal pain management is used for chronic pain after surgical interventions, for various illnesses, in oncology and palliative medicine, as well as for pain that is proving difficult to diagnose.
Both the duration of multimodal pain management and the various measures and forms of treatment selected are customised to suit the patient and their underlying condition. They are adjusted as the course of treatment progresses if need be.
Doctors tend to prescribe multimodal pain management if the following conditions are met:
Multimodal pain management is based on a detailed medical history taken by asking questions on, and recording, as many complaints suffered by the patients affected as possible. The question as to whether outpatient or inpatient pain management is recommended is a matter for the patient to decide together with a team of doctors and therapists.
Previous findings from various areas – and often also from different medical specialists – are evaluated as part of this process. Based on this evaluation, a pain diagnosis is made that determines the next steps in the patient’s pain management journey. The aim of all of the measures selected is to enable patients to live without pain, or to learn ways of coping with the pain so that their quality of life is improved.
The question as to how long multimodal pain management lasts depends to a considerable degree on the patient’s specific situation. Generally speaking, a course of pain management lasts at least seven days, often spanning a period of several months or years. Acute pain can often be reduced quickly. In cases involving chronic pain, it can take longer to find the right combination of possible treatment methods.
Multimodal pain management brings together experts from various therapeutic areas – mostly doctors, physiotherapists and psychologists, but also other treatment providers. This ensures that all levels of pain are taken into account: physical, mental and also social.
Multimodal pain management methods are performed as inpatient procedures, i.e. in hospital, or on an outpatient basis. Palliative pain management and pain management in oncology also focus on relieving pain and discomfort during treatment on a multimodal level.
Multimodal pain management strategies are always customised and are adjusted on an ongoing basis – depending on the patient’s progression and the success of the treatment. The following types of pain management can be used:
Doctors specialising in “interventional pain management” come from various disciplines such as rheumatology, neurology, anaesthesiology, surgery and physical medicine. They look in detail at the mechanisms of how pain arises.
Interventional pain management is a form of treating pain using “interventions”. The focus is on local injections of anaesthetics, as well as minimally invasive and microsurgical treatment techniques. Some interventions, such as injections into the nerve roots along the length of the spine, can be targeted to treat the specific areas causing the pain using radiological monitoring.
Manual therapy aims to get people moving and uses targeted hands-on treatment to achieve fast pain relief.
Non-drug pain management means that no medication is used. The range of treatment methods is varied: heat and cold, transcutaneous electrical nerve stimulation (TENS), kinesiology taping, acupressure, etc. In particular, non-drug pain management offers people suffering from chronic pain key incentives regarding the steps they themselves can take to make an important contribution to their recovery.
Psychosomatic pain treatment focuses on the link between physical, psychological and also social factors.
Multimodal pain management often includes the following main methods:
Physiotherapy involves individual movements, massages and other physical measures, for example manual lymphatic drainage. The aim is to relieve pain and improve the patient’s mobility. Physiotherapy can be provided on an inpatient basis (in a hospital or rehabilitation centre) or as an outpatient procedure in a physiotherapy practice.
Various painkillers (analgesics) can be used under professional supervision to relieve both acute and chronic pain. They either act centrally, targeting the nervous system in the brain and spinal cord, or act locally at the site of pain. Examples include tablets and patches, opioids and non-steroidal anti-inflammatory drugs (NSAIDs).
In general, painkillers are used immediately in the event of illness, after accidents or surgery to keep patients as pain-free as possible. The most suitable medication depends on the nature and intensity of the pain and always has to be monitored by a doctor.
Psychological aspects play a key role in treating pain. This is why the treatment plan very often includes psychotherapy in combination with physiotherapy and painkillers. The attending therapist should be specifically trained to treat pain patients.
Counselling sessions or targeted training are used to break old patterns of thought. Antidepressants are also used if necessary, an approach that makes the pain treatment much more likely to succeed. Even for individuals not suffering from depression, these drugs can help with pain management.
Relaxation plays a key role in coping with pain. This is why learning effective methods like mindfulness-based stress reduction is another component of pain management. This gives patients even more power over their own symptoms.
Another method that can be used to treat pain is Traditional Chinese Medicine (acupuncture, acupressure).
Individuals suffering from non-specific lower back pain can improve their symptoms with pain treatment aimed at the back. Nowadays, medical professionals focus on rapid mobilisation for back pain if possible. The aim is for patients to be able to resume their daily activities as soon as possible.
The methods used to treat back pain range from physiotherapy to correct poor posture and regain mobility to targeted massage, acupuncture, cognitive behavioural therapy and the correct use of painkillers.
In cases involving specific back pain, interventional pain management as well as the use of anaesthesia pain management can be successful.
Multimodal pain management – on both an outpatient and inpatient basis – is a key approach to relieving pain for as long as possible. The selection of suitable treatment methods is just as important as patients having an open mind to trying new things in order to be able to live pain-free.
The expert provided the editorial team with advice and input for this article. Tim Reck (anaesthesiology specialist) has worked in the field of pain medicine for 15 years. He is Chief Physician at the Swiss Paraplegic Centre in Nottwil (LU). The Centre for Pain Medicine uses a multimodal approach to treat all types of pain and covers the entire range of therapies.
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