Physical therapy is an essential part of physical reconditioning, 1 of 4 treatment areas for chronic pain examined in a new technical brief from the Agency for Healthcare Research and Quality. The brief identifies important issues and gaps in the evidence base assessing multidisciplinary pain programs (MPP) for chronic noncancer pain and describes some of the key trends and challenges with implications for the future of MPP treatment.
The most pressing problem facing MPPs is declining access, including obtaining adequate reimbursement from third-party payers to providers of MPP treatment. In addition, says the brief, "carving out" certain benefits, such as physical therapy and psychological/behavioral treatments, has "paradoxically produced the effect of steering patients away from multidisciplinary treatments that demonstrably reduce health-care utilization, and toward more extensive unimodal therapies associated with poorer outcomes."
The 183 papers considered in Multidisciplinary Pain Programs for Chronic Noncancer Pain followed a biopsychosocial model of chronic pain, including treatment components in each of 4 areas: medical; behavioral; physical reconditioning; and education. Most of the studies were observational before-after designs. Although several different clinical conditions were studied, 90% of the studies included chronic back pain, the most frequent condition addressed in the literature. Differences were apparent between studies based in the United States and those in Europe. Recent European studies were more likely than US studies to include inpatient delivery of MPP treatment.