Evaluating Components of Interdisciplinary Treatment Programs for Chronic Pain: A Scoping Review

Evaluating Components of Interdisciplinary Treatment Programs for Chronic Pain: A Scoping Review

Background:

Chronic pain is debilitating, prevalent and costly. Traditional biomedical treatments and monotherapies often lack long-term benefits, while interdisciplinary pain management is more effective and cost-efficient. Interdisciplinary teams (IDTs) are supported by several clinical practice guidelines; however, due to such heterogeneity in the types of programs, there is a growing need for meta-analyses and systematic reviews¹. What constitutes an interdisciplinary team approach varies, but guidance on the essential elements exist. In his seminal article, Gatchel2 offered core elements that should constitute IDTs, including the following: the biopsychosocial model of pain care is shared by all providers, an active treatment component is included, the IDT should be comprised of three or more disciplines and all treatments should be co-located. The degree to which IDTs in the extant literature report core elements included, as well as defined content and structure of IDTs, is unknown.

Purpose/Objectives:

Previous scoping and systematic reviews focused on IDTs for chronic pain have only included specific types of studies (e.g., randomized controlled trials), limited the scope to specific types of chronic pain (i.e., nonspecific low back pain or musculoskeletal pain) and to our knowledge, no studies have examined the presence of Gatchel’s core elements2 in IDTs. We sought to identify gaps in interdisciplinary chronic pain treatment with the goal of contributing to the development of a universal definition of interdisciplinary treatment, and provide a basis for future research protocols comparing IDT approaches. Thus, the primary aim of this study was to determine whether IDT programs include Gatchel’s core elements2. The secondary aim was to determine the structure and content of IDT programs.

Method:

Studies were identified using keyword and MeSH term searches in PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as previously conducted systematic and scoping reviews. All included studies were published between 1970-November 2022, involved adults with chronic pain, and were conducted using the following methodologies: qualitative, randomized control trials, cohort, pre-post-test case control, and cross-sectional studies. Each study was screened independently by at least two members of the research team at every stage of selection to reduce the risk of bias with conflicts resolved through discussion among three authors. Study selection involved three rounds of screening including title, abstract, and full text. Rayyaan software was used for screenings and RedCap and Google Forms were used for data extraction.

Results:

Of the 256 articles coded, 36% percent included a shared biopsychosocial philosophy2 (n=92),  84% included an active treatment component (n=214), 72% included a least 3 healthcare providers from various disciplines (n=184), and 73% were co-located (n=188). Secondary findings demonstrated of 256 studies, there were 10 distinct disciplines across all study protocols. IDTs tended to include physical therapy (69%, n=177), psychology (66%, n=169), and nursing (30%, n=77) with programming including pain education (75%, n=191), health coaching (37%, n=94), and complementary and integrative health services provided within the appointment (25%, n=64).  Only 17.0% reported a shared-appointment model with patient and providers present (n=40).

Conclusions: We sought to examine the presence of core elements identified by Gatchel2, which were included in a vast majority of IDT programs. However, this study was concurrent with previous studies which found significant variability among the content and structure of IDT chronic pain programs. Further, very few programs used a shared meeting with patients, which may increase patient satisfaction and decrease patient and health care system burden. Future research needs to simultaneously examine the effectiveness of the shared meeting approach compared to the traditional interdisciplinary care as well as create clear, adaptable constructs, elements, and tenets of the IDT approach to enhance replicability.
Notably, this scoping review was limited by some nonreporting of key data. This study built upon previous work by using broad inclusion criterion which facilitated the detection of existing, diverse models of pain care. This scoping review adds to the existing calls for a unified model of interdisciplinary chronic pain management, which will enhance future comparison studies.

References: 1. Murphy JL, Palyo SA, Schmidt ZS, Hollrah LN, Banou E, Van Keuren CP, Strigo IA. The resurrection of interdisciplinary pain rehabilitation: outcomes across a veterans affairs collaborative. Pain Medicine. 2021 Feb;22(2):430-43
2. Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. American psychologist. 2014 Feb;69(2):119.
3. Staudt MD. The Multidisciplinary Team in Pain Management. Neurosurgery Clinics. 2022 Jul 1;33(3):241-9.
4. Danilov A, Danilov A, Barulin A, Kurushina O, Latysheva N. Interdisciplinary approach to chronic pain management. Postgraduate Medicine. 2020 Nov 16;132(sup3):5-9.