Multidisciplinary inpatient pain management program for chronic musculoskeletal pain

Multidisciplinary pain management is one of the useful methods for the treatment of chronic musculoskeletal pain, as has been demonstrated in the USA since 1950s. A biopsychosocial model of well-being is a very important concept in the multidisciplinary treatment. This model is a general model or approach stating that biological, psychological, and social factors play a significant role in human functioning in the context of disease or illness. Currently there are few facilities in Japan that administer a multidisciplinary pain treatment, especially an inpatient pain management program. We are implementing a multidisciplinary pain management program based on biopsychosocial model guided by the IASP recommendations for such a program in Fukushima, Japan. The purpose of this study was to describe our initial efforts in creating a Japanese inpatient pain management program using the biopsychosocial method of self-pain management. The pain management center was started in April 2015 with a team consisting of orthopaedic surgeons, psychiatrists, nurses, physical therapists, clinical psychologists, pharmacists, and nutritionists. Our 3-week inpatient pain management program is indicated for patients who find it hard to work or go to school due to chronic musculoskeletal pain, and/or are confined to life at home but want to return to work or school. This program consists of exercise therapy, psychotherapy, and cognitive behavioral therapy. Using this program, our inpatients with intractable chronic musculoskeletal pain were evaluated using brief pain inventory (BPI), pain catastrophizing scale (PCS) (rumination, magnification, and helplessness), pain disability assessment scale (PDAS), hospital anxiety and depression scale (HADS), pain self-efficacy questionnaire (PSEQ), EQ-5D, and physical functions (flexibility, muscle endurance, walking ability, and physical fitness). Statistical analyses were performed using the paired t-test and Wilcoxon matched pairs signed rank sum test with Bonferroni correction after Friedman test. Twenty-one patients (7 male and 14 female; 20-79 years old (Average 52.2 years old)) were analyzed from April 2015 to December 2017. Comparing results before and after the program, the following statistically significant improvement were seen in BPI, PCS (rumination, magnification, helplessness), PDAS, HADS anxiety and depression scale, PSEQ, EQ-5D, 30-sec sit to stand test (muscle endurance), 2 step test (walking ability), and 6-minute walking test (physical fitness). Six (3 male and 3 female; 20-69 years old (Average 45.3 years old) of the twenty-one patients could be analyzed not only before and just after the program, but 3 and 6 months after the program. Statistically significant improvement was seen in PCS (helplessness) (before the program - three months after the program) and PSEQ (before the program - after the program and before the program - three months after the program). We developed an inpatient pain management program. We may be able to improve the coping mechanisms of our patients for dealing with intractable chronic musculoskeletal pain, and that the program can improve their quality of life and physical function. Our inpatient multidisciplinary pain management program is being expanded to better assist the patients with intractable chronic musculoskeletal pain.