Pain management: multidisciplinary approach

Management of chronic incapacitating pain requires a multidisciplinary approach, integrated into a comprehensive treatment program. Adequate detailed clinical evaluation includes physiatric, neurological, orthopedic, rheumatologic and phychosocial examination. Pain rehabilitation program should begin with the search for the underlying etiologic factor, in order to remove it. Clinical experience has demonstrated that most patients with chronic pain present primary or secondary muscle involvement which must be correctly diagnosed and treated. Conservative treatment with physical medicine and rehabilitation procedures including inactivation of myofascial trigger points and tender spots by needling and infiltration, electrical stimulation, ice packs, heat, Ryodoraku electroacupuncture associated with tricyclic antidepressants, phenothiazines and non steroid anti-inflammatory drugs are employed. Relaxation exercises should be performed before and after stretching and strengthening of key muscles in a regular and active rather than passive basis. In those patients without symptomatic relief of pain with conservative treatment, spinal cord electrical stimulation, lumbar infusion of morphine among other neurosurgical interventions are indicated for the relief of pain and should be followed by an adequate rehabilitation program aiming functional recovery. The therapeutic approach provided satisfactory results in patients with failed back surgery, cumulative trauma disorders, complex regional pain syndrome among other chronic painful conditions.