Chronic Pain Relief: A Multimodal Treatment Approach

In the United States alone, up to 25 million adults struggle with some form of daily chronic pain. Even more people struggle with pain they define as “severe”, although not as often. Pain is a serious issue in this country, and one that is estimated to cost roughly $635 billion per year in both lost productivity and health care costs.

It is in our best interests as a society to find an answer to help those suffering around us, especially as a rising opioid crisis and mounting evidence casts doubt on the efficacy and longevity of opioids as a tool for long-term pain management. However, the future does not lie in finding one answer – it lies in finding as many as possible. Pain management and relief has to be custom-tailored to every individual, based on their unique circumstances, rather than relying on a single approach to solve pain-related issues.

Ever since medicine has started to address long-term pain, the most affect approach has been a multimodal approach, using not one, not two, but as many forms of treatment as necessary to bring a patient relief and improve their quality of life. For millions of Americans, chronic pain can be debilitating and humiliating. It’s our goal to offer them a way out of the pain, and a path forward.

What Does “Multimodal” Mean?

A multimodal approach is characterized by the usage of several modalities to treat a condition. A modality, in this context, refers to a tool or form of therapy. As our understanding of pain has evolved, it has become increasingly clear that pain is a biopsychosocial condition, meaning that it involves biological, social, and psychological factors.

Pain cannot just be addressed through pharmacotherapy (medication), rather, pain management clinics must go deeper to help a patient understand where their pain is coming from, what aspects of their life is intensifying the pain, and what they can do to reduce the pain. For example: a patient struggling from chronic pain may be under constant stress, physically and emotionally, and may be struggling to maintain healthy relationships and employment.

Without a sense of purpose, connections to others, and a stronger sense of self-appreciation, pain can worsen. Low mood and depression heighten sensitivity to pain, which further feeds both the psychological and social factors, and escalates the experience. Multimodal pain management should include various treatment types to address the physical aspect of the pain, as well as help a patient work through the issues caused by (and worsening) the pain.

Another reason for multimodal treatment is the fact that not every case has the same severity or root cause. While interventions in the form of surgery and injections can greatly help a patient with severe chronic pain, these interventions are not always necessary and may pose risk for further pain in patients who do not need them.

Furthermore, the need for psychological treatments needs to be evaluated on a case-by-case basis. Not everyone with pain issues struggles with depressive symptoms, and it’s generally accepted that only a minority of patients will need serious treatment – such as antidepressants – to help with depression. However, certain therapies such as music therapy or relaxation techniques like aromatherapy are of little risk and can distract a patient from their pain.

Certain complementary or even alternative medicines may be considered, as per a doctor’s own expertise. Most alternative medicines are understudied and show little promise, which is why they should never be a first line for pain management. However, some treatments may be effective yet are less known than others.

The key to successful multimodal treatment is a thorough examination of each patient. It’s important that pain management professionals are working with patients to determine the best treatment. Combining non-medicine options with the right pharmacological approach and, when necessary, certain medical interventions, is what constitutes a multimodal treatment.

Treatment Types for Chronic Pain Relief

General treatment types can be classified as medicinal, non-medicinal, and interventional. Medicinal treatment often includes opioids, but can also include non-opioid medication as per the origin of the pain, with medicine such as:

• • Sedatives (such as ketamine)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
  • Muscle relaxants (such as carisoprodol)
  • Anticonvulsants (such as gabapentin)
  • Antidepressants (SSRIs)
  • Non-NSAID topical pain relievers (such as capsaicin)

Non-medicinal modalities are numerous, and their effectiveness depends largely on a patient’s willingness to cooperate, as well as their response to the treatment. Individuals respond very differently to music therapy, as some experience pleasure and joy when listening to music, while others can be generally indifferent to it. The same goes for other forms of therapy, such as:

• • Massage
  • Relaxation techniques (yoga, mindfulness, breathing techniques)
  • Physical therapy
  • Pet therapy
  • Thermotherapy

Finally, there are interventional treatments that can greatly relieve pain and fight the underlying issue of chronic pain, in cases where there are no other feasible options to fight the discomfort and improve quality of life. Interventional treatments such as injections and surgeries are often the most expensive kind of treatment but are necessary and very much worth it when an injury or pain has led to disability and severe and unavoidable discomfort on a day-to-day basis.

Interventional Treatment

Interventional treatment is named such because it specifically describes treatment types that differ from conventional pain management through the use of more invasive treatments, including injections, nerve blocks, the removal of certain nervous tissue, radiotherapy, and more. Specific treatments include:

• • Radiofrequency ablation
  • Medial branch blocks
  • Epidural steroid injections
  • Joint steroid injections
  • Spinal cord stimulators
  • Intrathecal pumps

These treatments may come with risks and complications, especially if they involve surgery or the introduction of a foreign object into the body, as with the installation of an intrathecal pump. Precautions are taken to protect a patient, sometimes through the use of a trial to test the efficacy and safety of the procedure.

But when done successfully, these interventional treatments can save a patient their life and their livelihood. Life in constant pain is difficult to say the least, but more often than not, patients struggling with daily pain can find the relief they need through a comprehensive multimodal approach to pain management.