Chapter 8

Your Healing Team

From our earlier discussion you learned how chronic pain is like the old story of the Six Blind Men and the Elephant. There are many different aspects to chronic pain, and they must be treated in a unified fashion. This is why you benefit from a team of providers skilled in chronic pain and its treatment. They each see the same problem from slightly different perspectives.

So what kinds of healthcare professionals should be on your healing team?

Most people have a primary care physician for their general health needs. This clinician most often would be an internist or a family practitioner. Occasionally, some women may choose to see their gynecologist (OB-GYN) for their primary care needs. This is useful and appropriate for most general health concerns, particularly when the problem is acute, of recent onset. This is the place to address everyday health problems and ongoing health maintenance. This is the place for annual physical examinations, cuts, broken bones, infections, recent-onset headache, recent-onset back pain, digestive distress, and so on.

However, as you have read here so far, chronic pain lasting longer than three to six months is more complex to treat. There are multiple factors affecting your pain beyond the physical realm, and into emotional, social, recreational, vocational, financial, and legal spheres as well. Research tells us that a multidisciplinary team is the most effective way of treating chronic pain. Because of the complexity of chronic pain, no single specialist has the expertise to assess and manage it independently. The goal of multidisciplinary pain treatment is not only to provide good pain relief, but also to improve physical, psychological, and behavioral functioning.

You Are Not Starting from Scratch

If the notion of assembling a healing team seems like a daunting or even impossible task, not to worry. You are not starting from scratch here. Most likely, you are already being treated by your primary care physician, and possibly also an additional physician pain specialist such as a neurologist or orthopedist. You can proceed right now, confidently, using the ABC method. My goal in educating you about the healing team is to empower you on your healing journey by supplementing your healing team with a few additional highly skilled health professionals to help you on your way.

Advancement on the chronic pain journey can feel arduous, frustrating, and sometimes downright impossible! Since chronic pain has multiple causes, you need to be provided with education, skills, and training in how to deal well with relapses. Having the skilled guidance and reassurance of a team of specialized practitioners provides the foundation of support needed to achieve successful healing.

Some people might be able to find these services through an integrated chronic pain treatment program in a hospital or outpatient clinic. These programs house all the professionals you need to see in one place. However, there are a decreasing number of accredited multidisciplinary chronic pain programs in the United States. An increasingly common scenario is for chronic pain patients to form their own team. They find providers in the community who can work together, even though they are not located in the same clinic.

Assembling Your Healing Team

Your healing team is a group of health professionals who will help you to maximize your quality of life. At a minimum, your team should include:

•Your primary care physician.

•Another physician who has specialized experience treating chronic pain, such as a neurologist, rheumatologist (specializing in diseases of joints, muscles, and surrounding soft tissue), or physiatrist (a.k.a. a physical medicine and rehabilitation specialist).

•A physical therapist (PT)—Be sure to find one with specialized training and experience in treating various types of chronic pain. The PT may provide massage and manipulation of joints and muscles. They may advise on posture and exercises to relieve pain, and may use such treatments as heat, ultrasound, and traction to improve pain symptoms.

•A clinical psychologist with specialized training in assessment and treatment of chronic pain. This PhD-level clinician should be trained and experienced in the multitude of physical and psychological factors that can affect your pain. The psychologist helps reduce emotional distress associated with chronic pain and helps the patient develop skills to help cope with stress and pain.

Additional providers may also be helpful, including nurses, social workers, and occupational therapists. Dentists who treat head and neck pain (such as temporomandibular disorders, or TMJ) may also be beneficial collaborators.

Everyone on your team should be conversant in the core concepts of pain medicine, including central sensitization, autonomic dysregulation, and the importance of addressing any complicating factors such as depression, anxiety, or trauma.

Things to Keep in Mind
with Your Team

There are certain standards to follow, whether you seek out an integrated team program affiliated with a hospital or health plan (a “one-stop-shop”), or individual providers who treat chronic pain.

Team Communication

All the members of your healing team should have experience in treating chronic pain and be willing to collaborate with each other. They need to know about the others and keep open lines of communication. Successful chronic pain treatment requires continuity of care, where all the team members are operating from the same playbook. Each of them should remain open to ideas from other team members—even if they might not agree with them. They should offer suggestions and treatments that are consistent with the rest of the team. If one or more of the team members give suggestions that are inconsistent or contradictory with the rest of the team, you need to have your team correct this problem.

The various clinicians should be receptive to discussing your care with them, and should not make you feel rushed during your treatment session. They should be prepared to admit when the answer to your question is not known, and should show willingness to do some additional digging to find out what they don’t know. Furthermore, they should be willing to communicate with your family as well.

Be Your Own Best Advocate

The most important member of your healing team is you. The more you actively participate in the process, the better the outcomes will be. Be sure to ask questions when you are unclear about the various types of treatments and exercises they recommend. If you are wondering about how a particular treatment or exercise fits in to your overall healing goals, ask about it. The more you know about these details, the more likely you will be to follow through consistently with all suggestions. (Read more about your responsibilities in the next section, “The Role of Self-Care in Healing from Chronic Pain.”)

It feels very reassuring to have a team of great health practitioners supporting your healing journey. If you need help finding clinicians in your area who can provide these services, these resources may be helpful:

•International Association for the Study of Pain

•National Fibromyalgia & Chronic Pain Association

•American Academy of Pain Medicine