A holistic approach to chronic pain management that involves all stakeholders: change is needed
Open accessAbstract
Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses', pharmacists' and physiotherapists' skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late. Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels - for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain. Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain - it is vital they continue.
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A multidisciplinary treatment approach for pain management, aimed at supporting people in coping with physiological and psychological challenges, is recommended.
“Given the complexity of chronic pain and living with chronic pain, a multidisciplinary treatment approach for pain management, aimed at supporting people in coping with physiological as well as psychological challenges, is recommended [2,6,7].”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [7]
Evidence-based in-person psychological treatments for chronic pain are not always offered or accessible.
“Regrettably, such evidence-based in-person psychological treatments are not always offered or accessible [7,14]”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [7]
Treatment strategies regarded as clinically effective and cost efficient tend to be multidisciplinary and based on the biopsychosocial model of pain, acknowledging psychological risk factors and offering holistic approaches to multimodal pain management.
“Treatment strategies, which are regarded as clinically effective and cost efficient, tend to be multidisciplinary and are based on the biopsychosocial model of pain (Gatchel et al., 2007), acknowledging psychological risk factors (Nicholas et al., 2011) and offering holistic approaches to multimodal pain management (Kress et al., 2015).”
From The Development of Mindful-Based Dance Movement Therapy Intervention for Chronic Pain: A Pilot Study With Chronic Headache Patients (2021) · cites this paper as Kress et al., 2015
Individual or group in-person psychosocial interventions are not always an option for patients living with chronic pain.
“Unfortunately, such individual or group in-person psychosocial interventions are not always an option for patients living with chronic pain [15].”
From Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study (2020) · cites this paper as [15]
Content development for EPIO was based on well-known evidence-based aspects from CBT, with some integrated aspects of ACT, focusing on self-management and coping for patients living with chronic pain in general.
“Content development [26] was based on well-known evidence-based aspects from CBT, with some integrated aspects of ACT, focusing on self-management and coping for patients living with chronic pain in general [7,11,15,30,41,42].”
From Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study (2020) · cites this paper as [15]
Given this complexity, chronic pain can also be perceived as unavoidable, unmanageable, and challenging to disengage from.
“Given this complexity, chronic pain can also be perceived as unavoidable, unmanageable, and challenging to disengage from [5].”
In-person interventions are not always offered or available, and multiple barriers to attendance may be present for people living with chronic pain conditions.
“Unfortunately, such in-person interventions are not always offered or available [5], and multiple barriers to attendance may be present for people living with chronic pain conditions.”
Researchers have made recommendations for utilization of a more user-centered design approach, ideally involving all stakeholders in the eHealth intervention development process from the early idea initiation to the final intervention evaluation.
“Researchers have made recommendations for utilization of a more user-centered design approach, ideally involving all stakeholders (eg, patients, health care providers and caregivers, pain and eHealth researchers, and designers and information technology [IT] developers) in the eHealth intervention development process from the early idea initiation to the final intervention evaluation [5,27,39].”
The lack of user involvement (patients and health care providers) and human centeredness in development of eHealth interventions have been criticized repeatedly.
“The lack of user involvement (ie, patients and health care providers) and human centeredness in development of eHealth interventions have been criticized repeatedly [5,21,27,32,34,36,39], and this lack of user involvement in the development process can potentially also explain the high attrition rates and low adherence associated with such interventions [32,40-42].”
The study included a broad range of stakeholders (patients, spouses, health care providers, eHealth experts, researchers, editors, software developers, and user representatives) from the project planning stage and throughout the development process.
“As recommended by existing research [5,27,39] and to ensure trustworthiness [78], the study included a broad range of stakeholders (ie, patients, spouses, health care providers, and eHealth experts as well as researchers, editors, software developers, and user representatives) from the project planning stage and throughout the development process.”
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- Authors
- Kress, H.-G., Aldington, D., Alon, E., Coaccioli, S., Collett, B., Coluzzi, F., Huygen, F., Jaksch, W., Kalso, E., Kocot-Kępska, M., Mangas, A. C., Ferri, C. M., Mavrocordatos, P., Morlion, B., Müller-Schwefe, G., Nicolaou, A., Hernández, C. P., & Sichère, P.
- Affiliations
- Vienna General Hospital (AT)
- Royal Hampshire County Hospital (GB)
- University Hospital Zurich (CH)
- Azienda Ospedaliera S.Maria (IT)
- University Hospitals of Leicester NHS Trust (GB)
- Sapienza University of Rome (IT)
- Erasmus MC (NL)
- Wilhelminen Hospital (AT)
- University of Helsinki (FI)
- Jagiellonian University (PL)
- kUNIDOR, Centro Hospitalar de Leiria, Leiria, Portugal
- lHospital General Universitario de Alicante, Spain
- Hirslanden Clinique Cecil (CH)
- Universitair Ziekenhuis Leuven (BE)
- oSchmerz- und Palliativzentrum, Göppingen, Germany
- St George's Hospital (GB)
- Hospital Universitario de La Princesa (ES)
- Centre Hospitalier Saint-Denis (FR)
- Corresponding author
- Kress, Hans-Georg
- ORCID
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa UK Limited
- Published
- 2015-08-20
- Volume
- 31
- Issue
- 9
- Pages
- 1743-1754
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W1748921979
- Cited by
- 178
- References
- 56
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 15 · 2023: 23 · 2022: 14 · 2021: 19 · 2020: 26 · 2019: 22 · 2018: 13 · 2017: 7 · 2016: 6 · 2015: 1
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (other-oa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic pain management, multidisciplinary pain management, biopsychosocial model, stakeholder perspectives, general practitioners, pain specialists, medical education, patient-centered care, psychotherapy, pain assessment tools, pain policy, barriers to treatment
- MeSH terms
- Holistic Health, Humans, Pain Measurement, Patient Care Management, Psychological Techniques, Needs Assessment, Chronic Pain, Pain Management
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