Alternatives to opioids, continued: Understanding the nature of pain

These articles complement a three-part CARF webinar series on pain management, starting with the physiology of pain, and continuing with a discussion surrounding the interdisciplinary pain care model presented by CARF surveyor Greg Smith, whose Community Integration Pain Rehabilitation program is accredited under CARF’s Behavioral Health Standards Manual.

In October, we highlighted some emerging medtech options that may help reduce reliance on opioids for pain management. Next, in our series on pain management, in the context of the current opioid crisis, we examine the deeper issue of the nature of pain itself.

Although pain stems from physical injury or tissue damage, it actually is a mental and emotional response. An injury causes nerve pathways to send a signal to the brain. The brain then generates a mental and behavioral response, which a person experiences as pain. The experience of pain, the brain’s responses, can exist or remain even in the absence of physical damage to the body. And because pain is a sensory experience, much like the experience of fatigue or hunger, it cannot be precisely measured. A quantifiable dose of opioid pain medication is able only to reduce sensory awareness of pain. The effectiveness of opioids to counteract pain in this way decreases over time, meaning a person will need an increased dose to achieve the same sensory-awareness reduction, causing dependence and eventual addiction.

The National Institutes of Health’s National Pain Strategy concludes that pain is best managed with a “biopsychosocial” approach, a combination of methods to address the physical, psychological, and emotional needs of each individual person. This holistic, person-centered approach has been supported by CARF standards for Interdisciplinary Pain Rehabilitation (IPR) programs for more than 30 years.

Key elements of an IPR program:

  • Primary focus is return to functioning rather than simply eliminating pain.
  • Uses a multifaceted approach that considers the psychology of living with pain, including a person’s life roles, children and family, and quality of life.
  • Considers a variety of treatment approaches based on evidence-based practices, clinical pathways, and protocols.
  • Person served is engaged in his or her treatment plan; self-management of care.   

Webinar 1:

April 17, 2019 – Understanding Persistent Pain: Physiology and a Population Health Approach

Presenters: Zachary Watson, PT, D.P.T., OCS, National Director of Quality and Research, PT Solutions

Tye Marr, PT, OCS, Senior Residency Faculty, PT Solutions

Webinar 2:

May 14, 2019 – The Treatment of Persistent Pain: The History and Evolution of Models of Care

Presenter: Gregory Smith, Ph.D., Director, Progressive Rehabilitation Associates

Webinar 3:

June 18, 2019 – Managing Persistent Pain and Substance Use Disorder: Identifying Trusted Providers and Building a Continuum

Presenter: Gregory Smith, Ph.D., Director, Progressive Rehabilitation Associates