Looking beyond medication: Could multi-modal pain treatment be a model for the future?

David Floyd • Aug 2, 2016 at 5:40 PM

Patients who visit Pain Medicine Associates in Johnson City oftentimes lead lives saddled by persistent, invisible discomfort.

Pain Medicine Associates, a multi-disciplinary treatment center, has multiple locations in the Tri-Cities and offers a variety of in-house pain therapy options. Medication is one of those options.

But it definitely isn’t the only one.

At the center’s Johnson City office, physicians and registered nurses work alongside a physical therapist and a psychologist to ensure patients receive the treatment they need.

The center connects patients with various types of treatments, including acupuncture, massage therapy and implants. The sheer amount of resources at the clinic’s disposal can be helpful to physicians when they’re dealing with patients who need more specialized forms of treatment.

For example, physicians at the center see a lot of degenerated spinal discs — soft, fibrous cushions that prevent vertebrae in the spine from grinding against each other. This condition is a relatively common cause of lower back pain, producing troubled sleep and intense, day-to-day pain.

One patient, who remained anonymous to keep her medical history confidential, cannot receive surgery on the degenerated discs in her spine because her back is too fragile. But the clinic has managed to provide her with alternative paths to relief.

“The only relief I get from pain is through the epidurals,” the patient said, describing the injections she receives at the center on a regular basis. “They last me about three months, and I’ve been getting them for about two or three years now.”

Another of the center’s patients works on a dairy farm, a job that requires a lot of backbreaking lifting and lugging.

“If I wasn’t coming here,” he said, “I couldn’t work.”

The patient has been visiting Pain Medicine Associates for about 15 years. Like the first patient, he receives injections, but he also takes a pain pill a couple of times a day.

However, injections and medication aren’t the only aces up the center’s sleeve.

Marcus Cooper, the Pain Medicine Associates’ in-house psychologist, said the center’s strong focus on multi-faceted, in-house treatment is relatively unique.

“What sets our clinic apart from a lot of clinics ... is we have an in-house psychologist, an in-house acupuncturist, an in-house physical therapist,” Cooper said. “So we are a true multi-disciplinary pain clinic, and that sets us apart from most pain clinics in the area who just kind of pass out pain medicines.”

Pain Medicine Associates also takes behavioral health into account when it treats patients. 

Cooper said people who suffer from chronic pain also generally suffer from various co-morbidities, additional diseases or conditions that co-exist with their pain. This can make treatment difficult.

“If you have chronic pain, it starts affecting all sorts of things in your life,” Cooper said. “You can get depression, you can get sleep disorders, you can get anxiety ... but you also get morbid obesity, diabetes and it seems like the chronic pain patients have a lot of the other health problems.”

Because Cooper has an office in the Pain Medicine Associates branch in Johnson City, he has immediate access to other physicians and can suggest treatments for patients who have these additional conditions or are at risk of developing them.

Dr. Stephen Loyd, the medical director for substance abuse services at the Tennessee Department of Health, said multi-modal pain treatment centers are few and far between in East Tennessee, but they’re increasingly becoming a desired model for pain treatment.

“Those are the effective, legitimate places that we’re emphasizing that patients be referred to,” Loyd said.

The Tennessee Department of Health recently oversaw the creation of a series of a chronic pain guidelines that help physicians determine when it’s appropriate to prescribe opioids.

The guidelines encourage the use of multi-modal pain treatment, a term used to describe a multi-faceted approach to alleviating pain.

Loyd said the type of treatment offered at Pain Medicine Associates could eventually become the norm, but the cost of offering alternative treatments does frequently act as a barrier, which could explain why multi-modal treatment isn’t as prevalent as experts desire.

Loyd, however, is hopeful.

“We’re realizing that abuse of opioid pain medications are obviously more widespread than the literature of the 1990s and early 2000s told us it was,” Loyd said. “Places that take a multi-modal approach to the treatment of chronic pain, it’s my opinion that they’ll become the standard.”

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