Burnham Robert, Day Jeremiah, Dudley Wallace
Central Alberta Pain and Rehabilitation Institute, Alberta Health Services, Lacombe, Altanta, USA.
Can J Rural Med. 2010 Winter;15(1):7-13.
Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta.
The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program.
Patients achieved clinically and statistically significant improvements in pain and disability.
Successful multidisciplinary chronic pain management services can be provided in a rural setting.
慢性疼痛普遍存在且情况复杂,多学科团队进行治疗最为有效,尤其是在心理社会问题占主导的情况下。对于农村患者而言,获得此类服务的机会有限且费用高昂,常常令人望而却步。我们描述了在艾伯塔省农村地区一位医生办公室开展的小型多学科慢性疼痛管理项目的发展情况及18个月的成果。
多学科团队由一名家庭医生、一名物理医学与康复医生、一名心理学家、一名物理治疗师、一名运动机能学家、一名护士和一名营养师组成。专职医疗人员为兼职参与。团队对转诊信息进行分类,患者接受脊柱或医疗评估。根据评估结果,团队采用以下四种方法之一对患者进行护理:仅咨询、介入性脊柱护理、监督药物管理或全面多学科管理。我们对该项目中监督药物管理和全面多学科部分的疼痛和残疾自我报告测量指标进行了前瞻性和连续性记录。
患者在疼痛和残疾方面取得了临床和统计学上的显著改善。
在农村地区可以提供成功的多学科慢性疼痛管理服务。